Neonatal management and outcome in alloimmune hemolytic disease
| Autor: | Jeanine M.M. van Klink, Dick Oepkes, Vivianne E.H.J. Smits-Wintjens, Johanna G. van der Bom, Enrico Lopriore, Isabelle M C Ree |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Anemia
Hemolytic medicine.medical_specialty Time Factors Anemia medicine.medical_treatment Exchange Transfusion Whole Blood Exchange transfusion Disease 03 medical and health sciences 0302 clinical medicine Isoantibodies hemic and lymphatic diseases 030225 pediatrics medicine Humans 030212 general & internal medicine Intensive care medicine Kernicterus Alloimmunization Hyperbilirubinemia Fetus Anemia Neonatal Obstetrics business.industry Infant Newborn Disease Management Immunoglobulins Intravenous Hematology medicine.disease anemia exchange transfusion Combined Modality Therapy hemolytic disease of the fetus and newborn Treatment Outcome embryonic structures Fluid Therapy business phototherapy |
| Zdroj: | Expert Review of Hematology, 10(7), 607-616 |
| ISSN: | 1747-4094 1747-4086 |
| DOI: | 10.1080/17474086.2017.1331124 |
| Popis: | Hemolytic disease of the fetus and newborn (HDFN) occurs when fetal and neonatal erythroid cells are destroyed by maternal erythrocyte alloantibodies, it leads to anemia and hydrops in the fetus, and hyperbilirubinemia and kernicterus in the newborn. Postnatal care consists of intensive phototherapy and exchange transfusions to treat severe hyperbilirubinemia and top-up transfusions to treat early and late anemia. Other postnatal complications have been reported such as thrombocytopenia, iron overload and cholestasis requiring specific management. Areas covered: This review focusses on the current neonatal management and outcome of hemolytic disease and discusses postnatal treatment options as well as literature on long-term neurodevelopmental outcome. Expert commentary: Despite major advances in neonatal management, multiple issues have to be addressed to optimize postnatal management and completely eradicate kernicterus. Except for strict adherence to guidelines, improvement could be achieved by clarifying the epidemiology and pathophysiology of HDFN. Several pharmacotherapeutic agents should be further researched as alternative treatment options in hyperbilirubinemia, including immunoglobulins, albumin, phenobarbital, metalloporphyrins, zinc, clofibrate and prebiotics. Larger trials are warranted to evaluate EPO, folate and vitamin E in neonates. Long-term follow-up studies are needed in HDFN, especially on thrombocytopenia, iron overload and cholestasis. |
| Databáze: | OpenAIRE |
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