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MANAGEMENT OF THE SENSITIZED NEONATE
Category: Child Health
Abstract : Management of the sensitized neonate Mild hemolytic disease accounts for 50%
of newborns with positive DAT results. Most of these newborns have no anemia
(cord Hb >14 g/dL) and minimal hemolysis (cord bilirubin <4 mg/dL). Apart
from early phototherapy, they require no transfusions. However, these newborns
are at risk of developing severe late anemia with low reticulocyte count by
Management of the sensitized neonate
Mild hemolytic disease accounts for 50%
of newborns with positive DAT results. Most of these newborns have no anemia
(cord Hb >14 g/dL) and minimal hemolysis (cord bilirubin <4 mg/dL). Apart
from early phototherapy, they require no transfusions. However, these newborns
are at risk of developing severe late anemia with low reticulocyte count by 3-6
weeks of life.
Therefore, monitoring their Hb levels after hospital discharge is
important.
Moderate hemolytic disease accounts for approximately 25% of
affected neonates. Moderate HDN is characterized by moderate anemia and
increased cord bilirubin levels. These infants clinically are not jaundiced at
birth but develop rapid unconjugated hyperbilirubinemia in the first 24 hours of
life. Peripheral smear shows numerous nucleated RBCs, decreased platelets, and,
occasionally, a large number of immature granulocytes. These newborns often have
hepatosplenomegaly and are at risk of developing bilirubin encephalopathy
without adequate treatment. Early exchange transfusion with type-O Rh-negative
fresh RBCs with intensive phototherapy is usually required. These newborns also
are at risk of developing late hyporegenerative anemia of infancy at 6 weeks of
life.
Severe hemolytic disease accounts for the remaining 25% of the
alloimmunized newborns who are either stillborn or hydropic at birth. The
hydrops fetalis is predominantly caused by a capillary leak syndrome due to
tissue hypoxia, hypoalbuminemia secondary to hepatic dysfunction, and
high-output cardiac failure from anemia. About half of these fetuses become
hydropic before 34 weeks' gestation and need intensive monitoring and management
of alloimmunized gestation as described earlier.
A previous history of
neonatal hemolytic disease and rising maternal titers prompts a fetal blood
sampling to establish the fetal blood type by direct cordocentesis (PUBS).
Alternatively, Rh genotype can be determined by polymerase chain reaction
technique using amniocytes or chorionic villus samples. No further monitoring is
necessary if the fetus is Rh negative.
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