S3E1: Top 5 Things to Save HDFN Babies 

Bethany and Molly begin Season 3 with a review of the episodes ahead before challenging each other to list what they think are Top 5 things that would keep the most HDFN babies safe. The episode takes a turn when they reveal that they have signed themselves up for plenty more than 5 things (listed below). 

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Watch this episode on YouTube:YouTube The Essential 5

Join the AHF patient support group: https://www.facebook.com/groups/antibodiesinpregnancy

Top 5 Prenatal Things (in no particular order): 

Bethany:

1. Quick referral to MFM (and a list of MFMs worldwide who specialize in treating alloimmunized pregnancies)
2. Preventative medications accessible to all women who need them (Rh immune globulin/RhoGAM; intravenous immune globulin, plasmapheresis for severely affected pregnancies)
3. Weekly, accurate MCA scans beginning at 16-17 weeks for those with critical titers or previously affected babies; for those with early onset severe disease, starting sooner
4. MFMs who collaborate with other experts and refer when necessary
5. IUTs performed on time, using fetal paralytic meds, by providers with ample experience performing IUTs who know to space and attempt the last IUT at 34-35 weeks if possible
6. (Honorable mention): Referring all women with positive antibody screen to Allo Hope Foundation 
7. (Honorable mention): Delivery at 37-38 weeks unless you are certain baby is antigen negative

Molly: 

1. Immediate referral to MFM after positive antibody screen
2. Weekly MCA scans for critical titer/previously affected pregnancies (Weekly MCA recommendation from the group who developed MCA scans: www.academia.edu) 
3. Establishing global referral centers for IUTs
4. An awareness that the seriousness of the disease can change at any time (e.g., low titers can jump up, first pregnancies can be severely affected - will result in closer monitoring)
5. Go in if you notice a change in baby’s movement or something doesn’t feel right about your treatment or monitoring

Top 5 Neonatal Things (in no particular order): 

Molly:

1. Establishing neonatal care in advance of delivery (NICU/hematology in cases where pregnancy has needed treatment or high titers; pediatrician for lower titers)
2. Create a fetal care record for your baby (AHF is developing this and it is not yet publicly available: e-mail us at [email protected] if you would like to use a draft version in the interim)
3. Following bilirubin closely after birth and doing a trial off of lights before discharge (AAP hyperbilirubinemia guidelines: aap.org/pediatrics
4. Weekly hemogobin/hematocrit after discharge until consistently trending upward or stable in a healthy range for 2+ weeks (Neonatal management from the Netherlands: research.rug.nl
5. Follow the trend. Do not rely on one laboratory reading. Two readings are needed for a trend. Bili should be trending down; hemoglobin/hematocrit increasing.

Bethany: 

1. Continuity of care from MFM to neonatologist to pediatrician to pediatric hematologist
2. Test cord blood at birth (hematocrit/hemoglobin, bilirubin, Direct Coombs Test (DCT))
3. Providers who understand how hemolytic jaundice and hemolytic anemia work (as opposed to newborn jaundice and iron deficiency anemia)
4. Close monitoring and aggressive treatment for hyperbilirubinemia (see AAP guidelines linked above)
5. Follow-up blood tests weekly after hospital discharge