Advertisement

35: Long-term neurodevelopment in children after intrauterine transfusion for Parvovirus B19 infection

      Objective

      to determine the incidence of neurodevelopmental impairment (NDI) in survivors of fetal Parvovirus B19 infection treated with intrauterine blood transfusion (IUT).

      Study Design

      Prospective cohort study of children born after IUTs performed between 1997 and 2009 for fetal Parvo B19 infection. We formally assessed neurologic functioning and development in children at least 1.5 yrs. NDI is a composite outcome defined as at least one of the following; cerebral palsy, severe developmental delay, bilateral deafness requiring hearing amplification and/or bilateral blindness.

      Results

      A total of 45 IUTs were performed in 44 fetuses, 32 survived. All fetuses were hydropic. Mean gestational age at IUT was 22 weeks and at birth was 39 weeks. Three cases were lost to follow up, we excluded one case because of Buschke Ollendorff syndrome. In total, we included 28 children for follow up, at a median age of 6 yrs (range 1.5-14). One child was diagnosed with both cerebral palsy and severe developmental delay. Two others had severe developmental delay only. Minor neurologic dysfunction was found in 3 children, minor developmental delay in 2 others. Overall incidence of NDI was 11%.

      Conclusion

      In this largest follow-up study to date, children after IUT for Parvovirus B19 induced hydrops were found to be at increased risk for long term impairment. In a group of survivors of fetal hydrops due to Rh-alloimmunization with hydrops, the rate of NDI was 12% (9/75). In our general population the rate of CP is 0.2% and the rate of severe development delay 2.15%. Larger, multicenter studies are needed to provide more insight in the causes and risk factors for an adverse outcome in this special group of children.