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

The diagnosis of Hydrops fetalis still carries a grave prognosis with reported mortality ranging from 50 to 100%. With the advent of more aggressive therapy, improvement of survival is undetermined. The study population of this outcome case series was gathered from all cases of hydrops fetalis admitted to our Loyola University Medical Center Neonatal Intensive Care Unit (NICU) from 1990 to 1997. Forty-one patients were eligible for inclusion. Only four had a diagnosis of immune hydrops fetalis, while the remainder had varied nonimmune causes. Models predicting survival were constructed with various neonatal and maternal factors as explanatory variables using Cox proportional Hazards technique. Kaplan-Meier estimates of median survival times for different stratifying variables were likewise computed. The overall mortality rate was 49% with an overall median survival time of 15 days (95% CI 8-38). Median survival time estimates differed significantly between patients who had (a) proven infection or not and (b) had less than or greater than two fluid-filled cavities. The use of steroids, surfactant, or high-frequency ventilation did not improve survival. Stratifying the study base into those treated in early or late 1990s likewise failed to show difference in survival times. Infection remains a significant problem (46%). In our series 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 prolong survival times, these treatments failed to alter overall survival outcome.