Hemolytic disease of the newborn: from prevention to treatment, all-round protection of baby's health

Author: Zhong Yan, Chief Physician, Beijing Children's Hospital, Capital Medical University

Reviewer: Meihua Park, Chief Physician, Peking University Third Hospital

Hemolytic disease of the newborn, an immune disease caused by blood type incompatibility between mother and fetus, often leads to serious consequences such as neonatal jaundice, anemia, and even bilirubin encephalopathy. It is one of the common emergencies in the neonatal department.

Therefore, understanding the relevant knowledge about hemolytic disease of the newborn is of great significance for early identification, timely treatment and effective prevention.

The occurrence of hemolytic disease of the newborn is mainly due to blood type incompatibility between mother and baby. Among them, ABO blood type incompatibility and Rh blood type incompatibility are the two most common types. In ABO blood type incompatibility, if the mother is type O and the fetus is type A or type B, hemolysis may occur; and in Rh blood type incompatibility, if the mother is Rh negative and the fetus is Rh positive, the risk of hemolysis increases significantly.

For families at risk of blood type incompatibility, jaundice should be closely monitored after the birth of the newborn. Jaundice appears early, progresses rapidly and is severe, which is a typical manifestation of neonatal hemolytic disease. In addition, by testing hemoglobin, reticulocyte and bilirubin levels, combined with anti-human globulin tests, it can be further clarified whether hemolysis occurs. It is worth noting that even if hemolysis does not occur in the first pregnancy, there is still a risk of hemolysis in the second pregnancy.

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The principle of treatment for neonatal hemolytic disease is to quickly reduce bilirubin levels and prevent the occurrence of hyperbilirubinemia and bilirubin encephalopathy. The main treatment methods include phototherapy, exchange transfusion therapy, blood transfusion therapy, and drug-assisted therapy.

Phototherapy: As the most commonly used and safe treatment method, phototherapy uses light of a specific wavelength to promote the conversion and excretion of unconjugated bilirubin, effectively reducing bilirubin levels. During treatment, single-sided or double-sided phototherapy should be selected according to the specific situation of the child, and attention should be paid to protecting the eyes and genitals, monitoring body temperature, vital signs and bilirubin levels, and adjusting the treatment plan in a timely manner.

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Exchange transfusion therapy: For children with severe hyperbilirubinemia, exchange transfusion therapy is the fastest and most effective treatment. By extracting part of the child's blood and transfusing fresh blood, sensitized red blood cells, immune antibodies and bilirubin are replaced, thereby reducing the bilirubin level and avoiding the occurrence of bilirubin encephalopathy. The exchange transfusion process must strictly follow the indications to ensure safe operation.

Blood transfusion therapy: For children with anemia caused by hemolysis, blood transfusion therapy is required if the anemia is severe and affects growth and development or is accompanied by heart failure. Blood without antigens and antibodies that cause re-hemolysis should be selected to ensure the safety of blood transfusion.

Drug-assisted treatment: Intravenous injection of immunoglobulin and albumin is also an important means of treating neonatal hemolytic disease. Immunoglobulin can bind to Fc receptors to block the hemolytic process; albumin can bind to free bilirubin, reduce the amount of bilirubin passing through the blood-brain barrier, and prevent the occurrence of bilirubin encephalopathy.

Although hemolytic disease of the newborn cannot be completely prevented, there are certain preventive measures for hemolysis caused by Rh blood incompatibility. Mothers with Rh-negative blood can be injected with anti-D immunoglobulin within 72 hours after giving birth to a fetus with Rh-positive blood to neutralize the D antigen that enters the mother's body and avoid hemolysis during the next pregnancy. However, there is currently no effective prevention method for hemolysis caused by ABO blood incompatibility and other Rh blood system incompatibility.

Therefore, strengthening prenatal education and screening, raising awareness of hemolytic disease of the newborn among parents and medical staff, and achieving early detection, early diagnosis, and early treatment are the keys to reducing the harm of hemolytic disease of the newborn. At the same time, timely and effective treatment should be given to children who have already developed hemolysis to avoid the occurrence of serious complications such as bilirubin encephalopathy and ensure the healthy growth of newborns.