Avaliação da evolução dos recém-nascidos com doença hemolítica perinatal por aloimunização materna, submetidos e não à transfusão intrauterina

Abstract

Hemolytic disease of the newborn (HDN) due to maternal Rh alloimmunization, though rare, is still very serious and affects many newborns (NB). Improvements in prenatal care in the recent decades effectively reduced perinatal mortality. With increased survival, outcome studies of short and long term are needed.Objectives: 1/ To evaluate birth conditions,treatment, and outcome of newborns with HDN by Rh alloimmunization after delivery, during hospital stay. 2/ To compare the postnatal clinical course of those who underwent transfusion procedure during pregnancy with those who did not receive intrauterine transfusion (IUT). Patients and methods: A cohort study in which all 114 pregnant women with Rh alloimmunization enrolled in the CEMEFE-HC/UFMG were recruited. Pregnancy facts that might influence the outcome of post-natal development were described and analyzed. The 75 resulting fetuses with HDN born in the HC/UFMG Otto Cirne maternity were evaluated for clinical and laboratory characteristics, treatment, comorbidity and mortality. The postnatal outcomes of the group exposed to the IUT were compared to those of the group not exposed to the IUT.Results: Of the 75 newborns, 31 were exposed to the IUT and 44 were not. The two groups were similar in the following characteristics: postnatal mortality, Apgar score at 5th minute, need for therapy (phototherapy and exchange transfusion), and total hospital days, which can be partly explained by the excellence of care. Newborns undergoing IUT had more serious neonatal progression in the Apgar score 1 minute, needing resuscitation in the delivery room, and showing prematurity, low birth weight, hydrops at birth, low hemoglobin levels during hospital stay, high cord blood bilirubin levels, sepsis, respiratory distress, need for mechanical ventilation, intraventricular hemorrhage, and need for intensive care.Conclusions: The prenatal and postnatal treatments in a reference center meant that mildly anemic and severely anemic fetuses, even with different characteristics at birth, presented with courses similar in many ways, requiring similar therapeutics for HDN treatment. There was, however, a demand for differentiated treatment of comorbidities, probably secondary to the prematurity characteristics to low birth weight and not just to the HDN.