What is HDFN?
Hemolytic disease of the fetus and newborn (HDFN) is a rare disorder in which certain maternal antibodiesAntibody A protein made by the immune system that recognizes and attacks foreign substances, such as bacteria, or in HDFN, fetal red blood cells carrying incompatible antigens. cross the placenta and reduce the lifespan of fetal red blood cells (RBCs). This leads to the development of fetal anemia. In HDFN, the fetus’s RBCs begin to break down at a rapid rate, which is called hemolysis.
What are the possible complications of HDFN?
HDFN can be associated with a variety of complications. Fetal anemiaAnemia A condition that occurs when the body doesn’t have enough healthy red blood cells to carry oxygen to its tissues. In HDFN, anemia occurs when maternal antibodies destroy fetal red blood cells. can result in severe complications, including hydrops fetalis.
What is hydrops fetalisHydrops fetalis A serious, sometimes fatal condition in which fluid builds up in a baby’s tissues and organs due to severe anemia from HDFN.?
Hydrops fetalis is a symptom of an underlying medical condition that affects an unborn baby and can occur with HDFN. In this condition, large amounts of fluid accumulate in the baby’s tissues or organs. If it remains untreated, this abundance of fluid can place stress on the fetal heart and other vital organs, thus causing the life of the fetus to be at risk.
In the first 24 hours following a baby’s birth, hemolysis and hyperbilirubinemia may occur. In hyperbilirubinemiaHyperbilirubinemia A common cause of jaundice, this refers to higher than normal bilirubin levels in the blood., there is too much bilirubinBilirubin A yellow substance produced when red blood cells break down. High bilirubin levels in newborns with HDFN can cause jaundice or, in severe cases, brain damage. in the blood, which can lead to jaundiceJaundice A common symptom of HDFN, jaundice is caused by excess bilirubin and is characterized by a yellow tint to the skin or eyes.. In such instances, severe complications may be reported, including kernicterus and acute bilirubin-induced encephalopathy (BIE).
KernicterusKernicterus A rare but serious brain condition caused by very high bilirubin levels., which results from untreated jaundice, is caused by excess bilirubin that damages the central nervous system or brain.
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How can HDFN affect the nutritional status of a newborn?
Some complications of HDFN may affect a newborn’s nutritional status. In these babies, strict attention to diet and appropriate treatment, along with careful monitoring, can affect long-term outcomes.
Do HDFN newborns experience feeding difficulties?
Feeding among newborns with HDFN may be poor. This may be due to neuromuscular impairments, such as a poor suck reflex, which can be related to BIE or kernicterus. The presence of anemia also can impede a neonate’s ability to feed, since feeding is considered the most aerobic activity among newborns.
Poor nutrition, inadequate feeding, and dehydration can all further increase levels of total serum bilirubin in a neonate.
Is malnutrition reported among neonates with HDFN?
In neonates with HDFN, malnutrition can lead to hypoalbuminemia, which can be linked to an increased risk for hyperbilirubinemia. In those with hypoalbuminemia, the liver does not produce sufficient albumin protein, which prevents fluid from leaking out of blood vessels.
Among newborns with kernicterus, malnutrition is common. At times, malnutrition and hypoglycemia (low blood sugar) in neonates with HDFN-related kernicterus may necessitate feeding support with total parenteral nutrition (TPN). In TPN, intravenously administered nutrition is the only source of nutrition being received.
Breastfeeding and HDFN
In neonates with HDFN that does not resolve following birth, breastfeeding may contribute to persistent HDFN. This can occur through the newborn passively acquiring the anti-D immunoglobulin in breast milk. In such cases, breastfeeding may need to be discontinued.
HDFN is more likely to be prolonged in babies who are breastfed compared with formula-fed babies.
Managing iron levels in neonates with HDFN
Adequate nutritional support is critical in neonates with HDFN. This includes sufficient iron and vitamin supplementation. Iron supplements should be considered only if laboratory tests show a true ferritin deficiency. Ferritin is a blood protein that stores iron inside the body.
The results of some studies have revealed that neonates with HDFN may be at increased risk for iron overload if they receive an intrauterine transfusionIntrauterine transfusion A procedure that delivers donor red blood cells to the fetus through the umbilical vein to treat severe anemia caused by HDFN. (IUTIntrauterine transfusion A procedure that delivers donor red blood cells to the fetus through the umbilical vein to treat severe anemia caused by HDFN.).
What other issues may develop?
Newborns with severe HDFN have an elevated risk for cholestasis—especially those who require multiple IUTs. In cholestasis, elevated levels of conjugated bilirubin are observed. In fact, TPN can generate cholestasis in a newborn.
The role of prebiotics
The role played by prebiotic supplements in treating neonatal hyperbilirubinemia is being studied. It is believed that the group of nutrients known as prebiotics improve feeding tolerance and the growth of beneficial bacteria in the gut.
