Maternal Hemolysis, Elevated Liver Enzymes, Low Platelet Count, and Neonatal Outcome

Pregnancies complicated by the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP) have been associated with both a poor maternal and a poor neonatal outcome in several publications. Because many studies were small and gave only scant information regarding the infants, we analyzed the clinical course of 89 neonates born to mothers with the HELLP syndrome. Ninety-eight percent of the neo-nates were born by cesarean section. Infants with a maternal HELLP syndrome were often small for gestational age (39%). The incidence of perinatal asphyxia was found to be 5.6%. Additionally, the affected very low birthweight (VLBW) infants had relatively high incidences of leukopenia (21%), neutropenia (33%), and thrombocytopenia (33%). Initially, 54% of the LBW infants were found to have normoblasts and 25% erythrocytosis. The incidence of these changes in blood cell count increased with decreasing birth-weight. Nosocomial infections occurred more often in infants with a reduced neutrophil count. The overall mortality rate was 56 per 1000. Comparing the statistics of the VLBW infants with a maternal HELLP syndrome (n = 32) to all infants with a birthweight less than 1500g (n = 521) during the investigational period, we found a similar mortality rate (9.3% and 8.4%, respectively). The pulmonary morbidity was also similar. The incidence of intracranial hemorrhage in VLBW infants with a maternal HELLP syndrome was lower (12.5% versus 18.2%) and of necrotizing enterocolitis was higher (6.2% versus 1.9%).