ABSTRACT
The diagnosis of Hydrops fetalis still carries a grave prognosis with reported mortality
ranging from 50 to 100%. With the advent of more aggressive therapy, improvement of
survival is undetermined. The study population of this outcome case series was gathered
from all cases of hydrops fetalis admitted to our Loyola University Medical Center
Neonatal Intensive Care Unit (NICU) from 1990 to 1997. Forty-one patients were eligible
for inclusion. Only four had a diagnosis of immune hydrops fetalis, while the remainder
had varied nonimmune causes. Models predicting survival were constructed with various
neonatal and maternal factors as explanatory variables using Cox proportional Hazards
technique. Kaplan-Meier estimates of median survival times for different stratifying
variables were likewise computed. The overall mortality rate was 49% with an overall
median survival time of 15 days (95% CI 8-38). Median survival time estimates differed
significantly between patients who had (a) proven infection or not and (b) had less
than or greater than two fluid-filled cavities. The use of steroids, surfactant, or
high-frequency ventilation did not improve survival. Stratifying the study base into
those treated in early or late 1990s likewise failed to show difference in survival
times. Infection remains a significant problem (46%). In our series of 41 infants
with hydrops fetalis, survival rates remain comparable to those reported in the literature,
despite aggressive therapy. Although the use of surfactant, steroids, and high-frequency
ventilation appear to prolong survival times, these treatments failed to alter overall
survival outcome.
KEYWORD
Hydrops fetalis - survival - infection
