Okay, we’ve had the podcast baby, now what? Molly and Bethany discuss the medical measures needed to keep the baby healthy after they join us on the other side. As our new patient is born we have a new series of information and tips to keep baby safe until baby is finally cleared of mom’s antibodies, usually by 12 weeks of age. 

Episode themes: 

• Why baby is still affected by mom’s antibodies after birth
• Two major effects of HDFN: hyperbilirubinemia and anemia
• Monitoring bilirubin via blood test or photo sensor.
• Transfusions: exchange, top-up and IVIG, and tips if your baby needs one
• Delayed onset anemia: why a baby with no symptoms at birth needs to be monitored
• Weekly blood tests for reticulocyte count and hematocrit/hemoglobin
• When to treat anemia and hyperbilirubinemia
• When we’re done with HDFN
• HDFN babies do not need iron supplements: request ferritin tests before care teams give iron supplements
• Special considerations in babies who received intrauterine transfusions (IUTs) in utero
• Baby’s pre-birth medical history is not automatically recorded in baby’s medical record

Terminology used in this episode: 

• Bilirubin: The substance formed when red blood cells are broken down. Bilirubin is part of the bile, which is made in the liver and is stored in the gallbladder. The abnormal buildup of bilirubin causes jaundice.
• Exchange transfusion: A blood transfusion in which the patient's blood or components of it are exchanged with (replaced by) other blood or blood products.
• Hematocrit: The ratio of the volume of red blood cells to the total volume of blood
• Hemoglobin: A protein inside red blood cells that carries oxygen from the lungs to tissues and organs in the body and carries carbon dioxide back to the lungs.
• Hyperbilirubinemia: High levels of a product produced when red blood cells are broken down. In the case of alloimmunization, they are broken down by the mother’s antibodies. Excess bilirubin can cause jaundice, kernicterus, hearing loss, tooth enamel problems, permanent brain damage or even death if left untreated.
• Kernicterus: Bilirubin-induced permanent brain damage as a result of high levels of bilirubin, also called bilirubin encephalopathy. Signs of Kernicterus are considered a medical emergency and include: a high pitched cry, arched back, and an inconsolable infant.
• Reticulocyte count (Retic): This is a measure of how many immature blood cells are in the bloodstream. These are future RBCs and can give an idea of how quickly a baby is making new blood to replace what the antibodies are destroying. It can be used to decide if a top up transfusion is needed or if another check in a couple days will suffice.
• Top-up transfusion: Adding blood or blood products without removing any blood, these are also known as simple transfusions.

Linked mentioned in this episode: 

AAP hyperbilirubinemia guidelines:  

https://www.aap.org/en/patient-care/hyperbilirubinemia/

AAP treatment chart for hyperbilirubinemia in HDFN babies (also available within the overall guidelines linked above): 

https://publications.aap.org/view-large/figure/10539368/PEDS_2022058859_f3.tif

Get free HDFN Prenatal and Postnatal information booklets: 

https://allohopefoundation.org/library/booklets/

Untreated hyperbilirubinemia leads to kernicterus in 25% of cases, see HDFN review of current trends and treatments:

https://pubmed.ncbi.nlm.nih.gov/34675752/

Post-birth guidelines from Netherlands: Smits-Wintjens, V. E. H. J. (2012, February 15). Neonatal management and outcome in red cell alloimmunization.

https://scholarlypublications.universiteitleiden.nl/access/item%3A2894186/view

Allo Hope Terminology Library https://allohopefoundation.org/library/terminology/

For more on tests during pregnancy, see our prenatal testing guide at https://allohopefoundation.org/library/prenatal-testing/

Research for this episode provided by Bethany Weathersby and Molly Sherwood of the Allo Hope Foundation. Find more information at https://allohopefoundation.org

The Allo Podcast is produced and edited by https://www.mediaclub.co