Pregnancies in which the mother is alloimmunized against the Rh antigen in red blood cells are at higher risk of hemolytic disease of the fetus and newborn (HDFN), and it appears that infants born of alloimmunized mothers also have a higher risk of brain lesions, such as intraventricular hemorrhage (IVH) and periventricular leukomalacia. (PVL), according to a recently published study in Indian Pediatrics.
HDFN consists of antibody-mediated destruction of fetal red blood cells before and after birth; the typical clinical manifestations associated with the condition include anemia, which causes difficulties in the oxygen supply to vital organs, and excessive indirect bilirubin levels (hyperbilirubinemia), which causes yellowish coloration of the skin and annexes known as jaundice and can also lead to permanent neurological damage (kernicterus).
Mainly due to anemia, fetuses most often undergo intrauterine blood transfusions (IUTs); this is an invasive procedure associated with complications such as infection, maternal hemorrhage and early delivery. There are, however, other less-known complications associated with IUTs. PVL and IVH, for example, have been reported to affect between 30% and 50% of cases.
PVL is the death of white matter cells that communicate the brain with the spinal cord. It can lead to clinical manifestations such as brain palsy that are only noticeable months after birth. IVH is bleeding in the fluid-filled ventricles of the brain that can lead to complications such as brain palsy and neurodevelopmental abnormalities.
The authors aimed to assess the frequency of IG and PVl in infants born of all immunized pregnancies using neuro sonography to detect both complications. The authors used a sample of 71 infants born of alloimmunized pregnancies between 2022 and 2020, over 40% of which underwent IUT.
Results showed that 38% of infants had either IVH, PVL, or both. Except for one case, all IVLs and PVLs were mild. The authors observed both complications were equally common in infants who received IUTs and those who didn’t.
Researchers detected specific risk factors that significantly increased the risk of both complications, namely, severe infection (sepsis), lower gestational age at the moment of IUT, and small size for gestational age.
The study does not describe the long-term complications associated with the neuro-sonographic findings.
“Further larger studies beginning from the fetal period (to determine the timing of occurrence) are required to estimate the true incidence and predictors for cranial abnormalities,” the authors wrote.” Long-term follow-ups to determine the association of the milder abnormalities with neurodevelopmental outcomes would be invaluable.”
