Newborns affected by hemolytic disease of the fetus and newborn (HDFN) require immediate treatment to ensure the best outcomes. First-line treatment of HDFN includes phototherapyPhototherapy A treatment that uses special blue light to help newborns break down bilirubin and prevent kernicterus., extra fluids and in some cases, blood transfusions.
Both iron and folic acid are recommended in some circles to treat HDFN, but it is vital for parents to understand that while one is recommended, the other is not. Folic acid can be part of a treatment plan to stimulate red blood cell growth, but iron is not recommended in the treatment of HDFN and can actually be dangerous for the infant.
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.
Symptoms of HDFN in newborns
Post-delivery, neonates with HDFN will have very pale skin, yellowing of the skin and the whites of the eyes (jaundiceJaundice A common symptom of HDFN, jaundice is caused by excess bilirubin and is characterized by a yellow tint to the skin or eyes.), with some swelling (edema) in some cases. Additionally, the newborn will be very tired, irritable and have trouble feeding.
HDFN 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 jaundice (hyperbilirubinemiaHyperbilirubinemia A common cause of jaundice, this refers to higher than normal bilirubin levels in the blood.) can vary in severity in newborns. The greatest risk is that the levels of 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 will rise, leading to long-term complications such as brain damage and deafness.
Most newborns affected by HDFN will spend some time in the NICU where they will be closely monitored. In most cases, phototherapy is prescribed to treat jaundice. Anemia is often treated with blood transfusions.
Learn more about HDFN treatment and care
The benefits of folic acid
HDFN is a red blood cell disorder. During pregnancy, the mother’s immune system attacks the fetus’ red blood cells, gradually breaking them down and causing anemia. Severe anemia can be life-threatening in utero and post-delivery, leading to cardiac arrest and severe swelling of the internal organs. Newborns with HDFN, therefore, have low levels of red blood cells.
Folic acid is prescribed to help boost the creation of new red blood cells. It is a once-daily dose by mouth for the first three months following birth.
Why iron supplements are not recommended
It is a common misconception that infants with HDFN are low in iron and therefore require iron supplementation. Iron supplements will not treat anemia in HDFN newborns, as these infants have hemolytic anemia, not iron deficiency anemia. In fact, iron supplements can lead to iron overload, as even though the red blood cells are destroyed, the iron is still stored in the body.
Newborns with HDFN who are treated in utero with an intrauterine blood transfusion (UIT) are at a greater risk of iron overload, even without iron supplements. Iron overload can have serious consequences, including, liver damage, portal hypertension, coagulopathy abnormal liver enzymes, free-radical damage and in some cases, death.
