Cerebral injury and long-term neurodevelopment impairment in children following severe fetomaternal transfusion: a retrospective cohort study.

Abstract

Objective: Fetomaternal transfusion (FMT) is associated with increased perinatal mortality and morbidity, but data on postnatal outcomes are scarce. Our aim was to determine the incidence of adverse short-termand long-term sequelae of severe FMT.

Design: Retrospective cohort study.

Setting: Dutch tertiary neonatal intensive care unit.

Patients: Liveborn neonates with FMT admitted in 2017-2022.

Main outcome measures: Severe FMT was defined as ≥30 mL of fetal red blood cells in the maternal circulation diagnosed with positive Kleihauer-Betke/flow cytometry test. Adverse outcomes were compared between severe and mild FMT (10-30 mL blood loss) to highlight the impact of FMT severity. Primary outcome was an adverse composite outcome consisting of neonatal mortality or severe neurological morbidity (ie, severe cerebral injury and/or neurodevelopmental impairment (NDI) at 2 years). Secondary outcome was perinatal asphyxia.

Results: 109 neonates with FMT were included, 16 with severe FMT and 93 with mild FMT. Neonatal mortality occurred in 19% (3/16) of neonates with severe FMT and in 4% (4/93) with mild FMT (p=0.063). Perinatal asphyxia was diagnosed in 25% (4/16) of neonates with severe FMT compared with 6% (6/93) with mild FMT (p=0.038). Long-term outcome was assessed in 60 neonates. NDI occurred in 22% (2/9) of children with severe FMT compared with 16% (8/51) with mild FMT (p=0.637). Adverse outcome occurred in 43% (95% CI 38 to 50%) of neonates with severe FMT compared with 18% (95% CI 17% to 24%) with mild FMT (p=0.074).

Conclusion: Neonatal mortality or long-term neurological morbidity occurred in 38%-50% of children with fetal blood loss and anaemia due to severe FMT.