Hemolytic Disease of the Newborn

ExitCare ImageHemolytic disease of the newborn (HDN) is when the red blood cells of an unborn baby (fetus) or newborn are destroyed. This breakdown of red blood cells is called hemolysis. It can lead to low amounts of red blood cells (anemia) and other problems.

CAUSES

Blood of the fetus can cross over into the pregnant woman's blood during pregnancy or labor. A difference in blood types between the mother and the fetus can cause the mother's blood to react to the blood cells of the fetus. This reaction is called being sensitized. When sensitized, the mother's blood produces antibodies (proteins that attack foreign substances) against the baby's red blood cells. In subsequent pregnancies, these antibodies can cross the placenta into the blood of the fetus. These antibodies then attack the red blood cells of the fetus causing hemolysis.

HDN can occur when the mother's blood type is O and the baby's is either A or B. It can also happen when the mother is Rh negative and the baby is Rh positive. There are other rare blood type differences that cause HDN.

HDN rarely occurs during the first pregnancy, as the mother is not usually sensitized. Medicine is given to Rh-negative pregnant women to prevent HDN in their babies. This medicine is called RhoGAM. There is no medicine that prevents HDN due to other blood types.

SYMPTOMS

Depending on how severe the HDN is, a baby may:

  • Appear pale due to anemia.

  • Appear yellow (jaundice). This is from the build up of waste products due to hemolysis.

  • Have difficulty in breathing.

  • Have swelling of the body (edema).

In mild cases, a baby may have no symptoms. The problem is found with blood testing.

DIAGNOSIS

Before birth, tests can be done on the mother's blood to check for sensitization. Ultrasound may show side effects of HDN in the fetus. Samples from the bag of water (amniotic fluid) can be tested. Blood tests on the fetus can be done.

After birth, tests can be done on blood collected from the umbilical cord and the baby to check for HDN and its side effects.

TREATMENT

Before the birth of the infant, the treatment can include:

  • Transfusion of red blood cells to treat anemia in the fetus. This is done by inserting a needle into a blood vessel in the umbilical cord. This called in utero transfusion.

  • Induction of early delivery if the fetus develops complications.

After the birth of the infant, the treatment may include:

  • Transfusion of blood to treat anemia.

  • Use of special lights to treat jaundice (phototherapy).

  • Replace the infant's blood with fresh blood (exchange transfusion). This:

  • Removes some of the mother's antibodies.

  • Treats anemia.

  • Treats jaundice.

  • Oxygen or a breathing machine (ventilator) to treat breathing problems.

  • Intravenous (in the vein 'IV') fluids to treat low blood pressure and to give fluids if the baby can not eat.

  • Medicine and extra iron to help the body make more red blood cells.

HOME CARE INSTRUCTIONS

  • Follow instructions given by your infant's caregiver.

  • Keep all follow-up appointments as directed by your infant's caregiver.

SEEK MEDICAL CARE IF:

  • Your infant's skin has new or worsening yellow color.

  • Your infant seems less active than expected.

  • Your infant is not feeding well.

  • Your baby has a rectal temperature of 100.5° F (38.1° C) or higher lasting more than a day and your baby is over age 3 months.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Your baby is 3 months old or younger with a rectal temperature of 100.4° F (38° C) or higher.

  • Your baby is older than 3 months with a rectal temperature of 102° F (38.9° C) or higher.

  • Your baby has trouble breathing. Watch for:

  • Rapid breathing.

  • Grunting sound when breathing out.

  • Sucking of the spaces between and under the ribs.

  • Flaring of the nostrils.

  • Blue color around the lips.