Search Encyclopedia. Hemolytic means breaking down of red blood cells. Erythroblastosis means making immature red blood cells. Fetalis means fetus. What causes HDN in a newborn? Which children are at risk for HDN? HDN is about 3 times more common in white babies than in African-American babies. What are the symptoms of HDN in a newborn? Symptoms can occur a bit differently in each pregnancy and child. But your healthcare provider may see the following during a prenatal test: A yellow coloring of amniotic fluid.
After birth, symptoms in your baby may include: Pale-looking skin. This is from having too few red blood cells anemia. Your newborn may have a big liver and spleen. How is HDN diagnosed in a newborn? It will be based on results from the following tests: Blood test. The following tests are used to diagnose HDN after your baby is born: Testing of your baby's umbilical cord. Testing of the baby's blood for bilirubin levels.
How is HDN treated in a newborn? During pregnancy, treatment for HDN may include the following. Intrauterine blood transfusion This test puts red blood cells into your baby's circulation. Early delivery If your baby gets certain complications, they may need to be born early. After birth, treatment may include the following. Blood transfusions This may be done if your baby has severe anemia. Intravenous fluids This may be done if your baby has low blood pressure.
Phototherapy In this test, your baby is put under a special light. Help with breathing Your baby may need oxygen, a substance in the lungs that helps keep the tiny air sacs open surfactant , or a mechanical breathing machine ventilator to breathe better.
What are possible complications of HDN in a newborn? Complications of HDN can be mild or severe. During pregnancy, your baby may have the following: Mild anemia, hyperbilirubinemia, and jaundice. After birth, your baby may have the following: Severe hyperbilirubinemia and jaundice.
What can I do to prevent hemolytic disease of the newborn? HDN happens when an Rh negative mother has a baby with an Rh positive father. Before your visit, write down questions you want answered. Know why a test or procedure is recommended and what the results could mean.
Babies can also experience a condition known as hydrops fetalis , where fluid starts to accumulate in spaces where fluid is normally not present. This includes spaces in the: abdomen heart lungs This symptom can be harmful because the extra fluid places pressure on the heart and affects its ability to pump.
What causes erythroblastosis fetalis? There are two main causes of erythroblastosis fetalis: Rh incompatibility and ABO incompatibility. Both causes are associated with blood type. Antigens are substances that trigger an immune response in your body. Rh incompatibility Rh incompatibility occurs when a Rh-negative mother is impregnated by a Rh-positive father. The result can be a Rh-positive baby. However, when the Rh-positive child is born, your body will create antibodies against the Rh factor.
These antibodies will attack the blood cells if you ever become pregnant with another Rh-positive baby. This condition is almost always less harmful or threatening to the baby than Rh incompatibility.
However, babies can carry rare antigens that can put them at risk for erythroblastosis fetalis. How is erythroblastosis fetalis diagnosed? This test is available in North America. If fetal blood is Rh negative or if MCA blood flow remains normal, pregnancy can continue to term untreated. If fetal anemia is likely, the fetus can be given intravascular intrauterine blood transfusions by a specialist at an institution equipped to care for high-risk pregnancies. Transfusions occur every 1 to 2 weeks, usually until 32 to 35 weeks.
During that time period, delivery may be recommended if there is continuing evidence of severe fetal anemia based on MCA blood flow. The woman may continue to term delivery if there is no evidence of severe fetal anemia based on MCA blood flow. Prevention involves giving the Rh-negative mother Rho D immune globulin at the following times:. Delivery should be as atraumatic as possible. Manual removal of the placenta should be avoided because it may force fetal cells into maternal circulation.
Maternal sensitization and antibody production due to Rh incompatibility can be prevented by giving the woman Rho D immune globulin. This preparation contains high titers of anti-Rh antibodies, which neutralize Rh-positive fetal RBCs. Because fetomaternal transfer and likelihood of sensitization is greatest at termination of pregnancy, the preparation is given within 72 hours after termination of each pregnancy, whether by delivery, abortion, or treatment of ectopic pregnancy.
The standard dose is mcg IM. A rosette test can be used to rule out significant fetomaternal hemorrhage, and if results are positive, a Kleihauer-Betke acid elution test can measure the amount of fetal blood in the maternal circulation. If given only after delivery or termination of pregnancy, treatment is occasionally ineffective because sensitization can occur earlier during pregnancy.
Therefore, at about 28 weeks, all pregnant women with Rh-negative blood and no known prior sensitization are given a dose of Rho D immune globulin. Some experts recommend a 2nd dose if delivery has not occurred by 40 weeks. Rho D immune globulin should also be given after any episode of vaginal bleeding and after amniocentesis or chorionic villus sampling.
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