Follow up of children after antenatal treatment for alloimmune thrombocytopenia.
OBJECTIVE
To evaluate the long-term follow-up of surviving offspring after antenatal treatment for fetal or neonatal alloimmune thrombocytopenia (FNAIT).


METHODS
Fifty children at risk of FNAIT were antenatally treated with maternal intravenous immunoglobulins (IVIG) (n=11), IVIG with intrauterine platelet transfusions (IUPT) (n=26) or IUPT alone (n=9). In four cases (n=4), only fetal blood sampling (FBS) was performed. One child died in the neonatal period and one was lost to follow up.


METHODS
The remaining 48 children, aged 1.3-11.6 years (median 5.1 years), were given both general and neurological examinations and assessed on their development and susceptibility for infections or atopic constitution. In addition, immunoglobulin levels were measured in 17 infants, aged 5 years and older.


RESULTS
Intracranial hemorrhage (ICH) was not observed. The general health and neurodevelopmental outcome in the children was comparable to a normal Dutch population. Children not exposed to maternal IVIG treatment had significantly more infections and hearing problems than children exposed to IVIG treatment or the normal population. Immunoglobulin G, A and M levels were within the normal range, independent of treatment and severity of FNAIT. A high IgE level was more frequently seen in children exposed to IVIG, but did not result in clinical consequences such as allergy or atopy.


CONCLUSIONS
Antenatal treatment of children for FNAIT did not affect general health or neurodevelopmental outcome. In particular, exposure to IVIG in utero showed no adverse effect on the clinical outcome of these children.
Radder
Celine M
CM
Department of Obstetrics, Leiden University Medical Center, H4-P, P.O. Box 9600, 2300 RC Leiden, The Netherlands. C.M.Radder@LUMC.nl
de Haan
Monique J J
MJ
Brand
Anneke
A
Stoelhorst
Gerlinde M S J
GM
Veen
Sylvia
S
Kanhai
Humphrey H H
HH
D001805:Blood Transfusion, Intrauterine; D002648:Child; D002657:Child Development / Q000145:classification; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005315:Fetal Diseases / Q000276:immunology / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D007136:Immunoglobulins / Q000097:blood; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007223:Infant; D017713:Platelet Transfusion; D011247:Pregnancy; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000628:therapy*
D007136:Immunoglobulins; D016756:Immunoglobulins, Intravenous