Bili is back and so is Dr. Lopriore!

Last week we talked about Phase 1 of neonatal management of HDFN and alloimmunization. This week we’re moving into Phase 2 while we discuss the following:

• Phase 1: intensive phototherapy – usually lasts about 1-2 weeks
• Phase 2: monitoring neonatal hemoglobin & hematocrit
• Outpatient neonatal monitoring – measuring hemoglobin, hematocrit, and reticulocyte counts
• Neonatal red blood cell production
• Why HDFN babies do NOT need supplemental iron
• The role of erythropoietin (EPO) in HDFN and the latest studies on it
• How HDFN treatment varies in different countries
• Other rare neonatal diseases related to HDFN
  • Inspissated bile syndrome or “bronze babies” – elevated direct bilirubin as a complicated or cholestasis
  • Neonatal hemochromatosis – elevated ferritin levels
• Difference between a ‘top-up’ or ‘simple’ transfusion vs. exchange transfusion
• Anecdotal evidence on the role of maternal phenobarbital prior to delivery
• Breastfeeding, hyperbilirubinemia, and phototherapy
• Reticulocyte count of 2% for two consecutive weeks to ‘graduate’ from pediatric hematology (in the US)
• Long term outcome & developmental expectations for children with HDFN

Articles:

• Antenatal maternal phenobarbital
  • doi: 10.1016/j.ajog.2004.08.016
• The LOTUS study: neurodevelopmental outcome after intrauterine transfusion for hemolytic disease of the fetus/newborn
  • doi: 10.1016/j.ajog.2011.09.024
• Updated AAP Neonatal Hyperbilirubinemia Management

A special thank you again to Dr. Lopriore for his time and all his contributions to this field!