Outcome of infants with a diagnosis of hydrops fetalis in the 1990s

The diagnosis of Hydrops fetalis still carries a grave prognosis with repor ted mortality ranging from 50 to 100%. With the advent of more aggressive t herapy, improvement of survival is undetermined. The study population of th is outcome case series was gathered from all cases of hydrops fetalis admit ted to our Loyola University Medical Center Neonatal Intensive Care Unit (N ICU) from 1990 to 1997. Forty-one patients were eligible for inclusion. Onl y four had a diagnosis of immune hydrops fetalis, while the remainder had v aried nonimmune causes. Models predicting survival were constructed with va rious neonatal and maternal factors as explanatory variables using Cox prop ortional Hazards technique. Kaplan-Meier estimates of median survival times for different stratifying variables were likewise computed. The overall mo rtality rate was 49% with an overall median survival time of 15 days (95% C I 8-38). Median survival time estimates differed significantly between pati ents who had (a) proven infection or not and (b) had less than or greater t han two fluid-filled cavities. The use of steroids, surfactant, or high-fre quency ventilation did not improve survival. Stratifying the study base int o those treated in early or late 1990s likewise failed to show difference i n survival times. Infection remains a significant problem (46%). In our ser ies 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 prol ong survival times, these treatments failed to alter overall survival outco me.