A team of Canadian medical experts arrived at a consensus on various aspects hemolytic disease of the fetus and newborn (HDFN) care, encompassing testing, treatment and surveillance. These findings were recently published in the Journal of Obstetrics and Gynaecology Canada.
While guidelines in Canada exist for the management of HDFN, some aspects of care have received less attention, such as the indication and timing of relevant tests. This has led to variability in clinical practice, possibly resulting in a variability of patient outcomes.
A team of 46 medical experts formed a panel in an attempt to reach a consensus on a number of matters important to HDFN care. This is known as the modified Delphi process, a technique used to guide experts to achieve consensus on a specific subject through a robust series of surveys. This process involves a number of rounds in which participants ranked their agreement on a given statement from a scale of 1 to 5.
A total of 44 statements achieved consensus. For routine care, prenatal testing for antibodies that can cause HDFN should ideally be conducted between 11 and 14 weeks of gestation. Rhesus immunoglobulin is recommended in Rhesus D-negative pregnancies of which antibodies other than anti-D are detected. A Rhesus D-positive newborn with a Rhesus D-positive mother should be administered Rhesus immunoglobulin within 72 hours of delivery.
Read more about HDFN testing and diagnosis
The expert panel agreed that communication between healthcare providers across the obstetric, neonatal and transfusion teams is important for pregnancies at risk of HDFN. In addition, maternal fetal medicine consultation is advised for all pregnancies at risk of HDFN due to the presence of clinically significant antibodies. Doctors should perform cord blood sample collection and testing in all newborns delivered from mothers suspected to be at risk of HDFN. If the newborn requires blood transfusions, a sample of the newborn’s blood or that of the newborn’s mother should be used to screen for relevant antibodies.
“In conclusion, the Delphi technique enabled the establishment of national expert consensus on prenatal, postnatal and neonatal immunohematology testing,” the study concluded. “These aspirational statements encourage care providers and laboratories to choose the best options when possible.”
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