EXTRACORPOREAL LIFE-SUPPORT FOR NONIMMUNE HYDROPS-FETALIS

Background/Purpose: Most babies born with idiopathic nonimmune hydrops fetalis (NIHF) suffer generalized cardiopulmonary collapse and die de spite maximal medical therapy. With reported survival rates of less th an 10%, many centers consider NIHF an unsalvageable situation and the babies who have this condition, untreatable. In this study, the author s questioned if the aggressive use of extracorporeal life support (ECL S) could salvage this condition and improve the chances of survival fo r babies born with NIHF. Methods: The Extracorporeal Life Support Orga nization's (ELSO) neonatal registry was searched for all available inf ormation on babies treated for hydrops fetalis. The ELSO records of al l hydropic babies were then reviewed to exclude those babies who had i dentifiable causes of hydrops. Survival statistics were then calculate d for the remaining core group of idiopathic NIHF babies before separa ting them into two groups based on survival. A detailed analysis compa ring the survivors with nonsurvivors was then performed. Results: A to tal of 28 hydropic babies were identified in the ELSO registry. Four b abies were excluded from analysis because of identifiable causes of hy drops (two with congenital diaphragmatic hernia, one with Rh incompati bility, and one with fetal anemia), Of the remaining 24 babies who had NIHF, 54% (13 babies) survived the neonatal period and were discharge d from the hospital, Analysis comparing the survivors with he nonsurvi vors in our study showed that the groups were similar in their gestati onal ages, birth weights, Apgar scores and the time to initial intubat ion. The most distinguishing factor of survival in our study was that the survivors, on average, received ECLS support 3 days sooner than no nsurvivors (mean, 17.5 +/- 1.3 hours of life for survivors v 105 +/- 3 6.6 hours for nonsurvivors, P less than or equal to .05). Conclusion: Idiopathic NIHF should no longer be considered an untreatable conditio n but a new indication for ECLS that, when begun early, may significan tly improve the chances of survival for these babies previously consid ered ''unsalvageable.'' Copyright (C) 1997 by W.B. Saunders Company.