Time is brain: Impact of early intervention on neurodevelopment after Fetomaternal hemorrhage

Abstract

Background

Fetomaternal hemorrhage (FMH) is a rare but serious condition. Early recognition and intervention are critical to reduce morbidity and mortality. This study aimed to evaluate the clinical presentations, management strategies and outcomes associated with FMH.

Methods

A retrospective case series (2009–2025) was conducted in a tertiary care hospital.

Results

Ten mother–infant dyads were analyzed. All neonates presented with pallor and/or hypotonia and required intensive care. Hemoglobin ranged from 2.1–9.5 g/dL (median 4.2 g/dL). Four neonates received red blood cell transfusion within the first hour of life. One neonate underwent therapeutic hypothermia. Favorable neurological outcomes were observed in three of the four neonates transfused within the first hour; the most severe long-term sequelae occurred among those who received later transfusions. Placental pathology (five cases) revealed features suggestive of fetal anemia/hypoxic stress.

Conclusion

FMH should be considered in any pale and/or hypotonic neonate. In this case series, earlier transfusion was more frequently observed among infants with favorable outcomes, but causality cannot be established. Placental pathology did not clarify the underlying pathogenesis of FMH. Brain MRI remains essential for prognosis. When feasible, therapeutic hypothermia should be considered when standard criteria are met and no contraindications are present.