Bili is back and so is Dr. Lopriore!
Last week we talked about Phase 1 of neonatal management of HDFN and alloimmunization. This week we’re moving into Phase 2 while we discuss the following:
- Phase 1: intensive phototherapy – usually lasts about 1-2 weeks
- Phase 2: monitoring neonatal hemoglobin & hematocrit
- Outpatient neonatal monitoring – measuring hemoglobin, hematocrit, and reticulocyte counts
- Neonatal red blood cell production
- Why HDFN babies do NOT need supplemental iron
- The role of erythropoietin (EPO) in HDFN and the latest studies on it
- How HDFN treatment varies in different countries
- Other rare neonatal diseases related to HDFN
- Inspissated bile syndrome or “bronze babies” – elevated direct bilirubin as a complicated or cholestasis
- Neonatal hemochromatosis – elevated ferritin levels
- Difference between a ‘top-up’ or ‘simple’ transfusion vs. exchange transfusion
- Anecdotal evidence on the role of maternal phenobarbital prior to delivery
- Breastfeeding, hyperbilirubinemia, and phototherapy
- Reticulocyte count of 2% for two consecutive weeks to ‘graduate’ from pediatric hematology (in the US)
- Long term outcome & developmental expectations for children with HDFN
Articles:
- Antenatal maternal phenobarbital
- doi: 10.1016/j.ajog.2004.08.016
- The LOTUS study: neurodevelopmental outcome after intrauterine transfusion for hemolytic disease of the fetus/newborn
- doi: 10.1016/j.ajog.2011.09.024
- Updated AAP Neonatal Hyperbilirubinemia Management
A special thank you again to Dr. Lopriore for his time and all his contributions to this field!
