Newborns with hemolytic disease of the fetus and newborn (HDFN) are often born prematurely and require close monitoring and specialist care for the first days or weeks following delivery, often in the neonatal intensive care unit (NICU).
Following discharge, a baby affected by HDFN will continue to need regular checkups, but it can be difficult to determine the right time to bring your baby in for a follow-up appointment.
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.
How long will my HDFN baby have to stay in the hospital?
The length of your baby’s hospital stay will depend on the severity of their symptoms and their gestational age at birth. If no complications develop and your baby responds well to treatment for jaundiceJaundice A common symptom of HDFN, jaundice is caused by excess bilirubin and is characterized by a yellow tint to the skin or eyes. and 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., you will be able to take your baby home sooner, once he or she reaches certain milestones.
As well as passing HDFN-related tests, these milestones include a hearing test, a pulse oximetry test to check the oxygen level in the blood and a newborn blood screen test.
Before being discharged, the NICU medical team will test your baby’s blood to measure the 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. levels. If they have fallen to a safe level, your baby will be able to leave the hospital. You may still need to continue phototherapyPhototherapy A treatment that uses special blue light to help newborns break down bilirubin and prevent kernicterus. treatment at home, with the help of a special phototherapy blanket.
Follow-up appointments after initial discharge
Once you and your baby have been discharged from the hospital, you will need to settle into your own daily routine. Your NICU healthcare team will give you a clear idea of when to schedule your first follow-up appointment, but it is usually within the first days or week following discharge.
These follow-up sessions will include monitoring for late-onset anemia, which can develop between two and 12 weeks of life. Your baby’s bilirubin levels will continue to be measured to check for jaundice flare-ups. In addition, your baby’s health, nutrition and development will be evaluated on a regular basis.
When to seek immediate medical attention
While most infants with HDFN will recover normally, you should watch your infant closely for any signs of anemia or jaundice. If these suddenly appear or worsen, you may want to consider taking your baby to your preferred hospital’s emergency department immediately, as a baby’s health can change rapidly.
Longer-term considerations for HDFN infants
HDFN is not usually associated with long-term complications except in rare severe cases. The antibodies that attack red blood cells of a baby affected by HDFN are generally eliminated in the first eight to 12 weeks of life. If anemia and jaundice are successfully treated, your baby will not have any lasting effects. In some cases, babies may need top-up transfusions post-discharge in the first months, including once discharged from hospital.
