Hemolytic disease of the newborn is a disease that occurs when the blood of the mother and fetus is incompatible. This situation is possible if the fetus inherits blood antigens from the father, and in the mother's blood there are no such antigens. Most often, the disease develops when Rhesus antigen is incompatible, but it can also be the result of incompatibility with other types of antigens.
Mechanism of disease development
In response to the effects of fetal antigens on the mother's body, antibodies to these antigens are produced in her blood. Penetrating through the placental barrier into the child's blood, antibodies cause hemolysis (destruction) of erythrocytes, which leads to a disruption of bilirubin metabolism. The situation is aggravated by the immaturity of the liver's enzymatic system in the fetus, which is not yet able to transfer toxic indirect bilirubin to a non-toxic direct, excreted through the kidneys. Maternal antibodies can penetrate the placenta both during pregnancy and during labor.
The severity of the hemolytic disease of the fetus and the newborn depends on how many antibodies were received from the mother in the baby's blood, and also on the compensatory possibilities of the latter. Rarely can the disease develop during the first pregnancy. The probability of its occurrence increases with each subsequent pregnancy, tk. there is an accumulation of antibodies in the blood of the mother.
Forms of hemolytic disease of newborns
If the child does not die in utero, then he is born with one of the forms of the disease:
- anemic;
- edematous;
- icteric.
Common symptoms of hemolytic disease of the fetus and newborn: normochromic anemia with the presence of young erythrocytes in the blood and hyperplasia (increase) in the spleen and liver.
Anemic form
The easiest of the three forms of the disease that occurs in the case of a short-term exposure to a small number of maternal antibodies to the fetus. Destroyed erythrocytes are derived through the placenta. In a newborn you can see the pallor of the skin, jaundice is absent. Anemia manifests itself at the end of the first week of life.
Edema form
Very severe form of hemolytic disease of the newborn, requiring treatment in the very first seconds after birth. Occurs when the mother's antibodies on the child persist for a long time. In utero, the fetus survives, because the products of intoxication are excreted through a sharply increased in the placenta. The fetus adapts to the situation and it has additional foci of hematopoiesis. Endocrine glands, liver and spleen significantly increase. Violated protein-forming function of the liver, reduces the amount of protein in the blood, there are massive swelling of the subcutaneous fat layer, the accumulation of fluid in the body cavities. The consequences of this form of hemolytic disease of newborns are fatal for the child. Almost all children born alive die within the next few minutes or hours.
Jaundice form
Occurs under the influence of the mother's antibodies on the fetus, which is already sufficiently ripe. A child is born on time with a normal body weight. Hemolytic disease develops in the first day. The next day there is jaundice, which is rapidly increasing. Internal organs increase in size. There is an intensive increase in the level of bilirubin, there are symptoms of bilirubin intoxication and disruption of the central nervous system: a number of reflexes are broken, vomiting and convulsions appear, and possibly the development of a bilirubin infarct of the kidneys. Without timely and correct treatment of icteric form of hemolytic disease of newborns, a child may die on the second day after birth. Surviving children lag far behind in mental development.
Treatment of hemolytic disease of newborns
Treatment of hemolytic disease of newborns should be comprehensive and timely, including:
- removal of intoxication in the shortest possible time;
- the removal of antibodies from the body of the child, which contribute to the further hemolysis of red blood cells;
- improvement of the functional state of various organs and systems, especially kidney and liver.
The most effective method of treatment is an exchange blood transfusion at the earliest possible time.
Hemolytic disease of newborns is better not to treat, but to warn. As a prophylaxis, the administration of antiresus gamma-immunoglobulin to a woman immediately after the birth of the first child, desensitization by replanting the skin flap from the husband, the elimination of abortions, especially during the first pregnancy, is used. first children are usually born healthy.