Learn The BasicsThere are many ways in which hemolytic disease of the fetus and newborn (HDFN) can be treated. These include preventative treatments, treatments in utero and treatments after the baby is born.
Prevention of HDFN
HDFN occurs when the pregnant mother’s immune system attacks her baby’s red blood cells. If 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. working against the baby’s red blood cells are detected in the bloodstream of the mother, she should be regularly be monitored throughout her pregnancy.
In most cases, the disease is caused by 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. incompatibility, in which Rh-D 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. are present in the blood of the baby but not in that of the mother, triggering the mother’s body to produce antibodies against them. So, mothers who are Rh-negativeRh-Negative A blood type trait that means your red blood cells lack the Rh(D) antigen. are often given an anti-D injection, unless the baby’s biological father is also Rh-negative and there is no risk of the baby being Rh-positiveRh-Positive A blood type trait that means your red blood cells have the Rh(D) antigen..
Prenatal treatment
When 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. is severe, an intrauterine blood transfusion may be necessary. This provides the baby with new red blood cells. The treatment involves the insertion of a needle into a vein in the umbilical cord so the blood can be delivered to the baby.
In some cases, the baby may be delivered early, as babies with severe anemia may not tolerate labor well.
Postnatal treatment
The treatment of HDFN after birth includes phototherapyPhototherapy A treatment that uses special blue light to help newborns break down bilirubin and prevent kernicterus., intravenous fluids, intravenous immunoglobulinIntravenous immunoglobulin A therapy made from donated antibodies that may help reduce the mother’s immune response and protect the fetus. (IVIGIntravenous immunoglobulin A therapy made from donated antibodies that may help reduce the mother’s immune response and protect the fetus.) and exchange transfusion. All of these treatments attempt to reduce the levels of bilirubinBilirubin A yellow substance produced when red blood cells break down. High bilirubin levels in newborns with HDFN can cause jaundice or, in severe cases, brain damage.—a byproduct of the breakdown of red blood cells, which can cause long-term neurological damage—from the baby’s body.
A normal blood transfusion may also be needed if the baby has severe anemia.
Phototherapy
Here, the newborn is placed under special lights to help remove extra bilirubin from their body.
Intravenous fluids
These can also help remove extra bilirubin as well as allow the baby’s body to stay hydrated.
IVIG
Intravenous immunoglobulin (IVIG) comes from donor blood and can help prevent the destruction of red blood cells, thereby lowering bilirubin levels.
Exchange transfusion
In this treatment, some of the baby’s blood is removed and replaced with donor blood to normalize the levels of bilirubin.
Actions to take for multiple pregnancies
If a baby is Rh-D-positive and the mother is Rh-D-negative, an anti-D immunoglobulinIntravenous immunoglobulin A therapy made from donated antibodies that may help reduce the mother’s immune response and protect the fetus. injection will often be given to the mother within 72 hours after birth.
This will destroy Rh-D-positive blood cells that may have crossed over from the baby to the mother and stop the mother’s body from producing antibodies, significantly reducing the risk of HDFN in future pregnancies.
Treating comorbidities
A baby born with HDFN is usually cared for in the neonatal intensive care unit. They may require assistance with breathing, including oxygen, artificial surfactant and mechanical ventilation.
Emerging treatments
Nipocalimab is a potential new treatment under investigation that could reduce levels of circulating antibodies associated with HDFN. It is a monoclonal antibodyAntibody 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 is injected into the mother’s bloodstream and could benefit pregnant women who are at high risk of having a baby affected by HDFN.
The treatment is thought to selectively block the neonatal Fc receptor, thereby reducing levels of circulating immunoglobulin G (IgG) antibodies that attack the baby’s red blood cells.
Reviewed by Hasan Avcu, M.D., on September 22, 2023.
