W. P. Boyan1, B. Shea1, N. Fiore2, Y. Fenig1, I. T. Cohen1 2St. George’s University School Of Medicine,St. George’s, St. George’s, Grenada 1Monmouth Medical Center,Surgery,Long Branch, NJ, USA
Introduction:
Knowledge of the correlation between maternal conditions, especially during pregnancy and fetal outcomes is paramount to optimal care in pediatrics. One which has not been frequently commented on in the literature is pre-eclampsia, eclampsia and hemolysis, elevated liver enzymes and low platelets (HELLP). This spectrum, which starts with hypertension and proteinuria in the pregnant mother, pre-eclampsia, affects 2-8% of all pregnancies. The transition to eclampsia occurs with seizures. Finally, 10-20% of severe cases result in HELLP, which carries a 1% mortality to the mother. Preterm delivery is increased in pre-eclampsia and HELLP at 25.5% and 50% respectively, which indicates the severe consequences of this disease for both mother and child. Intuitively, a disease which is caused by deranged blood flow and coagulation factors must have an effect on the developing fetus. This begs the question, why is there a paucity of information about these diseases and the consequences to the child?
Methods:
A retrospective review of all documented cases of pre-eclampsia, eclampsia and HELLP was done at a community Regional Neonatal Center. Over a five year period, 291 mothers were diagnosed with one of the three conditions and gave birth to 318 children. The children were stratified for gestational age, birth weight and any conditions within the first year of life. The characteristics of the neonates and incidence of all conditions were stratified for contributing factors and compared to established data.
Results:
Of the 318 neonates, two were still births and one mother died from intracranial hemorrhage in the face of HELLP. Two hundred and twelve (66.67%) were born before 37 weeks, which is higher than the expected rate for these conditions. A total of 114 neonates were low birth weight (36%), while 75 were very low birth weight (23%). The incidence of hematologic, cardiac, pulmonary and renal problems all initially appeared higher than expected, but once stratified for prematurity and birth weight, all but cardiac and renal abnormalities fit into expected ranges. Hernias, intestinal conditions and intracranial hemorrhages appeared on the low end of expected incidence.
Conclusion:
Eclampsia and HELLP are serious conditions in the pregnant patient, which significantly increase rates of preterm delivery as well as correlates with low birth weights. As with all maternal conditions, thought must be given to the effect of these derangements on the developing fetus. Conditions such as necrotizing enterocolitis (NEC) caused by low flow sates and intestinal atresias, thought to occur with vascular incidents, were not seen at a higher rate in these patients once stratified for gestational age and birth weight. The authors conclude that although pre-eclampsia, eclampsia and HELLP are a risk factor for prematurity and low birth weight, they are not themselves an independent risk factor for any identifiable neonatal surgical condition