Department of Pediatrics, Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands.
Department of Immunohematology Diagnostic Services, Sanquin Diagnostic Services, Amsterdam, The Netherlands.
BMC Pregnancy Childbirth. 2023 Oct 18;23(1):738. doi: 10.1186/s12884-023-06061-y.
Advances in postnatal care for hemolytic disease of the fetus and newborn (HDFN) have occurred over the past decades, but little is known regarding the frequency of postnatal treatment and the clinical outcomes of affected neonates. Most studies reporting on HDFN originate from high-income countries or relatively large centers, but important differences between centers and countries may exist due to differences in prevalence and available treatment options. We therefore aimed to evaluate the postnatal treatment landscape and clinical outcomes in neonates with Rhesus factor D (Rh(D))- and/or K-mediated HDFN and to provide recommendations for future research.
We conducted a rapid literature review of case reports and series, observational retrospective and prospective cohort studies, and trials describing pregnancies or children affected by Rh(D)- or K-mediated HDFN published between 2005 and 2021. Information relevant to the treatment of HDFN and clinical outcomes was extracted. Medline, ClinicalTrials.gov and EMBASE were searched for relevant studies by two independent reviewers through title/abstract and full-text screening. Two independent reviewers extracted data and assessed methodological quality of included studies.
Forty-three studies reporting postnatal data were included. The median frequency of exchange transfusions was 6.0% [interquartile range (IQR): 0.0-20.0] in K-mediated HDFN and 26.5% [IQR: 18.0-42.9] in Rh(D)-mediated HDFN. The median use of simple red blood cell transfusions in K-mediated HDFN was 50.0% [IQR: 25.0-56.0] and 60.0% [IQR: 20.0-72.0] in Rh(D)-mediated HDFN. Large differences in transfusion rates were found between centers. Neonatal mortality amongst cases treated with intrauterine transfusion(s) was 1.2% [IQR: 0-4.4]. Guidelines and thresholds for exchange transfusions and simple RBC transfusions were reported in 50% of studies.
Most included studies were from middle- to high-income countries. No studies with a higher level of evidence from centers in low-income countries were available. We noted a shortage and inconsistency in the reporting of relevant data and provide recommendations for future reports. Although large variations between studies was found and information was often missing, analysis showed that the postnatal burden of HDFN, including need for neonatal interventions, remains high.
PROSPERO 2021 CRD42021234940. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021234940 .
在过去几十年中，胎儿和新生儿溶血病（HDFN）的产后护理取得了进展，但对于新生儿的产后治疗频率和临床结局知之甚少。大多数报道 HDFN 的研究来自高收入国家或相对较大的中心，但由于患病率和可用治疗选择的差异，中心和国家之间可能存在重要差异。因此，我们旨在评估 Rh 因子 D（Rh(D)）和/或 K 介导的 HDFN 新生儿的产后治疗情况和临床结局，并为未来的研究提供建议。
我们对 2005 年至 2021 年间发表的描述 Rh(D)-或 K 介导的 HDFN 妊娠或儿童的病例报告和系列、观察性回顾性和前瞻性队列研究以及试验进行了快速文献综述。提取与 HDFN 治疗和临床结局相关的信息。通过标题/摘要和全文筛选，由两名独立评审员使用 Medline、ClinicalTrials.gov 和 EMBASE 搜索相关研究。两名独立评审员提取数据并评估纳入研究的方法学质量。
纳入了 43 项报告产后数据的研究。K 介导的 HDFN 中换血的中位数频率为 6.0%[四分位距（IQR）：0.0-20.0]，Rh(D)介导的 HDFN 中换血的中位数频率为 26.5%[IQR：18.0-42.9]。K 介导的 HDFN 中简单红细胞输注的中位数使用率为 50.0%[IQR：25.0-56.0]，Rh(D)介导的 HDFN 中简单红细胞输注的中位数使用率为 60.0%[IQR：20.0-72.0]。不同中心之间的输血率存在较大差异。接受宫内输血的病例的新生儿死亡率为 1.2%[IQR：0-4.4]。50%的研究报告了换血和简单 RBC 输血的指南和阈值。
大多数纳入的研究来自中高收入国家。没有来自低收入国家中心的更高证据水平的研究。我们注意到相关数据的报告不足且不一致，并为未来的报告提供了建议。尽管研究之间存在很大差异，并且信息经常缺失，但分析表明 HDFN 的产后负担仍然很高，包括需要新生儿干预。
PROSPERO 2021 CRD42021234940。可在：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021234940 获得。
