Central edema in critically ill neonates

Abstract

Background: We reviewed our cases of central edema defined as scalp/facial- and/or truncal edema or anasarca (Ana) hoping to identify prognostic factors that could aid in discussions of futility of care. Case presentation: This study was a retrospective chart review of all cases of central edema in our community level-3 neonatal intensive care unit (NICU) between 2006 and 2019. A total of 19 patients with central edema were found. In 6/19 the etiology was due to chylous losses and in 13/19 inflammation was believed to be the major cause. Outcome was known in 17 cases and only 41% survived. Among the survivors, 86% had a gestational age greater than 34 weeks and the edema resolved in less than 2 weeks in the majority. Fifty-nine percent of the patients expired. In those that expired, 80% were born at 30 weeks' gestation or less and the duration of edema exceeded 2 weeks in all cases and 4 weeks in 60% of the subjects. Conclusion: To the best of our knowledge, this is the first retrospective study of the outcome of central edema in a neonatal population and the results can be useful when discussing futility of care in cases of severe and long-standing or worsening edema not responding to medical management.