Diagnosis and management of non-immune hydrops in the newborn.

Non-immune hydrops fetalis is a relatively rare and complex disorder that requires detailed investigation and coordinated management by a multidisciplinary team. There is a lack of clear advice in the literature on the immediate management and investigation of neonatal hydrops. The approach described here has been used in our unit and has been welcomed, particularly by resident staff. Hydrops fetalis is associated with a large number of pathologies (see table 1) that are usually divided into: (1) Immunological. Anaemia results from maternal isoimmunisation against rhesus or other red cell antigens. The antenatal and postnatal aspects of investigation and management of immune hydrops are well covered in standard obstetric and neonatal textbooks. This condition is now extremely rare in our experience, less than 1:10 000 deliveries, as a result of improved antenatal intervention. (2) Non-immunological. Most cases of hydrops fetalis are now non-immunological. A wide range of associations have been reported in over 500 cases1-12 but the commonest are chromosomal abnormalities, cardiac anomalies, pulmonary abnormalities, infection and multiple births. In earlier series, no cause was found in approximately 50%/ of these cases,3 13 but more recent data suggest that with a complete prenatal and postnatal evaluation,2 5 a precise diagnosis can be arrived at in 85%.14 Approximately 40% of cases will have another congenital abnormality.3 The remainder of this article refers only to nonimmunological hydrops and is intended to provide guidelines for staff confronted with a hydropic infant at birth.