Long-term follow-up of a neonatal cohort after intrauterine exposure to maternal heparin-mediated extracorporal LDL-precipitation (HELP)-apheresis in very preterm preeclampsia.

OBJECTIVES

Preterm preeclampsia represents a significant contributor to maternal and fetal/neonatal morbidity and frequently results in preterm delivery. The Freiburg preeclampsia HELP (heparin-mediated extracorporal LDL-precipitation)-Apheresis study was a pilot study designed to investigate the effects of HELP-apheresis on the clinical and laboratory outcome of severe preeclampsia. Results of the study were promising, indicating that this approach may be beneficial in prolonging pregnancy. Nevertheless, the long-term effects on the children were not determined yet.

STUDY DESIGN AND MAIN OUTCOME MEASURES: Long-term outcomes of the 12 children from the Freiburg preeclampsia HELP-Apheresis study (6 from the intervention group, 6 from the control cohort) were assessed using Bayley Scales at 24 months corrected age and a parent questionnaire (CBCL4-18) at approximately 10 years of age.

RESULTS

Children exposed to maternal HELP-apheresis demonstrated a generally favorable outcome in terms of Bayley Scales, school and social skills, as well as body growth at 10 years of age. No significant difference between the intervention and the control cohort was observed. The results were consistent with larger cohorts studying the long-term outcomes of very low birth weight infants.

CONCLUSIONS

Prenatal exposure to maternal HELP-apheresis did not have any negative effect on the long-term outcome of very preterm infants born to mothers with severe preeclampsia. However, a potential beneficial impact of the intervention due to the prolongation of pregnancy would have been too small to be discernible. The results of this study justify further investigation of lipid-apheresis as a possible treatment option in severe, very preterm preeclampsia.