In a recent study, researchers surveyed experts in fetal medicine and hematology to develop a consensus-based set of recommendations for managing hemolytic disease of the fetus and newborn (HDFN). Findings were presented at a poster session during the Society for Maternal-Fetal Medicine 2025 Pregnancy Meeting.
The symptoms, clinical presentation and complications of HDFN can vary from case to case. Therefore, it is important to develop a set of workflows that accounts for this variability and reduces morbidity. “These workflows are intended to enhance clinical practice, improve outcomes, and facilitate future research,” the authors wrote.
The study utilized the Delphi technique, a method used to quantify levels of consensus. A global panel of experts was selected by examining level of expertise, affiliations and publications in the field. Consensus was defined as at least 70% agreement for a given guideline.
The questionnaire was administered in two rounds, allowing panel members to adjust their opinions on the basis of other expert opinions. The first round included 107 participants, while the second round included 100 participants.
Read more about HDFN treatment and care
The panel agreed on the use of cell-free DNA (DNA fragments found outside cells) to determine the antigen status of the fetus. For individuals who had a prior pregnancy requiring a uterine transfusion before 24 weeks gestation or resulting in fetal death due to HDFN, 70% of the panel members recommended administration of maternal intravenous immunoglobulin.
During the postnatal period, 92% of experts agreed that neonates should be monitored for anemia before discharge from the hospital, while 84% agreed that bloodwork should be repeated in the week after discharge for pregnancies that required an intrauterine transfusion.
The panel also agreed that exchange transfusions should be conducted in hospitals with adequate experience, whenever possible (96% consensus). Additionally, 92% of participants agreed that following discharge from the hospital, transfusion should be considered when hemoglobin levels drop below 7g/dL.
In terms of monitoring patients, 96% of panelists agreed that infants with HDFN should be followed for the first two to three months of life for symptom recurrence.
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