CAUSES OF DEATH IN INFANTS WITH HEMOLYTIC DISEASE OF THE NEWBORN (ERYTHROBLASTOSIS FETALIS)

Abstract

In a series of 882 infants with hemolytic disease, there were 82 fatalities, for which 74 necropsies were performed. In general, death resulted from severity of hemolytic disease in 59%, from delay in treatment leading to kernicterus in 18%, from profound late anemia in 3%, and from conditions unrelated to hemolytic disease in 20% of the cases in which necropsy was performed. Significant clinical and pathologic findings in the 74 infants were: anemia in 70%; aspiration of amniotic sac content in 55%; pulmonary hemorrhage in 54%; heart failure in 51%; with anascarca in 42%; death during or soon after the exchange transfusion in 32%; pneumonia in 19%; kernicterus in 18%; pulmonary hyaline membranes in 12%; rupture of the spleen in 5%; and cerebral intraventricular hemorrhage in 4%. The risk of death during or soon after the exchange transfusion was 2% per patient and per procedure, if infants with hydrops or fatal lesions are excluded. The total risk was 4% per patient and 3% per exchange transfusion. Approximately one-third of all fatalities occurred during or soon following exchange transfusion. In approximately one-third of infants who died at this time, no adequate cause of death was found pathologically. Pulmonary hemorrhage did not differ significantly in incidence or in degree between kernicteric infants, nonkernicteric infants with hemolytic disease, and a control series. Rupture of the spleen occurred significantly more frequently in infants with severe hemolytic disease than in the control series. The important problems of death during or soon following exchange transfusion, and of hemorrhage in infants with hemolytic disease, merit further study.