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# Hemolytic Disease of the Newborn Rh(D) sensitivity may occur when an Rh-negative mother's blood contacts blood of an Rh-positive fetus, resulting in anti-D antibodies that can cross the placenta and attack the fetal Rh-positive red blood cells, resulting in hemolytic disease of the newborn (HDN)....

# Hemolytic Disease of the Newborn Rh(D) sensitivity may occur when an Rh-negative mother's blood contacts blood of an Rh-positive fetus, resulting in anti-D antibodies that can cross the placenta and attack the fetal Rh-positive red blood cells, resulting in hemolytic disease of the newborn (HDN). This is primarily a problem during second or subsequent pregnancies. In the fetus, hemolysis triggers increased RBC production (erythroblastosis fetalis), a form of anemia that left untreated results in severe/fatal edema (hydrops fetalis) that can cause congestive heart failure. Erythroblastosis fetalis is characterized by jaundice, fever, generalized edema, cyanosis, and hepatosplenomegaly. Hyperbilirubinemia and jaundice associated with HDN occur from RBC destruction, leading to neurological impairment (kernicterus). Treatment includes exchange transfusion in utero or after birth. Management of fetal hemolysis may include early delivery (≥32 weeks after confirmation of pulmonary maturity if possible), with risks associated with prematurity, and intrauterine transfusion, which can cause fetal distress, hematoma, maternal-fetal hemorrhage, and fetal death (10-20%). # Hydrops Fetalis Hydrops fetalis is a condition in which the newborn is severely edematous with edema of the skin as well as in ≥2 internal compartments (ascites, pericardial and/or pleural effusion). While it may be caused by erythroblastosis fetalis related to Rh incompatibility, most cases in the United States are non-immune and often associated with other abnormalities, such as fetal hemorrhage, red blood cell production disorders, hemolytic disorders, cardiovascular abnormalities, infections (including CMV, herpes, toxoplasmosis), inborn errors of metabolism, tumors, and genetic defects. In some cases, no definitive cause can be identified. With hydrops fetalis, the production of interstitial fluid and lymphatic return are not balanced, so fluid accumulates. Mortality rates range from 60 to 90 percent, depending on underlying cause. Treatments vary but can include fetal or neonatal exchange transfusions, cardiovascular medications (digitalis, adenosine, amiodarone, procainamide), loop diuretics (furosemide), and corticosteroids. Surgical repair of underlying abnormalities or space-occupying tumors may be indicated. # Infection ## Congenital Varicella Syndrome Varicella infection (chickenpox) in the mother can affect the fetus in different ways, depending upon the time of exposure. Congenital varicella syndrome is characterized by many abnormalities, including eye abnormalities (cataracts, microphthalmia, pendular nystagmus and retinal scarring), skin abnormalities (hypertrophy and cicatrix scarring), malformation of limbs, hypoplasia of digits, retarded growth, microcephalus, abnormalities of the brain and autonomic nervous system, developmental delay, and intellectual disability. Mortality rates are high (≤50%) for those with severe defects: - First trimester: 1% risk of congenital varicella syndrome. - Weeks 23-20: 2% risk of congenital varicella syndrome. - 5 days before delivery to 2 days after delivery: Neonate may develop congenital varicella (20-25%). - 6-12 days after delivery: Neonate may contract congenital varicella but, if breast-feeding, the child may receive the mother's antibodies so the disease will be milder. # Hepatitis B, C, & E Routine screening of all pregnant women and all newborns helps to identify those infected with hepatitis B virus (HBV). Infants are routinely immunized at discharge from hospital, at 2 months and...