A case report recently published in the Biomedical Journal of Indonesia shows that despite extensive therapeutic efforts, child development disorders attributed to hemolytic disease of the fetus and newborn (HDFN) do not tend to evolve well. Therefore, researchers argued more effort should be made to prevent the disease.
The destruction of red blood cells of the fetus mediated by maternal antibodies can lead to severe anemia and accumulation of bilirubin, which can cause yellowish coloration of the skin (jaundice) and cross the blood-brain barrier causing neurological damage (Kernicterus).
Current therapeutic measures are mostly preventive, consisting of Rh immunoglobulin administration before and after the birth of the first child and intrauterine transfusions, measures that require extensive prenatal screening. Postnatal measures included phototherapy and transfusions.
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The case involved a baby born with jaundice after 39 weeks of gestation. Laboratory workup revealed increased bilirubin values and severe anemia, which led to the beginning of phototherapy. The mother had one previous pregnancy three years prior without complications, she had no significant medical history and the prenatal controls were carried out regularly without any abnormalities.
In the study, the researchers referred to HDFN as Rhesus hemolytic disease of the newborn (RHDN).
“Several postnatal complications of RHDN have been reported, including long-term impacts on child development,” the authors wrote.
Three days later, the patient presented with a fever and poor feeding. Despite continued phototherapy, the patient continued with worsening jaundice over the following days. Further, the workup led to the diagnosis of HDFN as the mother was Rh negative and the father Rh positive.
After numerous transfusions, administration of intravenous immunoglobulin, and intravenous protein administration, there was a reduction of bilirubin levels and improvement of anemia, and the patient was discharged in good condition.
Six months later, the patient was taken to the growth and development clinic as he could not smile or raise his head. Examination revealed stunted growth and delay in cognitive development. Revaluation after 12 months showed no improvement.
“The management of child development disorders with RHDN to date has not shown encouraging results,” the authors wrote. “Therefore, experts in the last decade have focused more on preventive measures, one of which is intrauterine fetal transfusion.”
