Background: Fetomaternal hemorrhage (FMH) can cause severe morbidity. However, perinatal risk factors for long-term poor outcome due to FMH have not been extensively studied.
Aims: To determine which FMH infants are likely to have neurological sequelae.
Study design: A single-center retrospective observational study. Perinatal factors, including demographic characteristics, Kleihauer-Betke test, blood gas analysis, and neonatal blood hemoglobin concentration ([Hb]), were analyzed in association with long-term outcomes.
Subjects: All 18 neonates referred to a Neonatal Intensive Care Unit of Kagoshima City Hospital and diagnosed with FMH during a 15-year study period. All had a neonatal [Hb] <7.5 g/dL and 15 of 17 neonates tested had Kleihauer-Betke test result >4.0%.
Outcome measures: Poor long-term outcome was defined as any of the following determined at 12 month old or more: cerebral palsy, mental retardation, attention deficit/hyperactivity disorder, and epilepsy.
Results: Nine of the 18 neonates exhibited poor outcomes. Among demographic characteristics and blood variables compared between two groups with poor and favorable outcomes, significant differences were observed in [Hb] (3.6 +/- 1.4 vs. 5.4 +/- 1.1 g/dL, P = 0.01), pH (7.09 +/- 0.11 vs. 7.25 +/- 0.13, P = 0.02) and base deficits (17.5 +/- 5.4 vs. 10.4 +/- 6.0 mmol/L, P = 0.02) in neonatal blood, and a number of infants with [Hb] <= 4.5 g/dL (78%[7/9] vs. 22%[2/9], P = 0.03), respectively. The base deficit in neonatal arterial blood increased significantly with decreasing neonatal [Hb].
Conclusions: Severe anemia causing severe base deficit is associated with neurological sequelae in FMH infants. (C) 2014 Elsevier Ireland Ltd. All rights reserved.