A recent review published in Best Practice & Research: Clinical Obstetrics & Gynaecology shows that findings from existing literature on the association between intrauterine transfusion (IUT) and long-term neurodevelopment in hemolytic disease of the fetus and newborn (HDFN) are inconclusive.
While some studies have shown a link between IUT and poorer developmental outcomes, these results could also be attributed to a number of factors including premature birth, HDFN severity and low birth weight, the authors explained.
In general, the long-term outcomes of IUT are widely considered favorable. However, few studies exist that follow children long-term, and of those that do exist, their conclusions are limited by small samples and inconsistent measurements.
The researchers found that the rate of neurodevelopmental impairment following IUT ranges from 0% to 18.8% across different studies. A prevalence of 5% is accepted by many experts, though.
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Additionally, health related quality of life and school performance do not appear to differ between families that are and are not impacted by HDFN. Again, few studies have investigated this relationship.
The authors lay out a set of recommendations to guide not only clinical practice but also future research.
Fetal therapy centers, they wrote, should be aware of the potential neurodevelopmental effects of HDFN and should implement tailored screening assessments in high-risk patients.
Psychologists or nurses may set up screening for neurodevelopmental or psychosocial difficulties in regular intervals. If they identify any issues, the child should undergo further testing to understand the nature of these difficulties.
The investigators also call for administration of patient-reported outcome measure surveys up to eight years of age.
Future studies should update their criteria for neurodevelopmental outcome, including mild difficulties, and incorporate measures of quality of life among parents.
“With the introduction of new non-invasive therapies, international collaborative efforts are of utmost importance to reliably investigate not just survival or neonatal outcome but also long-term neurodevelopment and wellbeing of children and caregivers,” the authors concluded.
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