Fetuses treated with intrauterine blood transfusion: Prenatal prophylaxis, treatment and long-term outcome

​The Ph.D.-project will consist of three separate studies concerning fetal anemia due to alloimmunisation: 1) the clinical effects of the extended national prophylactic program for prevention of RhD immunisation, 2) the brain development using MRI of fetuses treated with IUT, and 3) the neurodevelopmental outcome of children born after IUT

​​​A research project by Emilie Thorup Nielsen

In cases, where the fetus despite the prophylaxis program develops anemia, treatment consists of intrauterine blood transfusion (IUT). IUT was introduced in 1981 and has significantly improved the outcome and survival rates to over 90%. Hence, attention is now shifting towards the effects of severe anemia on the developing fetal brain and long-term neurodevelopmental outcome. 

An increasing number of antenatal magnetic resonance imaging (MRI) studies have assessed the fetal brain's volumetric growth to determine normal brain development(16-18) and assess differences in brain growth in several conditions. Volumetric measurements provide essential information on the brain development. To our knowledge, no studies have investigated brain volume development by MRI in fetuses treated with IUT due to fetal anemia. 

Moreover, the impact of fetal anemia on neurodevelopmental development can only be estimated accurately with long-term follow-up studies. A systematic review from 2011 identified nine studies focusing on neurodevelopmental outcomes after IUT due to alloimmunisation and found an overall incidence of neurodevelopmental impairment of 6.2%. However, the studies were very small and most studies did not include controls and had unclear criteria for neurodevelopmental impairment. Hence, larger systematic follow-up studies of children surviving fetal anemia are needed to optimize parental counseling.

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