Neonatal outcome after preterm delivery in HELLP syndrome

Abstract

The present study compares neonatal outcome after preterm delivery of infants in pregnancies complicated by the HELLP syndrome or severe preeclampsia (PS). The maternal and neonatal charts of 71 out of a total of 409 pregnancies that were complicated by hypertensive disorders at Severance hospital between January 1995 and December 2004 were reviewed. Twenty-one pregnancies were complicated by HELLP syndrome and 50 pregnancies were complicated by PS. Fifty normotensive (NT) patients who delivered because of preterm labor comprised the control group. Results were analyzed by the chi-square test and ANOVA. Gestational age and maternal age at delivery were matched among the three groups. The neonatal outcomes of the HELLP syndrome group were compared with the PS and NT groups. There were significant differences between the HELLP syndrome group and the PS group in the incidence of intraventricular hemorrhage (IVH) (61.9% vs. 26%, p = 0.006), sepsis (85.7% vs. 44%, p = 0.003) and mechanical ventilation (MV) rate (81% vs. 54%, p = 0.039). There were significant differences between the HELLP syndrome group and the NT group in the incidence of neonatal death (ND) (19.5% vs. 2.0%, p = 0.034), respiratory distress syndrome (RDS) (38.1% vs. 8%, p = 0.0045), IVH (61.9% vs. 4%, p <0.0001), sepsis (85.7% vs. 14%, p <0.0001), intensive care (IC) (85.7% vs. 24%, p <0.0001) and MV rate (80.1% vs. 14%, p <0.0001). There were also significant differences between the PS and NT groups in the incidence of ND (20% vs. 2%, p = 0.0192), RDS (30% vs. 8%, p = 0.0085), IVH (26% vs. 4%, p = 0.0070), sepsis (44% vs. 14%, p = 0.0015), IC (78% vs. 24%, p <0.0001), MV rate (54% vs. 14%, p <0.0001) and low 5-min APGAR score (50% vs. 16%, p = 0.0005). This study shows increased morbidity in newborns of mothers complicated with HELLP syndrome and indicates that early, regular and high quality management of these patients is essential to improve both maternal and neonatal outcome.