Department of Pediatrics, Istanbul University Faculty of Medicine, Istanbul, Turkey.
Department of Pediatrics, Division of Neonatology, Istanbul University Faculty of Medicine, Istanbul, Turkey.
Pediatr Neonatol. 2024 Sep;65(5):482-486. doi: 10.1016/j.pedneo.2024.02.004. Epub 2024 Mar 7.
The objectives were to evaluate the descriptive features of newborns with a diagnosis of Rhesus (Rh) hemolytic disease, to determine the morbidity and mortality rates, to evaluate the treatment methods and the factors affecting treatment requirements and clinical outcomes during a ten-year period at a tertiary center.
Newborn infants who had a positive direct Coombs test and/or had a history of intrauterine transfusion (IUT) due to Rh hemolytic disease were included. The data regarding the prenatal, natal and postnatal periods were collected from hospital records.
A total of 260 neonates were included of which 51.2% were female. The mean ± standard deviation gestational age was 36.9 ± 2.7 weeks. The rate of preterm birth was 41.2%. Of 257 mothers whose obstetric medical history could be accessed, 87.2% were multigravida, whereas 76.3% were multiparous. Among mothers who had a reliable history of anti-D immunoglobulin prophylaxis (n=191), 51.3% had not received anti-D immunoglobulin prophylaxis in their previous pregnancies. The antenatal transfusion rate was 31.7% and the frequency of hydrops fetalis was 8.8%. While combined exchange transfusion (ET) and phototherapy (PT) was performed in 15.4% of the babies, the majority either needed phototherapy only (51.1%) or no treatment (33.5%). The mortality rate was 3.8 % (n = 10), and nine babies out of these 10 were those with severe hydrops fetalis.
This study showed that Rh hemolytic disease is still a major problem in developing countries. Multiple comorbidities may occur in addition to life threatening complications, including hydrops fetalis, anemia and severe hyperbilirubinemia. High rates of multiparity and low rates of anti-D immunoglobulin prophylaxis are potential barriers for the eradication of the disease. It should be remembered that Rh hemolytic disease is a preventable disease in the presence of appropriate antenatal follow-up and care facilities.
本研究旨在评估在一家三级中心的十年期间，诊断为 Rh 溶血病的新生儿的描述性特征，确定发病率和死亡率，评估治疗方法以及影响治疗需求和临床结局的因素。
纳入直接 Coombs 试验阳性和/或因 Rh 溶血病接受宫内输血（IUT）的新生儿。从医院记录中收集围产期、产时和产后的数据。
共纳入 260 例新生儿，其中 51.2%为女性。平均胎龄为 36.9 ± 2.7 周。早产率为 41.2%。在可获取产科病史的 257 例母亲中，87.2%为多产妇，76.3%为经产妇。在有可靠抗 D 免疫球蛋白预防史的 191 例母亲中，51.3%的母亲在之前的妊娠中未接受抗 D 免疫球蛋白预防。产前输血率为 31.7%，胎儿水肿发生率为 8.8%。在 15.4%的婴儿中同时进行了换血（ET）和光疗（PT），而大多数婴儿仅需要光疗（51.1%）或无需治疗（33.5%）。死亡率为 3.8%（n=10），其中 10 例死亡的婴儿中有 9 例患有严重胎儿水肿。
本研究表明 Rh 溶血病在发展中国家仍然是一个主要问题。除了危及生命的并发症外，还可能发生多种合并症，包括胎儿水肿、贫血和严重高胆红素血症。多胎率高和抗 D 免疫球蛋白预防率低是疾病根除的潜在障碍。应该记住，在存在适当的产前随访和医疗设施的情况下，Rh 溶血病是一种可预防的疾病。
