Abstract

Aim: To describe neonatal outcomes following intrauterine transfusion (IUT) for severe rhesus isoimmunisation over a twelve year period (1993-2004).

Results: 116 neonates were identified who had undergone 457 IUTs (median 4; range 1-9). There were 3 neonatal deaths, all prior to 1995; 2 due to hypoxic ischaemic multi organ failure and 1 due to overwhelming E coli sepsis. 13 neonates (11%) were delivered by emergency Caesarean section following either an IUT complication or the spontaneous onset of preterm labour. They were more likely to require intubation (p<0.0001), on-going respiratory support (p=0.0007) and an exchange transfusion (p=0.007). Overall 23 babies (20%) required an exchange transfusion and 63 (54%) at least one top-up transfusion.

Conclusions: Contemporary management of severe rhesus disease is associated with encouraging neonatal outcomes and the majority of infants can be managed with phototherapy and a limited number of top up transfusions. IUT complications are rare but inevitably significantly increase neonatal mortality and morbidity. Antenatal counselling should address the likely postnatal course for these infants and this review provides recent data from the UK to assist in this.