Management and Treatment Outcomes of Hemolytic Disease of the Fetus and Newborn (HDFN)—A Retrospective Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Characteristics of the Study Group
3.2. Laboratory Test Results and Management of Newborns with HDFN
3.3. Comparison of Children with and without Intrauterine Fetal Transfusions (IUT)
4. Discussion
5. Study Limitations
- We obtained the data retrospectively, so there was no previously established HDFN management protocol; therapeutic decisions were made based on the doctor’s knowledge and individual experience, and not on previously established guidelines. This also applies to the doctor’s preferences regarding the first Hgb concentration measurement in the umbilical cord or peripheral blood sample.
- Furthermore, the patients’ highest ferritin concentrations remained unknown due to laboratory limitations, as the test’s detection range did not exceed >1650 ng/mL.
- In some neonates, the diagnosis of HDFN (especially in the case of AB0-alloimmunization) was made a few days after birth. Therefore, there is no complete data on the hemoglobin and bilirubin concentrations measured in cord or peripheral blood samples right after birth.
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | n (%) | M | SD | Me | Min | Max |
---|---|---|---|---|---|---|
Sex | ||||||
Female | 128 (46.7) | - | - | - | - | - |
Male | 146 (53.3) | - | - | - | - | - |
Gestational age [weeks] | - | 37.33 | 1.85 | 38.00 | 28.00 | 41.00 |
Gestational age < 37 weeks | 84 (30.7) | - | - | - | - | - |
Birth weight [g] | - | 3159.41 | 506.23 | 3190.00 | 1400.00 | 4570.00 |
Birth weight < 2500 g | 23 (8.4) | - | - | - | - | - |
Birth weight percentile | - | 63.20 | 25.28 | 66.50 | 0.40 | 100.00 |
Birth weight percentile < 10 | 3 (1.1) | - | - | - | - | - |
Types of red cell alloimmunization | ||||||
Rh | 151 (55.1) | - | - | - | - | - |
Kidd | 0 (0.0) | - | - | - | - | - |
Kell | 8 (2.9) | - | - | - | - | - |
Duffy | 1 (0.4) | - | - | - | - | - |
MNs | 2 (0.7) | - | - | - | - | - |
AB0 | 99 (36.1) | - | - | - | - | - |
Rh/Duffy | 5 (1.8) | - | - | - | - | - |
Rh/Duffy/Kidd | 1 (0.4) | - | - | - | - | - |
Rh/Kell | 1 (0.4) | - | - | - | - | - |
Rh/Kidd | 5 (1.8) | - | - | - | - | - |
Rh/MNs | 1 (0.4) | - | - | - | - | - |
Number of IUT-treated neonates | 46 (16.8) | - | - | - | - | - |
Number of IUTs in IUT-treated neonates | - | 3.59 | 2.54 | 3.00 | 1.00 | 11.00 |
Variable | n (%) | M | SD | Me | Min | Max |
---|---|---|---|---|---|---|
Hgb concentration [g/dL] | ||||||
Hgb after birth | - | 15.62 | 3.33 | 16.00 | 1.60 | 23.30 |
Howest Hgb during the hospital stay | - | 14.06 | 3.86 | 14.60 | 1.60 | 23.10 |
Number of TU-treated neonates | 37 (13.5) | - | - | - | - | - |
Number of TUs in TU-treated neonates | - | 1.33 | 0.59 | 1.00 | 1.00 | 3.00 |
Number of neonates with measured TsB 1 | 231 (84.3) | - | - | - | - | - |
TsB concentration [mg/dL] | ||||||
TsB after birth | - | 3.05 | 1.77 | 2.44 | 0.30 | 9.90 |
Highest TsB during the hospital stay | - | 11.85 | 4.92 | 11.66 | 2.12 | 50.90 |
Day after birth with the highest TsB | - | 4.60 | 2.29 | 4.00 | 1.00 | 18.00 |
Number of ET-treated neonates | 12 (4.4) | - | - | - | - | - |
Number of ETs in ET-treated neonates | - | 1.50 | 1.45 | 1.00 | 1.00 | 6.00 |
Number of PT-treated neonates | 193 (70.4) | - | - | - | - | - |
Duration of PT in PT-treated neonates [days] | - | 6.10 | 3.88 | 5.00 | 1.00 | 21.00 |
Number of IVIG-treated neonates | 64 (23.4) | - | - | - | - | - |
Number of IVIG infusions in IVIG-treated neonates | - | 1.50 | 0.78 | 1.00 | 1.00 | 4.00 |
Number of neonates with measured ferritin concentration | 110 (40.1) | - | - | - | - | - |
Number of neonates with ferritin < 1650 ng/mL 2 | 102 (92.7) | - | - | - | - | - |
Number of neonates with ferritin > 1650 ng/mL 2 | 8 (7.3) | - | - | - | - | - |
Ferritin concentration 3 [ng/mL] | - | 688.68 | 366.49 | 622.10 | 117.20 | 1617.60 |
Number of neonates with DBil > 1.0 mg/dL | 88 (32.1) | - | - | - | - | - |
DBil concentration [mg/dL] | ||||||
DBil after birth | - | 0.63 | 0.64 | 0.44 | 0.07 | 5.51 |
Highest DBil during the hospital stay | - | 2.56 | 6.15 | 1.42 | 1.01 | 50.20 |
Length of stay [days] | - | 8.39 | 7.08 | 6.00 | 1.00 | 56.00 |
Number of deaths | 3 (1.1) | - | - | - | - | - |
Variable | Children with IUT (%, n = 46) | Children without IUT (%, n = 228) | MD (95% CI) | p |
---|---|---|---|---|
Hgb concentration [g/dL] | ||||
Hgb after birth, median (IQR) | 13.05 (11.48; 14.97) | 16.35 (14.67; 17.95) | −3.30 (−4.10; −2.20) | <0.001 |
lowest Hgb, median (IQR) | 11.15 (8.43; 12.97) | 15.30 (12.70; 17.20) | −4.15 (−5.20; −3.10) | <0.001 |
Number of TU-treated neonates | 15 (32.6) | 22 (9.6) | - | <0.001 ** |
Number of neonates with TsB 1 measured after birth | 46 (100.0) | 185 (81.1) | - | 0.003 *** |
TsB concentration [mg/dL] | ||||
TsB after birth, median (IQR) | 4.61 (3.08; 5.88) | 2.18 (1.71; 3.23) | 2.43 (1.48; 2.68) | <0.001 |
highest TsB, median (IQR) | 10.53 (8.46; 14.61) | 11.73 (8.94; 14.38) | −1.20 (−1.85; 1.06) | 0.532 |
Day after birth with the highest TsB, median (IQR) | 4.00 (3.00; 5.75) | 4.00 (3.00; 5.00) | 0.00 (−1.00; 1.00) | 0.896 |
Number of ET-treated neonates | 8 (17.4) | 4 (1.8) | - | <0.001 *** |
Number of PT-treated neonates | 45 (97.8) | 148 (64.9) | - | <0.001 ** |
Duration of PT [days], median (IQR); (PT-treated neonates) | 6.00 (4.00; 8.00) | 4.00 (3.00; 9.00) | 2.00 (0.00; 2.00) | 0.128 |
Number of IVIG-treated neonates | 31 (67.4) | 33 (14.5) | - | <0.001 ** |
Number of neonates with measured ferritin concentration | 40 (87.0) | 70 (30.7) | - | <0.001 ** |
Number of neonates with ferritin >1650 ng/mL 2 | 8 (20.0) | 0 (0.0) | - | <0.001 *** |
Number of neonates with ferritin <1650 ng/mL 3 | 32 (80.0) | 70 (100.0) | - | <0.001 *** |
Ferritin concentration 4 [ng/mL], M ± SD | 1075.26 ± 270.75 | 511.96 ± 250.36 | 563.30 (454.56; 672.04) | <0.001 * |
Number of children with cholestasis | 24 (52.2) | 64 (28.1) | 0003 | |
Length of stay [days], median (IQR) | 9.00 (7.00; 14.00) | 6.00 (4.00; 9.00) | 3.00 (2.00; 5.00) | <0.001 |
Number of deaths | 1 (2.2) | 2 (0.9) | - | 0.425 *** |
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Drozdowska-Szymczak, A.; Łukawska, S.; Mazanowska, N.; Ludwin, A.; Krajewski, P. Management and Treatment Outcomes of Hemolytic Disease of the Fetus and Newborn (HDFN)—A Retrospective Cohort Study. J. Clin. Med. 2024, 13, 4785. https://doi.org/10.3390/jcm13164785
Drozdowska-Szymczak A, Łukawska S, Mazanowska N, Ludwin A, Krajewski P. Management and Treatment Outcomes of Hemolytic Disease of the Fetus and Newborn (HDFN)—A Retrospective Cohort Study. Journal of Clinical Medicine. 2024; 13(16):4785. https://doi.org/10.3390/jcm13164785
Chicago/Turabian StyleDrozdowska-Szymczak, Agnieszka, Sabina Łukawska, Natalia Mazanowska, Artur Ludwin, and Paweł Krajewski. 2024. "Management and Treatment Outcomes of Hemolytic Disease of the Fetus and Newborn (HDFN)—A Retrospective Cohort Study" Journal of Clinical Medicine 13, no. 16: 4785. https://doi.org/10.3390/jcm13164785