Hemolytic Disease of the Newborn Treatment
Dec 16, 2020
Source: Cainiu Health
Dr. Wang Qiuyue
Introduction
1. Pharmacological therapy: Intravenous immunoglobulin (IVIG) is administered to block Fc receptors on mononuclear phagocytic system cells, thereby inhibiting phagocytic destruction of antibody-sensitized red blood cells and reducing serum bilirubin levels.
2. Phototherapy: Typically, intermittent phototherapy for 2–3 days gradually resolves jaundice.
3. Exchange transfusion: This procedure prevents bilirubin from crossing the blood-brain barrier and damaging neurons, thereby preventing kernicterus.
Hemolytic disease of the newborn (HDN) is an alloimmune hemolytic reaction caused by ABO or Rh blood group incompatibility between mother and fetus. Treatment primarily consists of the following three approaches:
1. Pharmacotherapy: Intravenous immunoglobulin (IVIG) is administered to block Fc receptors on mononuclear phagocytic system cells, thereby inhibiting phagocytosis of antibody-sensitized red blood cells and reducing serum bilirubin levels.
2. Phototherapy: Blue-light phototherapy is safe and effective. Blue light converts water-insoluble, lipid-soluble unconjugated bilirubin into water-soluble isomers that can be excreted via bile or urine, thereby lowering serum bilirubin concentrations. Currently, we use cold-source blue-light units. The infant wears protective blue-light-blocking goggles and a diaper, lies unclothed in the phototherapy unit, and generally tolerates the procedure well. Intermittent phototherapy typically lasts 2–3 days, after which jaundice gradually resolves.
3. Exchange transfusion: This is indicated when hemolysis is severe or when phototherapy fails, to prevent bilirubin-induced neurologic dysfunction (BIND), including kernicterus.
