In most newborns, hemolytic disease of the fetus and newborn (HDFN) is a short-term condition that lasts a matter of weeks. The rarer longer-term effect on the health of babies born with HDFN depends on factors such as gestational age at birth and the severity of symptoms.
In these rare cases, HDFN can result in neurodevelopmental delays, brain damage, seizures and even death.
What is HDFN?
Hemolytic disease of the fetus and newborn (HDFN) is an immune-mediated red blood cell (RBC) disorder that occurs when a baby’s RBCs break down quickly, which is called hemolysis. HDFN is caused by a mismatch between a mother’s and her baby’s blood type (A, B, AB, or O) or Rhesus (Rh) factor (Rh-positive or Rh-negative) during pregnancy. Numerous antibodies to RBC antigens can be linked to HDFN, such as those from the ABO and Rh blood group systems.
HDFN and the neonatal immune system
The neonatal immune system doesn’t suffer HDFN-related long-term consequences. The antibodies produced by the mother that cross the placenta and break down the baby’s red blood cells while in utero are usually eliminated in the first eight to 12 weeks of life.
However, long-term complications related to HDFN, though rare, can seriously affect an infant’s health and development.
Prognosis of babies with HDFN
Due to advances in routine prenatal screening, preventative measures, early diagnosis and prompt treatment, the prognosis of babies affected by HDFN is generally good. Additionally, the quality of prenatal/postnatal management of HDFN and its associated symptoms play an important role in the future health of babies with HDFN.
Complications of HDFN
Newborns affected by HDFN require immediate and constant monitoring to treat symptoms that can create serious long-term consequences if care is delayed. These include anemia and hyperbilirubinemia (jaundice), fatigue, breathing difficulties and difficulties feeding.
Severe anemia can lead to the swelling of internal organs and urgent blood transfusions are sometimes needed. It also leads to hyperbilirubinemia, as when red blood cells break down, this causes the baby’s blood to have high levels of bilirubin, which the neonate is unable to eliminate on its own.
Treatment includes intensive phototherapy, and exchange transfusions if care needs to be escalated to prevent the onset of kernicterus. Kernicterus is a serious condition that occurs when bilirubin crosses into the baby’s brain. Delays in treatment can lead to long-term health implications such as neurodevelopmental impairment, deafness, seizures and cerebral palsy.
