CASE REPORT article
Front. Pediatr.
Sec. Neonatology
Neonatal Management of Parvovirus B19-Induced Hydrops Fetalis: A Case Report
Provisionally accepted
- 1University of Siena, Siena, Italy
- 2Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Tuscany, Italy
- 3Department of Neonatology, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
- 4Department of Pediatrics, Milano-Bicocca University, Fondazione IRCCS Ospedale San Gerardo dei Tintori, Monza, Italy
- 5Department of Obstetrics and Gynecology, ASST Papa Giovanni XXIII, Bergamo, Italy
- 6Department of Pediatric Surgery, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
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Background: Hydrops fetalis (HF) is a severe fetal condition, and congenital Parvovirus B19 (B19V) infection is a leading cause of the non-immune form (NIHF). The recent European B19V outbreak has had a substantial impact on obstetric and neonatal outcomes, leading to an increase in fetal anemia, NIHF, spontaneous abortions, and intrauterine demise. While prenatal diagnosis and intrauterine interventions are well established, postnatal management of B19V-related NIHF remains challenging and outcomes are often poor. Case Presentation: We report a preterm newborn with B19V-associated NIHF following intrauterine transfusions for severe fetal anemia. At birth, the neonate had generalized edema, ascites, and respiratory compromise. Despite aggressive medical management, the patient developed persistent, refractory edema. Intervention: Given the failure of conservative therapy, peritoneal dialysis (PD) was initiated as a rescue strategy. PD allowed gradual interstitial fluid removal, microcirculatory recovery, and functional "renal rest" after prolonged pharmacologic stress. Outcome: The neonate progressively improved, with resolution of edema, normalization of renal function, and successful respiratory weaning. At 12 months of corrected age (CA), neurodevelopmental milestones were appropriate, although ongoing long-term surveillance is warranted. Conclusion: This case contributes to the limited evidence on postnatal management of B19V-related NIHF. PD may be considered in neonates with persistent, refractory edema despite maximal conventional therapy, with careful individualization of treatment. Further research, including multicenter registries and controlled studies, is needed to define its role within standardized neonatal care protocols.
Keywords: Non-immune hydrops fetalis, Neonatology, congenital Parvovirus B19 infection, Fetal anemia, Intrauterine transfusion, Peritoneal Dialysis
Received: 13 Apr 2025; Accepted: 27 Oct 2025.
Copyright: © 2025 Colombo, Lorioli, Pagani, Patanè, Cheli and Mangili. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Marco Colombo, combo.marco@gmail.com
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