Due to the increased interest from many pregnant women, we will explain what this condition is.
Hemolytic disease of the newborn is due to immune conflict between mother and fetus due to Rhesus (Rh) antigenic incompatibility. The main antigen in the Rh system is the D antigen. In RhD (-) mother and RhD (+) fetus, anti-Rh (anti-D) IgG class antibodies are produced in the mother’s organism, which pass through the placenta in the fetus and cause tissue hemolysis.
What is the clinical picture of hemolytic disease of the newborn?
The first pregnancy usually occurs without an immune conflict, but with each subsequent pregnancy, the titer (number) of antibodies in the mother increases, immune hemolysis occurs in the child’s body. The severe form can cause intrauterine (intrauterine) death of the fetus (feto-placental anazarka), in other cases, variously expressed jaundice (jaundice) and anemia appear hours after birth. Hepatosplenomegaly (enlargement of the liver) is established. In very severe jaundice, the basal and central nuclei of the brain are irreversibly damaged by deposition of bilirubin in them (nuclear jaundice). The newborn is in serious condition with neurological symptoms and difficulty breathing. If he survives, the child is left with permanent defects in his physical and mental development.
What is the treatment for hemolytic disease of the newborn?
1. Treatment of the fetus:
- Intrauterine fetal transfusions;
- Childbirth – depends on how advanced the pregnancy is;
- Immunomodulation – this includes the administration of intravenous immunoglobulins, plasmapheresis combined with immunoglobulins, glucocorticoids.
2. Treatment of the newborn:
Phototherapy and volume transfusion are the main methods of treatment.
- Exchange transfusions – in this way, damaged erythrocytes, bilirubin and free maternal antibodies are exchanged in the plasma, anemia is corrected;
- Phototherapy – it is the main treatment for hyperbilirubinemia in order to prevent bilirubin neurotoxicity.
- Other methods of treatment – there are preliminary reports of administration of high doses of immunoglobulin in order to reduce the level of bilirubin and reduce the need for exchange blood transfusion in this disease.
In order to avoid this condition of pregnant women, already at the beginning of pregnancy, a blood group is made. If the blood group is Rh D/-/, additional tests for erythroantibodies are prescribed. When such are detected, their titer is tracked. The immunohematological follow-up of every pregnant woman is carried out when the pregnancy is registered – 10-16 weeks of gestation and in the period 28-34 weeks of gestation.
At delivery, every RhD/-/ woman is scheduled for maternal and infant testing. If they are negative, the woman is given prophylaxis with anti-D gammaglobulin. This is aimed at preventing the mother from being immunized and having no problems with subsequent pregnancies.