Fontanelle size in black and white term newborn infants

Abstract

course, the correction of severe fetal anemia, presumably prolonging intrauterine survival while delaying delivery to a more favorable gestational age. Bowman ~ has estimated that approximately 12% of transfused IP red blood cells are absorbed daily through the subdiaphragmatic lymphatics, absorption being complete in eight to nine days. Factors influencing the rate of peritoneal absorption of blood in humans, however, are unknown. In adult dogs, absorption of IP red cells is delayed under experimental conditions of anemia, hypoproteinemia, or ascites?. 4 Observations in human infants suggest that peritoneal absorption of red cells in a hydropic fetus is no less than that in a nonhydropic fetus? Our patient, though neither anemic, hypoproteinemic, nor hydropic, absorbed only an estimated 13% of the red cells given during her third IUT five days previously. This problem, coupled with premature delivery less than 48 hours after the IUT, contributed to an unusually recalcitrant hyperbilirubinemia. In contrast to 118 surviving recipients of IUT with initial AOD450's in the Liley upper zone, who required but 2.4 ETS on the average] our patient required in excess of 13 ETs. Since her hyperbilirubinemia was controlled only after the intraperitoneal evacuation of the equivalent of 87 ml of packed red cells, we attribute her unusually persistent jaundice to this extravascular source of hemolyzed red cells, not simply to Rh sensitization. Although maturation of liver enzyme systems and phenobarbital therapy cannot be excluded as contributing to the eventual decline in serum bilirubin concentration, we believe that removal of intraperitoneal blood Was the most important factor. This case is reported to alert other physicians to this previously undescribed complication of IUT.