Paediatrics MD3: Haemolytic Disease of the Newborn
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Questions and Answers

Which of the following best defines Hemolytic Disease of the Newborn?

  • A condition caused by Rh incompatibility leading to abnormal white blood cell production in the newborn
  • A condition caused by ABO incompatibility resulting in decreased RBC production in the fetus
  • A condition caused by maternal antibodies attacking the fetal RBC antigens, leading to increased RBC destruction (correct)
  • A condition caused by maternal antibodies attacking the fetal platelets, leading to clotting disorders

    • What is one of the major risk factors for Haemolytic Disease of the Newborn?

  • Newborn born to blood group O mother (correct)
  • Newborn born to Rh negative father
  • Newborn born to Rh positive mother
  • Newborn born to AB positive mother

    • In which scenario does Haemolytic Disease of the Newborn occur?

  • When both parents have blood group O and ABO incompatibility occurs
  • When an Rh negative mother has a baby with an Rh positive father (correct)
  • When a Rh positive mother has a baby with an Rh negative father
  • When both parents are Rh negative and ABO incompatibility occurs

    • What is the primary cause of Haemolytic Disease of the Newborn?

    <p>Transplacental passage of maternal antibodies attacking fetal RBC antigens</p> Signup and view all the answers

    What is the approximate annual incidence of Haemolytic Disease of the Newborn?

    <p>80/100,000 to 150/100,000</p> Signup and view all the answers

    Which condition is associated with Haemolytic Disease of the Newborn?

    <p>Decreased platelet count in the newborn</p> Signup and view all the answers

    What is the main pathophysiological process underlying Rh hemolytic disease of the newborn?

    <p>Transplacental passage of maternal anti-D antibodies into fetal circulation</p> Signup and view all the answers

    Which clinical feature is NOT commonly associated with Rh hemolytic disease of the newborn?

    <p>Hypertension</p> Signup and view all the answers

    What is the definitive diagnostic criterion for Rh hemolytic disease of the newborn?

    <p>Positive Coombs Test</p> Signup and view all the answers

    Which complication is NOT typically associated with Rh hemolytic disease of the newborn?

    <p>Pulmonary embolism</p> Signup and view all the answers

    Which investigation is used to detect antibodies or complement proteins attached to the surface of red blood cells in Rh hemolytic disease of the newborn?

    <p>Direct Coombs Test (Direct agglutination test)</p> Signup and view all the answers

    What is the main goal of jaundice management in Rh hemolytic disease of the newborn?

    <p>Prevent neurotoxicity from hyperbilirubinemia</p> Signup and view all the answers

    What is the immediate resuscitation therapy for live born infants with Rh hemolytic disease?

    <p>Correction of acidosis with sodium bicarbonate</p> Signup and view all the answers

    What is the primary preventive measure for rhesus negative mothers carrying an Rh-positive fetus to avoid developing anti-Rh IgG antibodies?

    <p>Giving anti-Rh-positive immuno</p> Signup and view all the answers

    When is delivery in advance indicated for unborn infants with Rh hemolytic disease?

    <p>Hydrops or anemia (Hematocrit less than 1:32)</p> Signup and view all the answers

    What is the rare occurrence during the first pregnancy involving an Rh-positive fetus in relation to Rh hemolytic disease?

    <p>Rh hemolytic disease manifestation in the first pregnancy itself</p> Signup and view all the answers

    What is the approximate level of blood glucose that indicates hypoglycemia in neonates?

    <p>Below 2.6 mmol/l</p> Signup and view all the answers

    Which condition can lead to increased glucose consumption and contribute to hypoglycemia in neonates?

    <p>Hypothermia</p> Signup and view all the answers

    What is the primary cause of hypoglycemia in neonates with inborn errors of metabolism?

    <p>Amino acid and organic acid disorders</p> Signup and view all the answers

    What are the clinical features that can be used to suspect hypoglycemia in neonates?

    <p>Low body temperature</p> Signup and view all the answers

    In neonates, what is the rate at which their skin temperature falls after birth?

    <p>0.1 degrees/min</p> Signup and view all the answers

    Why do neonates have a higher rate of heat loss compared to adults?

    <p>Higher surface area to volume ratio</p> Signup and view all the answers

    Which of the following clinical features is NOT commonly associated with neonatal hypoglycemia?

    <p>High urine output leading to dehydration</p> Signup and view all the answers

    What is the immediate management approach for symptomatic newborns with RBG < 2.6 mmol/l?

    <p>Give a bolus of Dextrose 10% 2 ml/kg stat IV</p> Signup and view all the answers

    What should be considered if a newborn still has hypoglycemia after 1 hour despite initial management?

    <p>Further investigations for hypothyroidism</p> Signup and view all the answers

    What is the threshold for considering treatment for hyperglycemia in neonates?

    <p>RBG &gt; 11 mmol/l</p> Signup and view all the answers

    What is the primary cause of hyperglycemia in neonates?

    <p>Failure of glucose autoregulation from hepatic and pancreatic immaturity</p> Signup and view all the answers

    What should be the initial approach to managing hyperglycemia in neonates?

    <p>Stop dextrose infusion and continue to monitor RBG hourly</p> Signup and view all the answers

    What should be administered if glucose levels are still > 11 mmol/l after stopping D10% infusion for 4 hours?

    <p>Insulin at a dose of 0.05 – 0.15 units/kg IV/SQ every 4 – 6 hours</p> Signup and view all the answers

    What should be considered if a newborn presents with persistent hyperglycemia?

    <p>Investigation for sepsis</p> Signup and view all the answers

    What is the threshold for considering treatment for hyperglycemia in neonates?

    <p>RBG &gt; 11 mmol/l</p> Signup and view all the answers

    What is the primary cause of hyperglycemia in neonates?

    <p>Failure of glucose autoregulation from hepatic and pancreatic immaturity</p> Signup and view all the answers

    Study Notes

    Hemolytic Disease of the Newborn

    • Hemolytic Disease of the Newborn is a condition where the mother's immune system produces antibodies against the fetus's red blood cells, leading to their destruction.
    • One of the major risk factors is a previous pregnancy or blood transfusion that sensitized the mother to the Rh antigen.
    • It occurs when an Rh-negative mother is carrying an Rh-positive fetus.
    • The primary cause is the incompatibility between the mother's Rh-negative blood and the fetus's Rh-positive blood.
    • The approximate annual incidence is not specified.
    • The condition is associated with jaundice and anemia.

    Pathophysiology and Diagnosis

    • The main pathophysiological process is the production of antibodies against the Rh antigen, leading to the destruction of fetal red blood cells.
    • The definitive diagnostic criterion is the presence of antibodies or complement proteins attached to the surface of red blood cells.
    • The investigation used to detect these antibodies is the direct Coombs test.

    Clinical Features and Management

    • Clinical features commonly associated with Rh hemolytic disease include jaundice, anemia, and hydrops fetalis.
    • The main goal of jaundice management is to prevent kernicterus.
    • The immediate resuscitation therapy for live-born infants is phototherapy.
    • The primary preventive measure for Rh-negative mothers is to administer anti-Rh IgG antibodies during pregnancy.

    Complications and Prevention

    • A complication not typically associated with Rh hemolytic disease is hypoglycemia.
    • Delivery in advance is indicated for unborn infants with Rh hemolytic disease when fetal distress or hydrops fetalis occurs.
    • A rare occurrence during the first pregnancy involving an Rh-positive fetus is the development of anti-Rh IgG antibodies.

    Hypoglycemia in Neonates

    • Hypoglycemia is indicated by a blood glucose level below 2.6 mmol/l.
    • A condition that can lead to increased glucose consumption and contribute to hypoglycemia is sepsis.
    • The primary cause of hypoglycemia in neonates with inborn errors of metabolism is impaired glucose metabolism.
    • Clinical features that can be used to suspect hypoglycemia include jitteriness, lethargy, and seizures.
    • The rate at which neonates' skin temperature falls after birth is 0.5°C per hour.
    • Neonates have a higher rate of heat loss compared to adults due to their larger surface-to-volume ratio.
    • A clinical feature not commonly associated with neonatal hypoglycemia is hypertension.

    Management of Hypoglycemia and Hyperglycemia

    • The immediate management approach for symptomatic newborns with RBG < 2.6 mmol/l is to administer glucose.
    • If a newborn still has hypoglycemia after 1 hour despite initial management, consider underlying causes such as inborn errors of metabolism.
    • The threshold for considering treatment for hyperglycemia in neonates is a glucose level above 11 mmol/l.
    • The primary cause of hyperglycemia in neonates is stress, such as during birth asphyxia or respiratory distress.
    • The initial approach to managing hyperglycemia is to stop any glucose infusions.
    • If glucose levels are still above 11 mmol/l after stopping D10% infusion for 4 hours, consider administering insulin.

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    Description

    This quiz covers the definition, epidemiology, risk factors, causes, pathophysiology, clinical features, complications, diagnosis, differential diagnosis, and management of Haemolytic Disease of the Newborn. It is part of the Paediatrics & Child Health MD3 curriculum taught by Dr. L. J. Malasa.

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