Hemolytic disease of the newborn(morbus haemolyticus neonatorum),fetal erythroblastosis(erythroblastosis fetalis) is a disease of the newborn that develops with the incompatibility of the blood of the mother and the fetus in different blood systems, most often in the Rh factor, as well as in the main. ABO blood groups. Frequency G. b. n - 1 case for 250-300 births.
G. b. n develops, if with Rh incompatibility of the blood of the mother and father (the mother is Rh-negative, the father is Rh-positive), the fruit inherits the Rh factor from the Rh-positive father.
CLINIC. The Rh fetus antigen penetrates the placenta into the bloodstream of the Rh-negative mother. The mother's body produces antibodies to the fetus Rh-antigen, which, entering the blood of the Rh-positive fetus through the placenta back, destroys its red blood cells (their hemolysis occurs). As a result, anemia (anemia) develops and the hemoglobin breakdown product - yellow pigment bilirubin - accumulates in the blood. G. b. n more often observed in children born from the 2nd, 3rd and subsequent pregnancies, as well as from pregnancy, which was preceded by abortion.It may occur during the first pregnancy, if the mother had previously transfused blood without taking into account the Rh factor. In AVO-incompatibility, the disease develops already at the first pregnancy, if the mother has the first blood type, and the child has the II or III. There are 4 forms of G. b. N .: fetal death with maceration, general swelling of the fetus, jaundice of newborns, congenital anemia of newborns.
The most common icteric form G. b. n Jaundice appears in the first 24-48 hours of life and progressively increases to 6-7th day. due to the accumulation in the blood of toxic to the body, especially for the brain, indirect bilirubin. The child has anemia with the presence of young forms of erythrocytes (erythroblasts, normoblasts), the liver and spleen are enlarged. If you do not take vigorous measures to reduce bilirubin, then on the eb day. marked toxic. the effect of indirect bilirubin and may develop a complication - bilirubin encephalopathy with subsequent lag in physical. and neuro-psychological development of the child.
The most effective method for the treatment of icteric form G. b. n - replacement blood transfusions, in which toxic is removed from the body.hemoglobin degradation products (bilirubin) and rhesus antibodies that have penetrated from the mother's body. An indication for immediate replaceable blood transfusion is the appearance of jaundice immediately after birth, an hourly increase in bilirubin of more than 0.25–0.3 mg% and another. Simultaneously, hemodez, glucose, albumin, vitamins B, C, K, glutamine K-that, phenobarbital are prescribed, Phototherapy and other. If the mother's milk contains antibodies, the baby should be fed with donor or pasteurized mother's milk.
PREVENTION. Early diagnostics is required. G. b. n., based on the determination of the Rh factor in all women, and the registration by women's clinics of all Rh-negative women, in whom rhesus antibodies are determined. After the first pregnancy (childbirth, abortion), angi-0 immunization is performed for such women. In subsequent pregnancies - systematic. determination of antibodies in the blood during the entire period of pregnancy (1 time per month in the 1st half and 2 times per month in the 2nd half) and the appointment of three courses of desensitization therapy (diet: cottage cheese, raw liver, vegetables, fruits); glucose with vitamins B and C, vitamin E, drugs,improving the function of the liver - vitohepat, Essentiale and others; Dimedrol for the night; by indications transplantation, 2-3 times, skin flap from the husband, hemosorption), early delivery in 37-38 weeks. With early diagnosis and timely treatment, the child develops without deviations from the norm.
With residual lesions of c. n from. during the year, 3 courses of treatment with Cerebrolysin, glutamic acid, vitamin B12; Showing massage, gymnastics. After discharge from the maternity hospital, newborns should be under the supervision of a pediatrician and a neuropathologist.