Overview
Neonatal hemolytic disease is a homozygous immune disorder resulting from a blood group incompatibility between the mother and the fetus, and can develop in the early fetal and neonatal stages. When the fetus inherits a dominant antigen from the father that the mother lacks, this antigen enters the mother’s body through pregnancy and delivery and stimulates her to produce immune antibodies. When this antibody enters the fetal bloodstream through the placenta, it can cause coagulation and destruction of the red blood cells, causing immune hemolysis in the fetus or newborn. This does not affect the pregnant woman, but the sick child may die due to severe anemia and heart failure, or die due to kernicterus caused by the infiltration of large amounts of bilirubin into the brain cells, and even if it survives, its nerve cells and mental development as well as motor function will be affected.
Causes
There are two main types of maternal and child blood group incompatibility, ABO and Rh. Other systems such as MN can also cause this disease, but it is very rare.
In the ABO blood group system, the pregnant woman is mostly type O, while the father and the fetus are type A, B or AB. There are 6 antigens in Rh blood group, namely C, c, D, d, E and e. Among them, D antigen is the strongest. The highest rate of hemolysis is caused by
Symptoms
In mild cases, there are no special symptoms, but in severe cases of hemolysis, fetal edema, abortion, premature birth and even stillbirth may occur. After delivery, the main symptoms are anemia, edema, hepatosplenomegaly, jaundice and kernicterus. The severity of symptoms depends on the amount of antibodies, maturity of the newborn and compensatory hematopoietic capacity.
Examination
The main reliance is on laboratory tests for specific antibodies.
Pregnant women should be routinely checked for blood type before delivery, and those whose husband is type O and whose husband is type A, B or AB should be examined for specific antibodies.
After 36 weeks of pregnancy, amniotic fluid bilirubin content >0.2mg% indicates fetal hemolytic damage.
Treatment
(A) Treatment during pregnancy.
1.Comprehensive therapy.
2.Chinese medicine.
Decoction of Artemisia insipidus soup (9g of Insipidus, 4.5g of Radix et Rhubarb, 9g of Scutellariae, 6g of Glycyrrhiza glabra) once daily until delivery.
3. Induction of labor.
(B) Treatment at delivery.
Strive for natural delivery and avoid using sedation and anesthetics to avoid increasing the chance of fetal infant asphyxia. Make good preparation for neonatal resuscitation. Break the umbilical cord immediately after delivery to reduce the antibodies entering the child’s body, and leave the umbilical cord about 10cm long for drug injection or blood exchange if necessary. Immediately after birth, inject 25% glucose 10ml, vitamin C 100mg, Niclosamide 125mg and/or hydrocortisone 25mg into the umbilical vein, and keep the umbilical cord blood on the placenta side for blood type, bilirubin, special antibody determination, red blood cell, hemoglobin and nucleated red blood cell examination, etc.
(C) Neonatal management.
1. Drug therapy.
(1) Hormone, plasma and glucose combination therapy.
(2) Phenobarbital.
(3) Chinese medicine San Huang Tang.
2.Light therapy.
3.Change therapy. For those with clear prenatal diagnosis, obvious symptoms and signs after birth of the fetus, and those who continue to rise in bilirubin close to 18mg% after treatment, consider blood exchange.