Learn The BasicsThe prognosis of patients with hemolytic disease of the fetus and newborn (HDFN) is generally good if the disease is identified and treated in a timely manner.
HDFN can cause neurological damage if treatment is delayed, but this is rare, as methods of early detection and preventative treatment are on the rise.
Factors affecting prognosis
There are several factors that can affect an HDFN patient’s prognosis. These include:
- The time of detection.
- Availability of preventative treatments such as anti-D injections to the mother.
- Availability of treatments such as intrauterine transfusions before birth.
- Availability of treatments such as phototherapy after birth.
- Development of complications such as hydrops fetalis.
Survival rate
Anti-D injections are immunoglobulins that neutralize molecules. When injected into the mother’s bloodstream during pregnancy, this treatment can trigger her immune response.
Before their introduction in 1968, the death rate of babies affected by HDFN was around 50%. The rate dropped to 0.5% after the introduction of the injection. Death rates due to HDFN went down even further with the introduction of anti-D injections during labor in 1970.
Research has shown that the development of complications such as hydrops fetalis—the accumulation of fluid in the heart, lungs, or abdomen or under the skin of the fetus caused by anemia—can reduce the chance of the baby’s survival by 11%. However, treatments before birth such as intrauterine blood transfusion can reverse hydrops fetalis and improve survival rates.
Long-term prognosis
Because the antibodies produced by the mother’s body, which attack the red blood cells of the baby, usually go away within 8 to 12 weeks, HDFN is most often considered a short-term condition.
With the right medical care, a baby affected by HDFN should not have any long-term medical problems.
Complications
In cases in which the disease is not treated, antibodies produced by the mother’s immune system lead to the breakdown of her baby’s red blood cells. The by-product of this breakdown is bilirubin. Because bilirubin is fat-soluble, it can cross the blood-brain barrier and accumulate in the baby’s brain.
This toxic buildup of bilirubin can cause significant damage and lead to long-term detrimental effects. Some of the resulting complications can include cerebral palsy, hearing problems or even deafness, upward gaze palsy and permanent intellectual disability.
However, these complications are uncommon with the right treatment. In more than 90% of cases, babies with HDFN go on to experience normal neurologic development.
Future pregnancies
Because the mother’s body keeps the antibodies that her body produces against the foreign red blood cells of her first baby, anemia can be more severe in future pregnancies compared to the first affected pregnancy. This is called sensitization, and subsequent pregnancies in parents whose children have been diagnosed with HDFN should be monitored closely. An antibody titer test can determine the level of antibodies within the mother’s blood and predict the risk level to the fetus.
Reviewed by Debjyoti Talukdar, M.D., on September 22, 2023.
