Therapeutic Hypothermia to Treat a Critical Neonate with Life-Threatening Anemia and Perinatal Asphyxia Caused by Massive Fetomaternal Transfusion

以低溫療法治療因大量胎兒母體間輸血所致之嚴重貧血與週產期窒息之新生兒案例報告

何正尹(Cheng Yin Ho) ； 顏俊宇(Chun-Yu Yen) ； 周佳穗(Chia-Sui Chou) ； 曹珮真(Pei-Chen Tsao) ； 李昱聲(Yu-Sheng Lee) ； 陳淑貞(Shu-Jen Chen) ； 宋文舉(Wen-Jue Soong) ； 鄭玫枝(Mei-Jy Jeng)

《輔仁醫學期刊》 15卷2期 (2017/06) Pp. 97-108

https://doi.org/10.3966/181020932017061502005

摘要

Massive fetomaternal transfusion (FMT) causes serious anemia, induces fetal/neonatal shock and asphyxia, and increases the risk of death or hypoxic-ischemic encephalopathy (HIE) in the neonate. Therapeutic hypothermia delays anoxic brain cell damage by suppressing tissue inflammation, intracellular signaling, and programed cell death; thus, it is neuroprotective in the neonatal brain with perinatal asphyxia. Therapeutic hypothermia is currently the standard of care for neonates with HIE. We report a neonate with life-threatening anemia and HIE caused by massive FMT who was successfully treated with therapeutic hypothermia. This newborn presented with birth asphyxia, general hypotonia, undetectable blood pressure, marked metabolic acidosis, profound anemia (hemoglobin = 2.0 g/dL), and stage 2 HIE. Therapeutic hypothermia with a target temperature of 33°C was initiated at the age of 4 h for a total of 72 h. A Kleihauer-Betke test of maternal blood was positive and the estimated blood loss from the fetus to the mother was approximately 240 mL. He was extubated on day 7, and the general activity, muscle tone, and oral feeding improved gradually. The hearing test revealed normal hearing bilaterally. Neurological development at 4 months of age was not delayed. Therefore, therapeutic hypothermia should be a choice for the treatment of critical newborn infants with massive FMT complicated with HIE.

關鍵字

anemia ； fetomaternal transfusion ； Kleihaure-Betke test ； hypoxic-ischemic encephalopathy ； neonate ； therapeutic hypothermia

並列摘要

大量的胎兒母體間輸血會導致嚴重的胎兒貧血，進一步導致胎兒或新生兒休克與窒息，甚至造成新生兒死亡或缺氧缺血性腦病變。治療性低體溫可以延緩腦部軸突細胞的死亡，理論上對於周產期窒息與缺氧的新生兒具有神經保護作用。我們在此報告一個以低溫療法成功治療的新生兒案例，該新生兒因大量胎兒母體間輸血造成致命的嚴重貧血與周產期窒息。此新生兒於出生時便呈現周產期窒息、全身性低肌張力，嚴重低血壓、嚴重代謝性酸中毒、嚴重貧血（血紅素值為2.0克／公合）以及第二級的新生兒缺氧缺血性腦病變。低溫治療於是於新生兒出生後四小時開始使用，溫度設定於攝氏33度，總共持續72小時。母體血液的Kleihauer-Betke測驗為陽性，計算得胎兒失血致母體的血量約為240毫升。胎兒於產後第七天成功拔管，且其整體活力、肌張力與經口進食能力皆於復健治療後逐漸改善。聽力測驗顯示兩側聽力皆為正常，於四個月大時也無發展遲緩情形。

並列關鍵字

貧血 ； 胎兒母體間輸血 ； Kleihaure-Betke test ； 缺氧缺血性腦病變 ； 新生兒 ； 低溫療法