Learn About Hemolytic Disease of the Newborn

What is the definition of Hemolytic Disease of the Newborn?

Hemolytic disease of the newborn (HDN) is a blood disorder in a fetus or newborn infant. In some infants, it can be fatal.

Normally, red blood cells (RBCs) last for about 120 days in the body. In this disorder, RBCs in the blood are destroyed quickly and thus do not last as long.

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What are the alternative names for Hemolytic Disease of the Newborn?

Hemolytic disease of the fetus and newborn (HDFN); Erythroblastosis fetalis; Anemia - HDN; Blood incompatibility - HDN; ABO incompatibility - HDN; Rh incompatibility - HDN

What are the causes of Hemolytic Disease of the Newborn?

During pregnancy, RBCs from the unborn baby can cross into the mother's blood through the placenta. HDN occurs when the immune system of the mother sees a baby's RBCs as foreign. Antibodies then develop against the baby's RBCs. These antibodies attack the RBCs in the baby's blood and cause them to break down too early.

HDN may develop when a mother and her unborn baby have different blood types. The types are based on small substances (antigens) on the surface of the blood cells.

There is more than one way in which the unborn baby's blood type may not match the mother's.

  • A, B, AB, and O are the 4 major blood group antigens or types. This is the most common form of a mismatch. In most cases, this is not very severe.
  • Rh is short for the "rhesus" antigen or blood type. People are either positive or negative for this antigen. If the mother is Rh-negative and the baby in the womb has Rh-positive cells, her antibodies to the Rh antigen can cross the placenta and cause very severe anemia in the baby. It can be prevented in most cases.
  • There are other, much less common, types of mismatch between minor blood group antigens. Some of these can also cause severe problems.
What are the symptoms of Hemolytic Disease of the Newborn?

HDN can destroy the newborn baby's blood cells very quickly, which can cause symptoms such as:

  • Edema (swelling under the surface of the skin)
  • Newborn jaundice which occurs sooner and is more severe than normal
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What are the current treatments for Hemolytic Disease of the Newborn?

Infants with HDN may be treated with:

  • Feeding often and receiving extra fluids.
  • Light therapy (phototherapy) using special blue lights to convert bilirubin into a form which is easier for the baby's body to get rid of.
  • Antibodies (intravenous immunoglobulin, or IVIG) to help protect the baby's red cells from being destroyed.
  • Medicines to raise blood pressure if it drops too low.
  • In severe cases, an exchange transfusion may need to be performed. This involves removing a large amount of the baby's blood, and thus the extra bilirubin and antibodies. Fresh donor blood is infused.
  • Simple transfusion (without exchange). This may need to be repeated after the baby goes home from the hospital.
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What is the outlook (prognosis) for Hemolytic Disease of the Newborn?

The severity of this condition can vary. Some babies have no symptoms. In other cases, problems such as hydrops can cause the baby to die before, or shortly after, birth. Severe HDN may be treated before birth by intrauterine blood transfusions.

How do I prevent Hemolytic Disease of the Newborn?

The most severe form of this disease, which is caused by Rh incompatibility, can be prevented if the mother is tested during pregnancy. If needed, she is given a shot of a medicine called RhoGAM at certain times during and after her pregnancy. If you have had a baby with this disease, talk with your health care provider if you plan to have another baby.

Intrauterine transfusion
Antibodies
What are the latest Hemolytic Disease of the Newborn Clinical Trials?
A Multicenter, Prospective Observational Study to Characterize the Clinical Course of Pregnant Women and Children at High Risk for Early Onset Severe Hemolytic Disease of the Fetus and Newborn

Summary: The primary purpose of the study is to characterize the current standard of care, clinical course, and outcomes of pregnant women and their offspring at high risk for early onset severe hemolytic disease of the fetus and newborn (EOS-HDFN).

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Neonatal Alloantibodies in Cord Blood for Early Detection of Hemolytic Disease of Newborn

Summary: To evaluate the diagnostic efficiency of antibodies screening in cord blood for detection of HDN. To help finding the antigen negative blood in a timely manner and reduce the morbidities and mortalities of HDN

What are the Latest Advances for Hemolytic Disease of the Newborn?
Neurodevelopmental outcome after antenatal therapy for fetal supraventricular tachyarrhythmia: 3-year follow-up of multicenter trial.
Clinical features and outcomes of congenital chylothorax: a single tertiary medical center experience in China.
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Intravenous immunoglobulin in hemolytic disease of the newborn: A moving target in time.
Who are the sources who wrote this article ?

Published Date: November 09, 2021
Published By: Kimberly G. Lee, MD, MSc, IBCLC, Clinical Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What are the references for this article ?

Josephson CD, Sloan SR. Pediatric transfusion medicine. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 121.

Niss O, Ware RE. Blood disorders. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 124.

Simmons PM, Magann EF. Immune and non-immune hydrops fetalis. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 23.