HEMOLYTIC DISEASE OF THE NEWBORN

 Lysis of red blood cells in the newborn leads to hyperbilirubinemia (an elevated level of bilirubin in
the blood)
 Causes: Rh and ABO incompatibility
ABO Incompatibility:
o the maternal blood type is O and the fetal blood type is A; it may also occur when the fetus has type B
or AB blood. A reaction in an infant with type B blood is often the most serious.
o With birth, progressive jaundice, usually occurring within the first 24 hours of life, will begin, indicating
in both Rh and ABO incompatibility that a hemolytic process is at work.
o The jaundice occurs because as red blood cells are destroyed, indirect bilirubin is released. Indirect
bilirubin is fat soluble and cannot be excreted from the body.
o Liver will relase an enzyme glucuronyl transferase converts indirect bilirubin to direct bilirubin to make
it water soluble and be excreted in urine( yellow in color urine)
o In preterm infants or those with extreme hemolysis, the liver cannot convert indirect to direct bilirubin,
so jaundice becomes extreme.
o An increasing indirect bilirubin level is dangerous because if the level rises above 20 mg/dL in a term
infant or 12 mg/dL in a preterm infant, brain damage from bilirubin-induced neurologic dysfunction
(BIND) or a wide spectrum of disorders caused by increasingly severe hyperbilirubinemia that range
from mild dysfunction to kernicterus (invasion of bilirubin into brain cells) can occur.
 
Therapeutic Management:
 Initiation of Early Feeding-Bilirubin is removed from the body by being incorporated into feces.
Therefore, the sooner bowel elimination begins, the sooner bilirubin removal begins.
 Phototherapy-With birth, exposure to light triggers the liver to assume this function and
Additional light supplied by phototherapy appears to speed the conversion potential of the
liver.
o In phototherapy, an infant is continuously exposed to specialized light such as quartz
halogen, cool white daylight, or special blue fluorescent light. The lights are placed 12 to 30
inches above the newborn’s bassinet or incubator
o An infant must continuously wear eye patches and a diaper during phototherapy to protect
the retinas and the ovaries or testes
o The stools of an infant under bilirubin lights are often bright green because of the excessive
bilirubin that is excreted as the result of the therapy. Urine may be dark-colored from
urobilinogen formation.
o Assess skin turgor and intake and output to ensure that dehydration is not occurring from
the warm environment.
 Exchange Transfusion-The umbilical vein is catheterized as the site for transfusion. The procedure
involves alternatively withdrawing small amounts (2–10 mL) of the infant’s blood and then replacing
it with equal amounts of donor blood. The blood is exchanged slowly this way to prevent alternating
hypovolemia and hypervolemia. This can make an exchange transfusion a lengthy procedure of 1 to
3 hours.