Newborns affected by hemolytic disease of the fetus and newborn (HDFN) can experience symptoms such as anemia and jaundice. This is due to the incompatibility of the mother’s red blood cells with her baby, primarily as a result of a blood type (ABO) or blood factor (Rhesus) mismatch.
Fatalities of this red blood cell disorder have become increasingly rare with medical advances in the routine prenatal screening, prevention, early detection and prompt treatment of HDFN in utero.
Severe HDFN more often occurs as a result of Rh(D) incompatibility, rather than ABO incompatibility. In RhD-negative women, the use of RhD immunoprophylaxis at 28 weeks and within 72 hours of the birth of their baby, has drastically reduced fetal mortality. Before the advent of this routine anti-D prophylaxis, HDFN was responsible for fetal loss in 1% of pregnancies. Today, the incidence of HDFN has decreased to 0.1% in newborns worldwide, in particular, as a result of the administration of RhD immunoprophylaxis.
Mild to severe outcomes in newborns
There is no cure for HDFN, so in all cases it requires treatment, either in utero or post-delivery. If left untreated, HDFN can result in fetal or neonatal death.
Today, HDFN affects up to 1,695 of 100,000 live births in the US. Symptoms are mostly mild and outcomes are generally positive, with newborns affected by HDFN requiring an average hospital stay of two extra days when compared with healthy newborns.
The severity of symptoms of HDFN in newborns varies, as do outcomes. Diagnosis often occurs during pregnancy, allowing the fetus to be monitored and treated in the womb. This contributes to better outcomes and prognosis is generally good.
The key role of blood transfusion in treating HDFN
However, even if the fetus is treated in the womb for anemia, post-delivery, newborns can still experience mild anemia or jaundice. This is routinely treated with phototherapy, blood transfusions or exchange transfusions, in more serious cases.
If diagnosis occurs post-delivery, the newborn baby may experience more severe symptoms. Mild anemia and jaundice may occur and can be treated with phototherapy. However, severe neonatal jaundice, also known as hyperbilirubinemia, can lead to kernicterus–bilirubin-induced neurological damage. This can be life-threatening if not treated immediately.
While overall outcomes in newborns are generally positive, severe cases of HDFN occasionally occur. While rare, long-term implications for newborns such as serious neurodevelopmental outcomes are possible. In some rare cases, these may include seizures, brain damage, deafness and even death.
