Differentiated Therapy of Hemolytic Disease of the Newborn in a Specialized Department

Introduction. Hemolytic disease of the newborn (HDN), despite significant advances achieved in its prevention and treatment, continues to contribute substantially to the structure of perinatal pathology, being a cause of severe complications.

Objective. To assess the necessity for a differentiated approach to the therapy of hemolytic disease of the newborn depending on its severity and the number of intrauterine hemotransfusions in the setting of a specialized intensive care unit.

Materials and Methods. A prospective cohort study was conducted, including 61 children with an established diagnosis of rhesus immunization of the fetus and newborn (ICD-10, P55.0), who received treatment in the intensive care unit and the neonatal pathology department. Group 1 consisted of 29 children without intrauterine correction of HDN. Group 2 consisted of 19 children who required 1–2 intrauterine intravascular blood transfusions for severe fetal hemolytic disease. Group 3 included 13 children who underwent 3 or more intrauterine intravascular blood transfusions. The study analyzed treatment strategies and the duration of children’s hospital stay depending on the presence and number of intrauterine interventions.

Results. The study revealed significant differences in the course of hemolytic disease of the newborn (HDN) depending on the presence and number of performed intrauterine blood transfusions (IUT). Newborns who underwent multiple intrauterine blood transfusions (IUT) demonstrated the most aggressive disease course, manifested by a significantly higher need for exchange blood transfusion (ET) and hemotransfusions at the start of treatment. On the other hand, it was this category of patients that showed more favorable dynamics regarding hyperbilirubinemia. In newborns who did not receive intrauterine correction of HDN, the need for ET was identified in approximately one-third of cases. However, it should be noted that in a larger number of cases, such children require repeated ETs. This group of children showed the lowest number of hemotransfusions, indicating a predominance of the icteric form of HDN with a less pronounced anemic component. The group of children who underwent 1-2 intrauterine blood transfusions occupied an intermediate position, combining clinical characteristics of both the first and third groups. The rate of requiring exchange blood transfusion (ET) in these patients was 36.8%, which is statistically comparable to the group without intrauterine interventions. At the same time, the need for hemotransfusions reached 42%, significantly exceeding the rate in the first group (17.2%) and approaching the values of the third group (38.4%).

Conclusion. The identified features of the pathogenesis and clinical course of HDN depending on the number of IUTs underscore the necessity of a differentiated approach to managing such patients, taking into account both the severity of the antenatal period and the specifics of postnatal adaptation.

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