Question

How to treat and prevent neonatal hemolytic disease?

Answer

The treatment and prevention methods for neonatal hemolytic disease are as follows:

  1. Prenatal Treatment:
    • When the Rh antibody in the pregnant woman’s blood is 1:64, consider plasma exchange surgery to remove Rh blood type antibodies.
    • When the fetus has hydrops or fetal Hb is less than 80g/L, and the lungs are not mature, consider intrauterine transfusion.
    • The pregnant woman should take phenobarbital 60mg/d orally for 1 to 2 weeks before delivery to induce the production of glucuronyltransferase in the fetus.
    • When the bilirubin in amniotic fluid is significantly elevated, and the ratio of lecithin to sphingomyelin (L/S) is greater than 2, consider an early delivery.
  2. Neonatal Treatment:
    • Medication Treatment:
      • Hepatic enzyme inducers: commonly phenobarbital.
      • Injection of albumin or plasma to increase the concentration of albumin in the blood, enhancing the binding of albumin to bilirubin.
      • Intravenous injection of gamma globulin.
      • Correct hypoxia and acidosis.
    • Phototherapy: Through light exposure, bilirubin at a depth of 2 millimeters in the skin is oxidized into non-toxic water-soluble products that are excreted through bile and urine.
    • Exchange transfusion: Replace free antibodies and sensitized red blood cells to reduce hemolysis; replace a large amount of bilirubin in the blood to prevent bilirubin encephalopathy; correct anemia, improve oxygen transport, and prevent heart failure.
  3. Prevention:
    • Rh-negative pregnant women should receive treatment after a miscarriage.