Pregnancies affected by hemolytic disease of the fetus and newborn (HDFN) require specialized care from a multidisciplinary team of maternal-fetal experts with access to the best facilities for prenatal and postnatal treatment. A children’s hospital will provide close monitoring and timely treatment – including urgent medical intervention if required – which can play an important role in achieving successful outcomes for the HDFN-affected infant.
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.
Prenatal care
If prenatal blood type screening reveals the risk of HDFN, mother and baby should be referred to a specialist healthcare team for more expert monitoring, regular blood tests and ultrasounds. If HDFN is diagnosed during pregnancy, the fetus is at risk of developing severe anemia, hydrops fetalis (swelling of the organs) or fetal death. An intrauterine blood transfusion (IUT) is the best option for treating anemia in the fetus and can only be performed in a maternity hospital or specialized center.
Learn more about HDFN treatment and care
Specialized care team in HDFN
A multidisciplinary care team will most likely be based in a children’s hospital or specialized medical center. HDFN remains a rare disease, and not many hospitals or doctors will be experts in the area.
A specialized care team may include fetal medicine specialists, obstetricians, neonatologists, sonographers, fetal nurses, nurse coordinators, genetic counselors, laboratory technicians, hematologists and palliative care providers. They will provide ongoing care during pregnancy and birth, as well as post-delivery to treat potential complications in the neonate. This continuity of care is a valuable resource for mother and baby.
Postnatal care
In HDFN-affected pregnancies, delivery often occurs preterm and in more severe cases, by emergency cesarean. During delivery the HDFN-affected baby is at risk of complications of anemia, including heart failure and stillbirth. The expertise of the care team is vital in this acute setting.
Immediately following the baby’s birth, blood sampling will check for blood type, anemia, bilirubin (causing jaundice), neutropenia (low white blood cell count) and thrombocytopenia (low blood platelet count). This will help determine the severity of the baby’s HDFN symptoms and inform the treatment pathway chosen by the healthcare team. Phototherapy to treat jaundice, blood transfusions for anemia If left untreated or not treated proactively, HDFN can lead to long-term consequences for the baby, such as kernicterus which can cause seizures, brain damage and deafness.
The continuous involvement of a specialized multidisciplinary healthcare team is a key contributor to successful outcomes in HDFN-affected babies. HDFN pregnancies are rare and high-risk, requiring close monitoring and expert medical intervention without delay.
