If you have just given birth following a high-risk pregnancy and/or you have delivered your baby before its due date, your baby will likely be admitted to the hospital’s neonatal intensive care unit (NICU) within 24 hours of delivery. Most babies affected by hemolytic disease of the fetus and newborn (HDFN) are born prematurely and require specialized care to treat and manage their HDFN symptoms.
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 (RhRh factor A protein or antigen found on red blood cells. When an Rh-negative mother carries an Rh-positive fetus, her immune system may make antibodies that attack the fetus' red blood cells.) factor (Rh-positiveRh-Positive A blood type trait that means your red blood cells have the Rh(D) antigen. or Rh-negativeRh-Negative A blood type trait that means your red blood cells lack the Rh(D) antigen.) during pregnancy. Numerous 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. to RBC antigensAntibody 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. can be linked to HDFN, such as those from the ABO and Rh blood groupBlood group A classification of blood based on inherited markers found on red blood cells. The ABO and Rh blood groups are most common in HDFN. systems.
As a result of improved prenatal screening, early detection and prompt treatment, HDFN is now quite rare. Close monitoring of babies affected by HDFN in utero and treatment by intrauterine blood transfusions are essential to good outcomes.
In the NICU, newborns are carefully monitored to ensure the disease doesn’t progress. Rapid intervention is required if symptoms worsen.
Learn more about HDFN treatment and care
Newborns affected by HDFN
Babies born with HDFN are often born preterm with symptoms of 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. and jaundiceJaundice A common symptom of HDFN, jaundice is caused by excess bilirubin and is characterized by a yellow tint to the skin or eyes. of varying severity. They may also have difficulty breathing and feeding and seem irritable and tired. Newborns with serious cases of HDFN can also have an enlarged spleen or liver and severe swelling of the whole body. In most cases, newborns with HDFN will be cared for in the NICU.
Treatment in the NICU
In the NICU, your baby will be placed in a small bed or incubator that is temperature-controlled. There is often quite a lot of equipment in the room, and your baby will be attached to monitors to make sure they receive the specialized care they need.
Doctors and nurses experienced in acute neonatal care will be monitoring blood pressure, temperature, heart rate, breathing and the level of oxygen in the blood. Depending on your baby’s condition, their treatment may include an IV for fluids, a feeding tube, a ventilator to help them breathe or a nasal cannula which feeds oxygen in through the nose.
You will be allowed to visit your baby, but the exact conditions of visiting and physical contact are decided on a case-by-case basis by your baby’s healthcare team.
While in the NICU, your baby will undergo treatment to treat their HDFN symptoms. Your baby is likely to have jaundice or hyperbilirubinemiaHyperbilirubinemia A common cause of jaundice, this refers to higher than normal bilirubin levels in the blood., which without treatment, can cause kernicterusKernicterus A rare but serious brain condition caused by very high bilirubin levels., a type of brain damage. Phototherapy is used to treat jaundice, followed by an exchange transfusion in severe cases. A blood transfusion may be needed to treat anemia.
These procedures on newborns, who are often born prematurely, are delicate and often life-saving. They require specialized equipment and a dedicated team of neonatal experts in the NICU.
