The long-term effects of hemolytic disease of the fetus and newborn (HDFN) can vary, depending on factors such as how early it was diagnosed, delay to treatment and the severity of symptoms. In most cases the newborn will fully recover from HDFN, but long-term consequences do occur.
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.
Effects in-utero and post-delivery
The breaking down of the fetus’s red blood cells during pregnancy causes fetal anemia. Severe fetal anemia caused by HDFN can lead to a lack of oxygen being circulated in the body, and to the brain. This can result in complications such as heart failure, hydrops fetalis or the severe swelling of the tissue and organs, developmental delays and, in the most serious cases, fetal death.
Early diagnosis of HDFN during pregnancy and proactive treatment are essential to avoid life-threatening complications and long-term consequences for the baby.
After delivery, a newborn affected by HDFN may require an urgent blood transfusion to manage anemia and its symptoms. Hydrops fetalis will require specialist care including extra oxygen, an intervention to drain excessive fluid from the lungs or stomach and medication to remove the fluid from the liver. The worst outcome is death, with long-term impact related to organ damage and developmental delays.
Learn more about HDFN prognosis
Immediate testing of bilirubin levels is also required to detect jaundice or hyperbilirubinemia. Bilirubin is produced when red blood cells break down. In utero, the placenta filters it out, but in newborns the liver struggles to process and eliminate the bilirubin as it is too immature.
Phototherapy is the standard of care for treating jaundice in newborns. It uses blue light to turn the bilirubin into a water-soluble form so it can be excreted without passing by the liver. Exchange transfusions and the administration of intravenous immunoglobulin (IVIG) may be required if bilirubin levels don’t drop fast enough. The risk of rising levels of bilirubin is that the substance will cross the blood-brain barrier and impact the brain and nervous system.
Long-term effects of HDFN
Kernicterus is the most dangerous complication of HDFN and it occurs when bilirubin crosses into the brain, potentially causing permanent brain damage, hearing and vision loss, cerebral palsy, seizures, dental problems, delayed development and even death.
The pain and stress experienced by the fetus and newborn as a result of HDFN symptoms, medical procedures and the time spent in the neonatal intensive care unit (NICU) can also have other consequences. Pediatric medical trauma can have long-term effects such as social, emotional, behavioral and development issues.
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