Neonatal management and outcome in alloimmune hemolytic disease
Open Access
- 25 May 2017
- journal article
- review article
- Published by Informa UK Limited in Expert Review of Hematology
- Vol. 10 (7), 607-616
- https://doi.org/10.1080/17474086.2017.1331124
Abstract
Hemolytic disease of the fetus and newborn (HDFN) occurs when fetal and neonatal erythroid cells are destroyed by maternal erythrocyte alloantibodies, it leads to anemia and hydrops in the fetus, and hyperbilirubinemia and kernicterus in the newborn. Postnatal care consists of intensive phototherapy and exchange transfusions to treat severe hyperbilirubinemia and top-up transfusions to treat early and late anemia. Other postnatal complications have been reported such as thrombocytopenia, iron overload and cholestasis requiring specific management. Areas covered: This review focusses on the current neonatal management and outcome of hemolytic disease and discusses postnatal treatment options as well as literature on long-term neurodevelopmental outcome. Expert commentary: Despite major advances in neonatal management, multiple issues have to be addressed to optimize postnatal management and completely eradicate kernicterus. Except for strict adherence to guidelines, improvement could be achieved by clarifying the epidemiology and pathophysiology of HDFN. Several pharmacotherapeutic agents should be further researched as alternative treatment options in hyperbilirubinemia, including immunoglobulins, albumin, phenobarbital, metalloporphyrins, zinc, clofibrate and prebiotics. Larger trials are warranted to evaluate EPO, folate and vitamin E in neonates. Long-term follow-up studies are needed in HDFN, especially on thrombocytopenia, iron overload and cholestasis.Keywords
This publication has 84 references indexed in Scilit:
- Haemolytic disease of the fetus and newbornVox Sanguinis, 2015
- The clinical syndrome of bilirubin-induced neurologic dysfunctionSeminars in Fetal and Neonatal Medicine, 2015
- Associations of Rhesus and non-Rhesus maternal red blood cell alloimmunization with stillbirth and preterm birthInternational Journal of Epidemiology, 2014
- Management of red cell alloimmunisation in pregnancy: the non‐invasive monitoring of the diseasePrenatal Diagnosis, 2010
- Fetal anemia due to non-Rhesus-D red-cell alloimmunizationSeminars in Fetal and Neonatal Medicine, 2008
- One single dose of 200 μg of antenatal RhIG halves the risk of anti‐D immunization and hemolytic disease of the fetus and newborn in the next pregnancyTransfusion, 2008
- Hyperbilirubinemia and KernicterusClinics in Perinatology, 2006
- Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of GestationPediatrics, 2004
- Thirty‐five years of Rh prophylaxisTransfusion, 2003
- RhD haemolytic disease of the fetus and the newbornBlood Reviews, 2000