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Frequently Asked Questions Regarding Hemolytic Disease of the Fetus and Newborn

This is a disease that often confuses many expectant parents and by better understanding the disease, many of the treatments required may be less stressful. With proper and timely treatment, the effects of the disease can often be minimized. Below are the answers to frequently asked questions concerning hemolytic disease of the fetus and newborn.

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Can red cell alloimmunization (Rh Disease) and subsequent hemolytic disease of the fetus and newborn be prevented?

Cases of Rh disease can be prevented. All Rh-negative women should receive a medication called Rhesus immune globulin after an abortion, miscarriage, or delivery of an Rh-positive infant. Rh-negative women should also routinely receive this medication during a pregnancy at 28 weeks’ gestation (7 months). Other rare times when the medication is required include tubal pregnancy (ectopic pregnancy), amniocentesis, and after automobile accidents. This medication is given as an injection in the arm or hip. If given correctly, Rhesus immune globulin is over 99% effective in preventing Rh disease. Unfortunately, the protection from this injection is not permanent. It must be given each time there is a chance for fetal red blood cells to enter your bloodstream. In some pregnancies, this may mean two or three injections for the protection.

An equivalent medication to Rhesus immune globulin is not available to protect women from forming antibodies to other red cell antigens such as Kell, Duffy, and MNS.

Does red cell alloimmunization cause repeated miscarriages?

No. Your anti-red cell antibodies do not even begin to cross to the unborn child until approximately 10 weeks’ gestation (two and a half months of pregnancy).

What is the chance my baby will survive if intrauterine transfusions are required?

Our experience indicates that 90% of babies survive intrauterine transfusions. Babies that are very sick early in pregnancy (less than 24 weeks’ or 6 months’ gestation) seem to have more problems with the first transfusion. If it is found that your baby has a very low blood count at this point in the pregnancy, your doctor may transfuse only a small amount of blood. Then you will be asked to return one or two days later to repeat the intrauterine transfusion. At the second procedure your baby would be given enough red blood cells to raise his/her blood count to normal.

When can I expect to have my baby delivered?

If all goes well, the last intrauterine transfusion would be performed at about 35 weeks’ gestation (eight months and three weeks). You may then be asked to take a medication called phenobarbital to help the baby’s liver mature more rapidly. This medication works in a similar fashion to the steroids used to help the baby’s lungs mature more rapidly. Our center has found this medication to be useful in preventing jaundice after the baby in born. The phenobarbital is given by mouth three times a day. During the first few days of taking this medication, you may experience some sleepiness. In addition, the medication may cause your baby to slow its movements. These effects will go away after several days. Delivery is usually planned for two to three weeks after the last intrauterine transfusion (37-38 weeks’ gestation).

Does having Hemolytic Disease of the Fetus/Newborn mean I will have to have a Cesarean Section?

Not necessarily. If all goes well and you are able to carry the baby to term, you should be able to have a normal vaginal delivery. Your doctor may, however, elect to induce labor.

Will my baby need special attention after he/she is born?

A neonatologist will be present at the time of your delivery. These doctors are specially trained to care for newborn infants with special problems including Hemolytic Disease of Fetus/Newborn. It is very likely that your baby will be taken to a nursery specially designed to meet his/her health needs. There, the baby will be closely monitored for any possible complications that may arise. On some occasions the baby may need additional blood transfusions to maintain his/her blood count. Because the baby is no longer attached to the placenta, he/she must now get rid of bilirubin – a yellow pigment in the bloodstream that results when red blood cells are destroyed.

Bilirubin comes in two forms. The first kind is called direct bilirubin. It is connected to a protein and although it can make the baby look jaundiced, it cannot cause any harm to the baby. The baby gets rid of its direct bilirubin through urine and through bowel movements. The second form of bilirubin is called the indirect fraction. This form is not connected to proteins. In very high levels, this type of bilirubin can pass into the baby’s brain and can cause a special type of cerebral palsy called kernicterus. For this reason, blood levels of bilirubin will be measured several times after the baby is born. Your baby may be placed under special blue lights often called bili lights or on a special blanket with blue lights (bili blanket) that reduces the amount of bilirubin being formed in the baby’s bloodstream. Occasionally, the baby may need to have an Exchange Transfusion, which means the baby’s blood is removed in small amounts, discarded, and replaced with new blood. This procedure is usually performed if the baby’s blood bilirubin level continues to rise despite the bili lights.

When will my baby get to come home?

The amount of time your baby will need to be hospitalized is variable. This depends on many different factors and can best be answered by your neonatologist. Generally, babies born to mothers with Rh disease do well but may need to be hospitalized a little longer than babies without the disease.

Will my baby require any other treatment after it comes home?

Yes. Your baby has a 50% chance of needing a Top-up Transfusion at about four to six weeks of life. This is necessary because the baby may not start making its own red blood cells until it is this old. You will be asked to have your baby see a pediatrician each week for a blood count. If your baby’s blood count becomes too low, then a top-up transfusion will be required. Generally, only one transfusion is necessary but on rare occasions, two or three transfusion may be required several weeks apart. Your pediatrician may decide to put your baby in the hospital for one or two days for each transfusion. Other pediatricians are comfortable giving the baby a blood transfusion as an outpatient.

Will my baby have any long-term problems as a result of its Hemolytic Disease of the Newborn?

Research studies to date have shown that approximately 90 to 95% of babies that survive intrauterine transfusions have no developmental problems. Five to ten percent of babies have been found to have evidence of cerebral palsy, but many times this is felt to be related to problems with prematurity itself. Studies have not shown a relationship between how sick the baby is in the womb and the chance for long-term developmental problems. Rh babies do have a slightly higher incidence of umbilical (belly button) hernias. Some of these may require surgery at a later date to be repaired.

Learn More

What is hemolytic disease of the fetus and newborn? »

Diagnosis of hemolytic disease of the fetus and newborn »

Treatment for hemolytic disease of the fetus and newborn »

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The Fetal Center at Children's Memorial Hermann Hospital
UT Professional Building
6410 Fannin, Suite 210
Houston, TX 77030

Phone:(832) 325-7288
Toll free:(888) 818-4818
Fax:(713) 383-1464