Non-Immune Hydrops-Etiology, Investigations And Treatment

• In the past, immune hydrops was very commonly seen due to Rh isoimmunization, but with better antenatal care and better immunization, the chances of immune hydrops are very low. Non-immune hydrops is more commonly seen as compared to immune hydrops. It is defined as presence of extracellular fluid in at least 2 sites with better antenatal care of Rh-negative case. The most common cause is cardiac. 
• The treatment is focused on etiology. It involves two or more body compartments with skin edema (>5mm thickness), pleural effusion, pericardial effusion, and ascites. It is generally associated with polyhydramnios and placentomegaly. Polyhydramnios is when the amniotic fluid index is greater than 24cm, the deepest vertical pocket is larger than 8cm, or the total amniotic fluid volume is >2000ml. Placentomegaly is when placenta is more than 4cm thick in the second trimester and more than 6cm thick in the third trimester. Other causes of this include idiopathic, chromosomal abnormalities, and hematologic causes. It can also be caused due to lymphatic dysplasia, congenital viral infections, CCAM, and storage disorders.

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Etiology Of Non-immune Hydrops

• There are several causes of non immune hydrops

• If there is fetal anemia, then there should be an MCA Doppler flow greater than 1.5MoM. If suspected, consider Parovirus B19, i.e., check if the child was exposed to the virus. The symptom of Parvovirus is a slapped-cheek appearance. Another cause of non-immune hydrops causing anemia is alpha thalassemia.
• Cardiac causes of non immune hydrops- Fetal myocarditis is caused by maternal adenovirus and is treated with maternal digoxin. Bradyarrhythmia’s is the fetal heart rate less than 50 due to maternal anti-Ro antibodies, and it is not amenable to therapy. Fetal atrial flutter and supraventricular tachycardia can cause non-immune hydrops, and it is treated with maternal digoxin followed by sotalol and flecainide.
• Fetal lung lesions- Chylothorax is typically presented with unilateral pleural effusion. It is treated with a thoracic amniotic shunt. CCAM and Bronchopulmonary sequestration are other disorders associated with fetal lung lesions.  Solid CCAM lesion is treated with a thoracic amniotic shunt and maternal steroids. Bronchopulmonary sequestration is treated with a laser to coagulate the feeder artery.
• Twin-to-twin transfusion- Hydrops is more common in the recipient twin. The treatment for it is laser coagulation. Donor twin hydrops can occur after treatment for the recipient twin laser.
• Maternal complications for fetal hydrops- It can be caused due to preterm labor, Premature rupture of membrane. Another maternal complication is Mirror Syndrome/Ballantyne syndrome I.e. triple edema or pseudo toxemia, characterized by fetal hydrops, placental hydrops, and maternal edema. The symptoms include edema, weight gain (most common), hypertension, anemia, and proteinuria.

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Investigations Of Non-immune Hydrops

• The screening test is amniocentesis, including FISH and karyotype, PCR for toxoplasma, Cytomegalovirus, adenovirus and enterovirus, and amniotic fluid mucopolysaccharide and neuraminic levels. If the previous child was affected, then cultured amniocyte assays for Wolman, Faber, Niemann pick, Mucolipidosis II, and multiple sulfatase deficiency.

Treatment Of Non-immune Hydrops

• It is a supportive treatment based on the cause, like tubes for pleural effusions. Intubation and ventilation should be done when necessary. The fluid requirement for a hydropic baby is calculated according to the 50th percentile for gestational age or dry weight. The outcome will depend on the etiology. For example, in storage diseases, the outcome may be poor.

Hope you found this blog helpful for your neonatology NEET SS pediatrics preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.