Among individuals with hemolytic disease of the fetus and newborn (HDFN) that warrants the use of intrauterine transfusionIntrauterine transfusion A procedure that delivers donor red blood cells to the fetus through the umbilical vein to treat severe anemia caused by HDFN. (IUTIntrauterine transfusion A procedure that delivers donor red blood cells to the fetus through the umbilical vein to treat severe anemia caused by HDFN.), a higher number of complications and treatments have been reported, according to findings from a retrospective, according to study published recently in the Journal of Clinical Medicine.
HDFN is caused by maternal 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. that are directed against fetal red blood cell 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., including 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.), ABO, Kidd, Kell, MNS, Duffy and Lewis. In spite of the utilization of routine antenatal anti-D prophylaxis, some individuals with the disorder nevertheless need to undergo IUTs.
Study method and criterion
Between January 1, 2017, and December 31, 2020, a total of 8340 newborns were hospitalized in the 1st Department of Obstetrics and Gynecology of the Medical University of Warsaw. Based on the institution’s electronic database, 274 newborns were diagnosed with HDFN. All of the medical histories of the children born from HDFN-complicated pregnancies were evaluated.
Study inclusion criteria were the performance of either a direct antiglobulin testDirect antiglobulin test A blood test used to detect antibodies attached to red blood cells. It helps confirm HDFN in newborns. or an IUT because of fetal 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. associated with HDFN. Among the 274 neonates with HDFN, 46 underwent IUT and 228 did not. Overall, 53.3% (146 of 274) of the newborns were male and 46.7% (128 of 274) of them were female. The mean gestational age was 37.33±1.85 weeks.
Read more about the testing and diagnosis of HDFN
IUT patients show higher rates of anemia, hyperbilirubinemiaHyperbilirubinemia A common cause of jaundice, this refers to higher than normal bilirubin levels in the blood.
Comparisons of laboratory results, management, and patient outcomes were conducted between the IUT-treated group and the non–IUT-treated group. Results of the study revealed that newborns who underwent IUT were more likely to have significant anemia, hyperbilirubinemia, and iron overload compared with those who did not receive IUT. Of note, this finding was indicative of a high ferritin concentration.
Hemoglobin levels were significantly lower among babies who needed IUT compared with infants in whom IUT was not performed, measured both immediately after birth and in the days that followed. In fact, the mean differences in hemoglobin concentrations in the two groups were –3.30 (95% CI, –4.10 to –2.20; P <.001) and –4.15 (95% CI, –5.20 to –3.10; P <.001), respectively.
Further, the number of newborns who needed to receive a top-up transfusion during hospitalization in the neonatal unit was statistically significantly higher in the group treated prenatally with IUT than in the group who did not undergo IUT (32.6% vs 9.2%, respectively: P <.001). Additionally, the infants treated with IUT received phototherapyPhototherapy A treatment that uses special blue light to help newborns break down bilirubin and prevent kernicterus. for a longer time period, were treated with intravenous immunoglobulinIntravenous immunoglobulin A therapy made from donated antibodies that may help reduce the mother’s immune response and protect the fetus. infusions, and underwent exchange transfusions more frequently.
“The careful management of patients with HDFN and early treatment are necessary to avoid major complications, especially in the children who receive IUT,” the authors concluded.
