Hemolytic Disease of the Newborn (HDN)
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Hemolytic disease of the newborn (HDN) is one of the central causes of miscarriage and infants’ mortality. The emergence of this disease depends on the compatibility of the fetus and mother's blood, and modern medicine develops and implements the new ways and methods to fight against HDN.
In 1609, the French midwife described the first HDN case, and the next 300 years people faced similar cases of newborns’ deaths (NSB). According to Lee (2013), “Hemolytic disease of the newborn (HDN) is a blood disorder in a fetus or newborn infant.” Additionally, it can be called erythroblastosis fetalis. It means breaking down red blood cells and production of immature red blood cells of a fetus (Stanford Children’s Health, 2016).
When a father and a mother of a baby have different Ph factors, their infant can have the hemolytic disease of the newborn. It mostly happens at delivery during the placenta separation. However, it is possible at any other events when the mother and newborn’s blood mixes (while an abortion, miscarriage, chorionic villus sampling or amniocentesis). The immune system of a mother sees Rh-positive red blood cells of the baby as ‘foreign’ (Stanford Children’s Health, 2016). It makes and keeps the antibodies using them against the foreign cells of future pregnancy. In addition, such a mother is called ‘Rh sensitized’. Hence, Rh sensitization is not possible during the first pregnancy.
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The antibodies of the mother attack the red blood cells resulting in their breaking down and destruction (hemolysis). It causes anemia that has a rather negative impact on the baby’s health. Moreover, the baby’s organism tries to make more red cells in the spleen, liver and bone marrow. As a result, these organs are increasing in size. Additionally, red blood cell destruction causes the formation of bilirubin, and it builds up in the blood and other fluids and tissues of the newborn’s body (Stanford Children’s Health, 2016).
It is the reason for hyperbilirubinemia and jaundice. Furthermore, another result of HDN during pregnancy is hydrops fetalis caused by anemia (Stanford Children’s Health, 2016). Therefore, after birth, the infant can have severe jaundice and kernicterus that is the result of hyperbilirubinemia as well; however, bilirubin accumulates in a brain causing deafness, seizures, brain damage, and death.
The most common symptoms of HDN appear during pregnancy and the postpartum period. Amniocentesis causes a yellow color of the amniotic fluid and the bilirubin presence. Moreover, the fetus ultrasound shows enlarged spleen, liver, heart, and fluid buildup in the abdomen, scalp of a fetus, and the area around the lungs (Dean, 2005). Additionally, symptoms after birth include a pale coloring of skin (anemia results), yellow color of an umbilical cord, amniotic fluid, eyes, and skin (results of jaundice). Moreover, babies can have enlarged spleen and liver. Particularly, hydrops fetalis newborns can suffer from the severe edema of the entire body, extremely pale skin, and difficulty in breathing.
The Treatment of Hemolytic Disease of the Newborn
The treatment of hemolytic disease of the newborn depends on the medical history, overall health, and gestational age of the baby. Moreover, a doctor should consider the disease extent, tolerance for procedures, medications, and therapies. The treatment during the pregnancy includes “intrauterine blood transfusion of red blood cells into the baby's circulation” (Stanford Children’s Health, 2016).
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The treatment after birth includes blood transfusions because of severe anemia and intravenous fluids caused by low blood pressure. Moreover, to relieve the respiratory distress, physicians use the surfactant, oxygen, and a mechanical breathing machine. Additionally, doctors can use exchange transfusion for the bilirubin level decrease or intravenous immunoglobin (IVIG) to reduce red blood cell breakdown and the level of bilirubin (Stanford Children’s Health, 2016).
In conclusion, the hemolytic disease in the newborn (HDN) was the main reason for newborns’ mortality level. However, modern medicine is successfully fighting such diagnosis and constantly improves different ways and methods for its treatment.