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Morbus haemolyticus neonatorum
Thanks to blood group testing and anti-D prophylaxis, blood group incompatibility has become rare and very treatable in Switzerland.
Also known as: haemolytic disease of the newborn · rhesus incompatibility · Rh alloimmunisation · ABO incompatibility · antibody-related newborn jaundice
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
In haemolytic disease of the newborn the mother makes antibodies against her baby’s red blood cells because their blood group markers are foreign to her. These antibodies cross the placenta and break down the baby’s red cells. The result is anaemia and an early, strong jaundice. Two routes matter. In rhesus incompatibility the mother is rhesus negative and the baby rhesus positive; the first pregnancy usually passes without trouble, because the mother only meets the foreign marker around the birth — a later pregnancy would be the affected one. This is exactly where anti-D prophylaxis comes in, preventing those antibodies from forming. In ABO incompatibility, usually a mother of group 0 with a baby of group A or B, even the first child can be affected, but the course is as a rule considerably milder. And that is the key message: in Switzerland blood group typing and an antibody screen are part of routine pregnancy care, and anti-D prophylaxis is well established. The severe cases of the past are now very much the exception. Assessment uses the antibody screen in the mother, the Coombs test in the baby and bilirubin measurement; ultrasound can assess the baby’s blood flow. Treatment depends on severity: phototherapy, frequent breastfeeding or feeding, and in rare severe cases an exchange transfusion, or a transfusion before birth. Stay alert to jaundice in the first 24 hours of life, to a very sleepy baby who feeds poorly, and to yellowing that deepens quickly.
Blood group typing and an antibody screen are standard in Switzerland. It is this routine that has made severe cases rare.
It is offered to rhesus negative women during pregnancy and after birth and prevents antibodies forming for later children.
Bleeding in pregnancy, miscarriage, amniocentesis, a fall onto the belly: report it promptly so prophylaxis happens in time.
By a window, not under artificial light, pressing gently on nose, chest or leg. That is how an increase is spotted early.
Eight to twelve feeds in 24 hours get the gut going; the yellow pigment leaves the body with the stools.
Blue light turns the yellow pigment into a form the body can excrete. It is painless, well studied and usually works quickly.
Jaundice on day one, a baby hard to rouse, a shrill cry or arching of the body: contact paediatrician, midwife or emergency care at once.
Much online material predates anti-D prophylaxis. Midwife, gynaecologist and paediatrician put your own findings in context.
Anti-D immunoglobulin prevents the mother from forming antibodies — it works preventively and only if given in time: at the twenty-eighth week of pregnancy and within seventy-two hours after the birth of a Rhesus-positive child. Once the antibodies are there, it no longer works — that is the decisive point. In the child, light therapy works against the jaundice; with severe anaemia, exchange or transfusion follows, in the womb or afterwards.
About fifteen in a hundred people in Europe are Rhesus negative. Without prevention, about one in six Rhesus-negative women forms antibodies after the birth of a Rhesus-positive child; with anti-D that falls to under two in a hundred. The first child is almost never affected, because the antibodies only form afterwards. The newborn’s bilirubin is judged in hours rather than days, because it rises fast in the first days.
Yellowing that appears on day one is never the harmless newborn jaundice and is always assessed straight away.
Colour spreads from face and whites of the eyes down over chest and belly to arms and legs. Speed and spread matter more than the shade.
The baby has to be woken to feed, lets go of the breast, has few wet nappies. Poor feeding and jaundice are judged together.
Skin and lips look strikingly pale, the baby breathes faster and tires while feeding. That is how red cell breakdown shows itself.
Entries such as “rhesus negative” or a positive antibody screen are not an alarm but the reason for the planned checks.
It shows antibodies attached to the baby’s red cells and explains a jaundice that would otherwise be hard to interpret.
The value that steers the treatment. Breaking down red cells releases bilirubin; the level at which light therapy or exchange transfusion is needed depends on hours of life and maturity.
Shows how deep the anaemia is — and it can still deepen in the first weeks of life, even once the jaundice has settled.
Young red cells. They rise because the marrow is trying to make good the loss — the proof that cells are being destroyed rather than underproduced.
Where blood is lost regularly the store empties long before the haemoglobin falls. Ferritin shows this earlier than the blood count — and refilling takes months, not weeks.
Clearly improves the uptake of plant iron. A glass of orange juice or some pepper with the iron-rich meal does more than the choice of preparation.
Belongs in the workup of any anaemia, because a lack makes the same picture as iron deficiency — only with large instead of small red cells. Both can exist side by side.
Needed for making new blood cells and quickly short with alcohol, in pregnancy and under certain medicines.
Clearly effective with proven deficiency, useless without. Take only with a documented deficiency — excess is harmful.
Clearly worthwhile and well supported when deficient — vegan, older adults, certain drugs. No energy boost without a deficiency.
In pregnancy clearly established against neural-tube defects, otherwise mainly with deficiency. Can mask a B12 deficiency — watch both.
The decisive point is prevention: a rhesus-negative woman receives an anti-D dose in pregnancy and after the birth. That turned this condition from a common one into a rare one — one of the most effective measures in birth medicine.
In the child the anaemia can continue for weeks after the birth, because the mother’s antibodies are still there. This is why the blood count is checked afterwards and not only the jaundice.
Frequent feeding — 8 to 12 times in 24 hours — helps clear bilirubin through the stool. Giving water or tea in addition does not help and can harm.
Frequent breastfeeding — 8 to 12 times in 24 hours — helps clear bilirubin through the stool. Giving water or tea in addition does not help and can harm.