In pregnancies affected by hemolytic disease of the fetus and newborn (HDFN), preterm delivery is common. To ensure the best outcomes for babies identified as being at risk of a premature birth and the associated complications from being born early, corticosteroids are administered during pregnancy. They help develop lung maturity, prevent respiratory problems and help improve survival outcomes.
What is HDFN?
Hemolytic disease of the fetus and newborn (HDFN) is an immune-mediated red blood cell 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.
What is considered preterm delivery?
When a baby is delivered before 37 weeks’ gestation, it is considered a premature birth. Babies can be delivered early as a result of complications in pregnancy such as preeclampsia, HDFN, diabetes, infection, high blood pressure, injury or trauma to the mother, unexplained bleeding or spontaneous early onset of labor. In the case of pregnancies affected by HDFN and FNAIT, preterm labor may be planned to remove the baby from the toxic effects of the maternal antibodies that cause anemia and thrombocytopenia, respectively.
Learn more about HDFN treatment and care
Being born early can lead to serious complications for the newborn. In most cases, babies born before 37 weeks are admitted to the neonatal intensive care unit (NICU) for specialized care. While a baby can survive if born after 24 weeks, complications can be life-threatening, with some causing long-term consequences, such as developmental delays, heart problems, anemia, digestive problems, poor growth, cerebral palsy and hearing and vision problems.
What are antenatal corticosteroids?
The most common antenatal corticosteroid is betamethasone (Celestone), administered by injection in a patient’s thigh or upper arm. It then crosses the placenta to help the baby’s lungs develop more rapidly.
Corticosteroids are recommended by the National Institutes of Health (NIH) and the American College of Obstetricians and Gynecologists (ACOG) if your baby is between 24 and 34 weeks’ gestation, and you are at risk of giving birth within the next 7 days. In this case, you will receive two doses, 24 hours apart. You may require another round of doses if you are still less than 24 weeks’ pregnant two weeks later and you are at risk of giving birth within the next 7 days. This, however, is assessed on a case-by-case basis.
What are the benefits of corticosteroids for preterm deliveries?
Corticosteroids accelerate the maturation of fetal lung tissue and other organs, preventing respiratory distress post-delivery. They have also been shown to positively affect intraventricular hemorrhage and reduce fetal and neonatal death.
