Hemolytic disease of the newborn is also called erythroblastosis fetalis. This condition occurs when there is an incompatibility between the blood types of the mother and baby. Show
HDN most frequently occurs when an Rh negative mother has a baby with an Rh positive father. When the baby's Rh factor is positive, like the father's, problems can develop if the baby's red blood cells cross to the Rh negative mother. This usually happens at delivery when the placenta detaches. However, it may also happen anytime blood cells of the two circulations mix, such as during a miscarriage or abortion, with a fall, or during an invasive prenatal testing procedure (such as an amniocentesis or chorionic villus sampling). The mother's immune system sees the baby's Rh positive red blood cells as "foreign." Just as when bacteria invade the body, the immune system responds by developing antibodies to fight and destroy these foreign cells. The mother's immune system then keeps the antibodies in case the foreign cells appear again, even in a future pregnancy. The mother is now "Rh sensitized." In a first pregnancy, Rh sensitization is not likely. Usually, it only becomes a problem in a future pregnancy with another Rh positive baby. During that pregnancy, the mother's antibodies cross the placenta to fight the Rh positive cells in the baby's body. As the antibodies destroy the red blood cells, the baby can become sick. This is called erythroblastosis fetalis during pregnancy. In the newborn, the condition is called hemolytic disease of the newborn. Babies affected by HDN are usually in a mother's second or higher pregnancy, after she has become sensitized with a first baby. HDN due to Rh incompatibility is about three times more likely in Caucasian babies than African-American babies. When the mother's antibodies attack the red blood cells, they are broken down and destroyed (hemolysis). This makes the baby anemic. Anemia is dangerous because it limits the ability of the blood to carry oxygen to the baby's organs and tissues. As a result:
Complications of hemolytic disease of the newborn can range from mild to severe. The following are some of the problems that can result: During pregnancy:
After birth:
The following are the most common symptoms of hemolytic disease of the newborn. However, each baby may experience symptoms differently. During pregnancy symptoms may include:
After birth, symptoms may include:
Because anemia, hyperbilirubinemia, and hydrops fetalis can occur with other diseases and conditions, the accurate diagnosis of HDN depends on determining if there is a blood group or blood type incompatibility. Sometimes, the diagnosis can be made during pregnancy based on information from the following tests:
Once a baby is born, diagnostic tests for HDN may include the following:
Once HDN is diagnosed, treatment may be needed. Specific treatment for hemolytic disease of the newborn will be determined by your baby's doctor based on:
During pregnancy, treatment for HDN may include:
After birth, treatment may include:
Fortunately, HDN is a very preventable disease. Because of the advances in prenatal care, nearly all women with Rh negative blood are identified in early pregnancy by blood testing. If a mother is Rh negative and has not been sensitized, she is usually given a drug called Rh immunoglobulin (RhIg), also known as RhoGAM. This is a specially developed blood product that can prevent an Rh negative mother's antibodies from being able to react to Rh positive cells. Many women are given RhoGAM around the 28th week of pregnancy. After the baby is born, a woman should receive a second dose of the drug within 72 hours, if her baby is Rh positive. If her baby is Rh negative, she does not need another dose. Which medication class may cause kernicterus in neonates?Sulfonamides and medications that are highly bound to plasma protein (e.g., ceftriaxone) are contraindicated in neonates because they can displace bilirubin, which may cause kernicterus.
Which is the reason drug toxicity is more likely to occur in the neonate?Higher concentrations of drug in the brain are more likely in neonates than in children and adults due to decreased protein binding, a higher relative brain weight, and higher ratio of cerebral to systemic blood flow (24).
Which drugs are contraindicated in pediatrics?Aspirin. Not recommended for: Children younger than 18 years old. ... . Ibuprofen. Not recommended for: Babies younger than 6 months old. ... . Prescription Codeine Cough Medicines. Not recommended for: Children younger than 12 years old. ... . Diphenhydramine. ... . Loperamide. ... . Xylometazoline Nasal Drops. ... . Benzocaine Teething Gels. ... . Senna glycosides.. Why are infants at risk for drug toxicity?Infants are at higher risk of toxicity via skin absorption due to a larger surface area to volume ratio and they also absorb more of a drug across skin due to their thinner stratum corneum.
|