245:"In only 2 situations are patients not monitored identically to patients who are Rh sensitized. The first is that of alloimmunization to the c, E, or, C antigens. Some concern exists that hemolysis may occur in these patients with a lower than 1:16 titer. Thus, if the initial titer is 1:4 and stable but increases at 26 weeks' gestation to 1:8, assessment with MCA Doppler velocity at that point is reasonable. However, if the patient presents in the first trimester with a 1:8 titer that remains stable at 1:8 throughout the second trimester, continued serial antibody titers are appropriate. The second situation in which patients should not be treated identically to patients who are Rh D sensitized is that of Kell isoimmunization because several cases of severe fetal hemolysis with anti-Kell antibodies have occurred in the setting of low titers."
181:"Acute hemolytic transfusion reactions may be either immune-mediated or nonimmune-mediated. Immune-mediated hemolytic transfusion reactions caused by immunoglobulin M (IgM) anti-A, anti-B, or anti-A,B typically result in severe, potentially fatal complement-mediated intravascular hemolysis. Immune-mediated hemolytic reactions caused by IgG, Rh, Kell, Duffy, or other non-ABO antibodies typically result in extravascular sequestration, shortened survival of transfused red cells, and relatively mild clinical reactions. Acute hemolytic transfusion reactions due to immune hemolysis may occur in patients who have no antibodies detectable by routine laboratory procedures."
242:
anemia and hydrops. Titers of 1:8 or higher is considered critical for Kell. Titers of 1:16 or higher are considered critical for all other antibodies. After critical titer is reached, care is based on MCA scans. If antibodies are low and have a sudden jump later in pregnancy, an MCA scan is warranted. If the titer undergoes a 4 fold increase, it should be considered significant regardless of if the critical value has been reached. Maternal titers are not useful in predicting fetal anemia after the first affected gestation and should not be used for the basis of care. Titers are tested monthly until 24 weeks, after which they are done every 2 weeks.
425:
Isoimmunization occurs when the maternal immune system is sensitized to red blood cell surface antigens. The most common causes of isoimmunization are blood transfusion, and fetal-maternal hemorrhage. The hemolytic process can result in anemia, hyperbilirubinemia, neonatal thrombocytopenia, and neonatal neutropenia. With the use of RhD Immunoprophylaxis, (commonly called Rhogam), the incidence of anti-D has decreased dramatically and other alloantibodies are now a major cause of HDN.
271:
routinely done in the UK at the
International Blood Group Reference Laboratory in Bristol. Sanequin laboratory in Amsterdam, Netherlands also performs this test. For US patients, blood may be sent to either of the labs. In the US, Sensigene is done by Sequenome to determine fetal D status. Sequenome does not accept insurance in the US, but US and Canadian patients have had insurance cover the testing done overseas.
411:
intravenousγ-globulin (0.5-1 g/kg over 2 hours) is recommended if the TSB is rising despite intensive phototherapy or the TSB level is within 2 to 3 mg/dL (34-51 μmol/L) of the exchange level . If necessary, this dose can be repeated in 12 hours (evidence quality B: benefits exceed harms). Intravenous γ-globulin has been shown to reduce the need for exchange transfusions in Rh and ABO hemolytic disease."
22:
256:
Blood is generally drawn from the father to help determine fetal antigen status. If he is homozygous for the antigen, there is a 100% chance of all offspring in the pairing to be positive for the antigen and at risk for HDN. If he is heterozygous, there is a 50% chance of offspring to be positive for
410:
IVIG - IVIG has been used to successfully treat many cases of HDN. It has been used not only on anti-D, but on anti-E as well. IVIG can be used to reduce the need for exchange transfusion and to shorten the length of phototherapy. The AAP recommends "In isoimmune hemolytic disease, administration of
1261:
Mari, Giancarlo; Deter, Russell L.; Carpenter, Robert L.; Rahman, Feryal; Zimmerman, Roland; Moise, Kenneth J.; Dorman, Karen F.; Ludomirsky, Avi; Gonzalez, Rogelio; Gomez, Ricardo; Oz, Utku; Detti, Laura; Copel, Joshua A.; Bahado-Singh, Ray; Berry, Stanley; Martinez-Poyer, Juan; Blackwell, Sean C.
326:
IVIG - IVIG stands for
Intravenous Immunoglobulin. It is used in cases of previous loss, high maternal titers, known aggressive antibodies, and in cases where religion prevents blood transfusion. Ivig can be more effective than IUT alone Fetal mortality was reduced by 36% in the IVIG and IUT group
281:
MCA scans: Middle cerebral artery - peak systolic velocity is changing the way sensitized pregnancies are managed. This test is done noninvasively with ultrasound. By measuring the peak velocity of blood flow in the middle cerebral artery, a MoM (multiple of the median) score can be calculated. MoM
265:
There are 3 possible ways to test the fetal antigen status. Free Cell DNA, Amniocentesis, and
Chorionic Villus Sampling (CVS). Of the three, CVS is no longer used due to risk of worsening the maternal antibody response. Once antigen status has been determined, assessment may be done with MCA scans.
241:
Blood testing for the mother is called an
Indirect Coombs Test (ICT) or an Indirect Agglutination Test (IAT). This test tells whether there are antibodies in the maternal plasma. If positive, the antibody is identified and given a titer. Critical titers are associated with significant risk of fetal
270:
Cell-free DNA can be run on certain antigens. Blood is taken from the mother, and using PCR, can detect the K, C, c, D, and E alleles of fetal DNA. This blood test is non-invasive to the fetus and is an easy way of checking antigen status and risk of HDN. Testing has proven very accurate and is
396:
Newborn
Screening Tests - Transfusion with donor blood during pregnancy or shortly after birth can affect the results of the Newborn Screening Tests. It is recommended to wait and retest 10–12 months after last transfusion. In some cases, DNA testing from saliva can be used to rule out certain
424:
Hemolytic disease of the fetus and newborn (HDN) is a condition where the passage of maternal antibodies results in the hemolysis of fetal/neonatal red cells. The antibodies can be naturally occurring such as anti-A, and anti-B, or immune antibodies developed following a sensitizing event.
380:
Reticulocyte count - Reticulocytes are elevated when the infant is producing more blood to combat anemia. A rise in the retic count can mean that an infant may not need additional transfusions. Low retic is observed in infants treated with IUT and in those with HDN from
1523:
Ruma, Michael S.; Moise, Kenneth J.; Kim, Eunhee; Murtha, Amy P.; Prutsman, Wendy J.; Hassan, Sonia S.; Lubarsky, Suzanne L. (2007). "Combined plasmapheresis and intravenous immune globulin for the treatment of severe maternal red cell alloimmunization".
414:
Exchange transfusion - Exchange transfusion is used when bilirubin reaches either the high or medium risk lines on the nonogram provided by the
American Academy of Pediatrics (Figure 4). Cord bilirubin >4 is also indicative of the need for exchange
2031:
1988:
1973:
1346:
Voto, L. S.; Mathet, E. R.; Zapaterio, J. L.; Orti, J; Lede, R. L.; Margulies, M (1997). "High-dose gammaglobulin (IVIG) followed by intrauterine transfusions (IUTs): A new alternative for the treatment of severe fetal hemolytic disease".
344:(IUT) is done either by intraperitoneal transfusion (IPT) or intravenous transfusion (IVT). IVT is preferred over IPT. IUTs are only done until 35 weeks. After that, the risk of an IUT is greater than the risk from post birth transfusion.
257:
the antigen. This test can help with knowledge for the current baby, as well as aid in the decision about future pregnancies. With RhD, the test is called the RhD genotype. With RhCE, and Kell antigen it is called an antigen phenotype.
372:
In some cases, the direct coombs will be negative but severe, even fatal HDN can occur. An indirect coombs needs to be run in cases of anti-C, anti-c, and anti-M. Anti-M also recommends antigen testing to rule out the presence of HDN.
1144:
Scheffer, PG; Van Der Schoot, CE; Page-Christiaens, Gcml; De Haas, M (2011). "Noninvasive fetal blood group genotyping of rhesus D, c, E and of K in alloimmunised pregnant women: Evaluation of a 7-year clinical experience".
2717:
2024:
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Palfi, Miodrag; Hildén, Jan-Olof; Matthiesen, Leif; Selbing, Anders; Berlin, Gösta (2006). "A case of severe Rh (D) alloimmunization treated by intensive plasma exchange and high-dose intravenous immunoglobulin".
2017:
277:
CVS is possible as well to test fetal antigen status but is not recommended. CVS carries a higher risk of fetal maternal hemorrhage and can raise antibody titers, potentially worsening the antibody effect.
330:
Plasmapheresis - Plasmapheresis aims to decrease the maternal titer by direct plasma replacement. Plasmapheresis and IVIG together can even be used on women with previously hydropic fetuses and losses.
932:
Heddle, N. M.; Wentworth, P.; Anderson, D. R.; Emmerson, D.; Kelton, J. G.; Blajchman, M. A. (1995). "Three examples of Rh haemolytic disease of the newborn with a negative direct antiglobulin test".
298:
positive blood for similar reasons). This would require a lot of extra work in blood transfusion departments and it is considered not economical to do the blood group screening at the present time.
178:
Once a woman has antibodies, she is at high risk for a transfusion reaction. For this reason, she must carry a medical alert card at all times and inform all doctors of her antibody status.
1390:
Novak, Deborah J.; Tyler, Lisa N.; Reddy, Ramakrishna L.; Barsoom, Michael J. (2008). "Plasmapheresis and intravenous immune globulin for the treatment of D alloimmunization in pregnancy".
728:
Rath, M. E. A.; Smits-Wintjens, V. E. H. J.; Oepkes, D.; Walther, F. J.; Lopriore, E. (2013). "Iron status in infants with alloimmune haemolytic disease in the first three months of life".
1215:
Finning, Kirstin; Martin, Peter; Summers, Joanna; Daniels, Geoff (2007). "Fetal genotyping for the K (Kell) and Rh C, c, and E blood groups on cell-free fetal DNA in maternal plasma".
2722:
1638:
Rimon, E.; Peltz, R.; Gamzu, R.; Yagel, S.; Feldman, B.; Chayen, B.; Achiron, R.; Lipitz, S. (2006). "Management of Kell isoimmunization — evaluation of a
Doppler-guided approach".
1936:
Antenatal & neonatal screening (second edition). Chapter 12: Rhesus and other haemolytic diseases, by E.A. Letsky, I. Leck, J.M. Bowman. 2000. Oxford
University Press.
353:
Early
Delivery - Delivery can occur anytime after the age of viability. Emergency delivery due to failed IUT is possible, along with induction of labor at 35–38 weeks.
274:
Amniocentesis is another recommended method for testing antigen status and risk for HDN. Fetal antigen status can be tested as early as 15 weeks by PCR of fetal cells.
301:
It is theoretically likely that IgG anti-Rhc antibody injections would prevent sensitization to RBC surface Rhc antigens in a similar way that IgG anti-D antibodies (
1770:
Onesimo, Roberta; Rizzo, Daniela; Ruggiero, Antonio; Valentini, Piero (2010). "Intravenous
Immunoglobulin therapy for anti-E hemolytic disease in the newborn".
1052:
Cacciatore, A; Rapiti, S; Carrara, S; Cavaliere, A; Ermito, S; Dinatale, A; Imbruglia, L; Recupero, S; La Galia, T; Pappalardo, E. M.; Accardi, M. C. (2009).
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Coombs - after birth baby will have a direct coombs test run to confirm antibodies attached to the infant's red blood cells. This test is run from cord blood.
2405:
107:
2420:
1712:
227:
Testing for HDN involves blood work from both mother and father, and may also include assessment with amniocentesis and Middle Cerebral Artery scans.
2400:
1192:
248:
In the case of a positive ICT, the woman must carry a medical alert card or bracelet for life because of the risk of a transfusion reaction.
2303:
1681:
1203:
1947:
Mollison PL, Engelfriet CP and Contreras M. Blood Transfusion in Clinical Medicine. 1997. 10th edition. Blackwell Science, Oxford, UK.
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Ferritin - because most infants affected by HDN have iron overload, a ferritin must be run before giving the infant any additional iron.
2732:
2308:
407:
Phototherapy - Phototherapy is used for cord bilirubin of 3 or higher. Some doctors use it at lower levels while awaiting lab results.
2086:
1941:
524:
Shapiro, Steven M (2004). "Definition of the Clinical Spectrum of Kernicterus and Bilirubin-Induced Neurologic Dysfunction (BIND)".
58:
1626:
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2395:
439:
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2214:
230:
Anti-C and anti-c can both show a negative DAT but still have a severely affected infant. An indirect coombs must also be run.
350:
Phenobarbital - Phenobarbital is sometimes given to the mother to help mature the fetal liver and reduce hyperbilirubinemia.
2727:
2388:
2624:
2547:
2365:
2313:
32:
2614:
2519:
2456:
1303:
Mari, G. (2005). "Middle cerebral artery peak systolic velocity for the diagnosis of fetal anemia: The untold story".
2337:
216:, which is usually caused when a RhD negative mother is sensitised by her first pregnancy with a RhD positive fetus.
2461:
2451:
2342:
1732:
646:
Koenig, J. M.; Christensen, R. D. (1989). "Neutropenia and thrombocytopenia in infants with Rh hemolytic disease".
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2200:
2196:
2156:
2009:
2557:
2478:
1613:
820:
Al-Alaiyan, S.; Al Omran, A. (1999). "Late hyporegenerative anemia in neonates with rhesus hemolytic disease".
387:
Thrombocytes - as thrombocytopenia is one of the complications of HDN, the thrombocyte count should be checked.
347:
Steroids - Steroids are sometimes given to the mother before IUTs and early delivery to mature the fetal lungs.
341:
233:
In the case of anti-c, the woman should be checked around 28 weeks to see if she has developed anti-E as well.
2653:
2619:
2224:
2144:
2134:
2081:
1264:"Noninvasive Diagnosis by Doppler Ultrasonography of Fetal Anemia Due to Maternal Red-Cell Alloimmunization"
602:
Lande, Lottie (1948). "Clinical signs and development of survivors of kernicterus due to Rh sensitization".
2534:
2352:
2261:
2244:
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than in the IUT alone group. IVIG and plasmapheresis together can reduce or eliminate the need for an IUT.
302:
2468:
2176:
444:
384:
Neutrophils - as Neutropenia is one of the complications of HDN, the neutrophil count should be checked.
110:
is the second most common cause of severe HDN. It occurs more commonly in women who are Rh D negative.
1204:
https://www.aacc.org/publications/cln/articles/2015/march/molecular-typing-for-red-blood-cell-antigens
159:
2506:
2496:
2298:
2254:
1438:"Maternal anti-M induced hemolytic disease of newborn followed by prolonged anemia in newborn twins"
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1992:
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https://www.mombaby.org/wp-content/uploads/2016/03/UNC-Isoimmunization-Detection-Prevention.pdf
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102:) can range from a mild to a severe disease. It is the third most common cause of severe HDN.
82:
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309:, but the methods for IgG anti-Rhc antibodies have not been developed at the present time.
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It has been suggested that women of child-bearing age or young girls should not be given a
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2319:
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193:(RBC) Rhc antigens by her first pregnancy with a Rhc positive fetus. The mother can make
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772:
501:
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190:
139:
1997:
1815:"Systematic review of intravenous immunoglobulin in haemolytic disease of the newborn"
1733:"Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation"
659:
615:
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2205:
2045:
1419:
1228:
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317:
There are several intervention options available in early, mid and late pregnancies.
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Arora, Satyam; Doda, Veena; Maria, Arti; Kotwal, Urvershi; Goyal, Saurabh (2015).
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1884:"Hemolytic disease of the fetus and newborn: Current trends and perspectives"
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American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. (2004).
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of 1.5 or greater indicates severe anemia and should be treated with IUT.
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202:
1965:
169:- Must NOT be treated with iron. Can persist up to 12 weeks after birth.
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1830:
219:
Sensitization to Rhc antigens can also be caused by blood transfusion.
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1111:
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741:
2102:
1977:
1651:
1316:
1187:
Transfusion Medicine and Hemostasis: Clinical and Laboratory Aspects
166:
567:
Blair, Eve; Watson, Linda (2006). "Epidemiology of cerebral palsy".
2486:
2233:
2013:
377:
Hgb - the infant's hemoglobin should be tested from cord blood.
205:
and enter the fetal circulation. If the fetus is Rhc positive
2718:
Haemorrhagic and haematological disorders of fetus and newborn
1147:
BJOG: An International Journal of Obstetrics & Gynaecology
15:
1819:
Archives of Disease in Childhood: Fetal and Neonatal Edition
481:
Archives of Disease in Childhood: Fetal and Neonatal Edition
1023:
1021:
1019:
684:
Lalezari, P; Nussbaum, M; Gelman, S; Spaet, T. H. (1960).
977:
975:
973:
971:
773:"Severe late anemia of hemolytic disease of the newborn"
40:
1054:"Obstetric management in Rh alloimmunizated pregnancy"
686:"Neonatal neutropenia due to maternal isoimmunization"
1882:
Basu, Sabita; Kaur, Ravneet; Kaur, Gagandeep (2011).
1772:
The Journal of Maternal-Fetal & Neonatal Medicine
37:
In particular, it has problems with not using MEDMOS.
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212:can occur leading to HDN. This is similar as for
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189:A Rhc negative mother can become sensitised by
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2723:Disorders originating in the perinatal period
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1526:American Journal of Obstetrics and Gynecology
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633:
8:
108:hemolytic disease of the newborn (anti-Kell)
390:Bilirubin should be tested from cord blood.
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2018:
2010:
1956:
1007:Erythrocyte Alloimmunization and Pregnancy
136:Bilirubin Induced Neurological Dysfunction
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59:Learn how and when to remove this message
1640:Ultrasound in Obstetrics and Gynecology
1305:Ultrasound in Obstetrics and Gynecology
569:Seminars in Fetal and Neonatal Medicine
456:
1711:: CS1 maint: archived copy as title (
1704:
1029:Hemolytic Disease of Newborn~treatment
475:Murray, N. A; Roberts, I. A G (2007).
1863:Hemolytic Disease of Newborn~followup
201:, which are able to pass through the
7:
2304:Infant respiratory distress syndrome
1888:Asian Journal of Transfusion Science
1442:Asian Journal of Transfusion Science
1099:Transfusion Medicine and Hemotherapy
869:Transfusion Medicine and Hemotherapy
77:HDN due to anti-Rhc alloimmunization
1813:Gottstein, R; Cooke, R. W. (2003).
983:Hemolytic Disease of Newborn~workup
477:"Haemolytic disease of the newborn"
2309:Transient tachypnea of the newborn
946:10.1111/j.1365-3148.1995.tb00197.x
14:
2087:Twin-to-twin transfusion syndrome
1490:Transfusion and Apheresis Science
1095:"Hemolytic Transfusion Reactions"
865:"Hemolytic Transfusion Reactions"
2605:Vertically transmitted infection
1229:10.1111/j.1537-2995.2007.01437.x
1159:10.1111/j.1471-0528.2011.03028.x
440:Hemolytic disease of the newborn
294:with Rhc positive blood (or Kell
124:High at birth or rapidly rising
96:Hemolytic disease of the newborn
20:
2697:Fetal Alcohol Spectrum Disorder
2647:Group B streptococcal infection
2215:Intrauterine growth restriction
1268:New England Journal of Medicine
162:- MUST NOT be treated with iron
2040:Conditions originating in the
777:Paediatrics & Child Health
771:Mitchell, S; James, A (1999).
31:comply with Knowledge (XXG)'s
29:This article needs editing to
1:
2389:Vitamin K deficiency bleeding
1502:10.1016/j.transci.2006.07.002
1392:Journal of Clinical Apheresis
1349:Journal of Perinatal Medicine
822:Journal of Perinatal Medicine
660:10.1016/s0022-3476(89)80709-7
616:10.1016/S0022-3476(48)80225-8
2548:Periventricular leukomalacia
2366:Persistent fetal circulation
2314:Meconium aspiration syndrome
1058:Journal of Prenatal Medicine
2457:Intraventricular hemorrhage
1281:10.1056/NEJM200001063420102
703:10.1182/blood.V15.2.236.236
2749:
2462:Germinal matrix hemorrhage
2452:Velamentous cord insertion
2343:Bronchopulmonary dysplasia
1561:"Intrauterine Transfusion"
1538:10.1016/j.ajog.2006.10.890
581:10.1016/j.siny.2005.10.010
2733:Acquired hemolytic anemia
2492:Necrotizing enterocolitis
2201:Large for gestational age
2197:Small for gestational age
1784:10.3109/14767050903544751
1578:10.1007/s40556-016-0072-4
1565:Journal of Fetal Medicine
1361:10.1515/jpme.1997.25.1.85
648:The Journal of Pediatrics
604:The Journal of Pediatrics
1455:10.4103/0973-6247.150968
342:Intrauterine transfusion
2654:Neonatal conjunctivitis
2145:Single umbilical artery
2135:Umbilical cord prolapse
2082:Placental insufficiency
2055:complicating pregnancy,
1901:10.4103/0973-6247.75963
1093:Strobel, Erwin (2008).
863:Strobel, Erwin (2008).
526:Journal of Perinatology
493:10.1136/adc.2005.076794
106:is the most common and
2630:ureaplasma urealyticum
2338:Wilson–Mikity syndrome
2262:Brachial plexus injury
1749:10.1542/peds.114.1.297
305:) are used to prevent
303:Rho(D) immune globulin
2578:Congenital hypertonia
2469:Anemia of prematurity
2177:Shoulder presentation
1559:Deka, Dipika (2016).
913:Transfusion Reactions
538:10.1038/sj.jp.7211157
445:Rh blood group system
335:Mid to late pregnancy
174:Transfusion reactions
2728:Transfusion medicine
2583:Congenital hypotonia
2497:Meconium peritonitis
2299:Intrauterine hypoxia
2255:Subgaleal hemorrhage
934:Transfusion Medicine
834:10.1515/JPM.1999.014
2692:Neonatal withdrawal
2675:Perinatal mortality
2525:Sclerema neonatorum
2381:hematologic disease
789:10.1093/pch/4.3.201
41:improve the content
2625:mycoplasma hominis
2610:Neonatal infection
2566:Gray baby syndrome
2543:Perinatal asphyxia
2433:Hyperbilirubinemia
2210:Postterm pregnancy
2057:labour or delivery
1831:10.1136/fn.88.1.F6
654:(4 Pt 1): 625–31.
132:hyperbilirubinemia
2705:
2704:
2593:
2592:
2443:Neonatal jaundice
2361:Pneumopericardium
2331:Pneumomediastinum
2272:Klumpke paralysis
2250:Caput succedaneum
2185:
2184:
2053:Maternal factors
2007:
2006:
1404:10.1002/jca.20180
1193:978-0-12-397788-5
1112:10.1159/000154811
881:10.1159/000154811
742:10.1111/vox.12061
93:
92:
71:Medical condition
69:
68:
61:
2740:
2685:Infant mortality
2520:Erythema toxicum
2512:thermoregulation
2479:Gastrointestinal
2287:
2283:Affected systems
2160:
2128:
2113:Chorioamnionitis
2106:
2077:Placenta praevia
2070:
2061:
2034:
2027:
2020:
2011:
1957:
1924:
1923:
1913:
1903:
1879:
1870:
1859:
1853:
1852:
1842:
1810:
1804:
1803:
1767:
1761:
1760:
1728:
1717:
1716:
1710:
1702:
1700:
1699:
1693:
1687:. Archived from
1686:
1678:
1672:
1671:
1652:10.1002/uog.2837
1635:
1629:
1624:
1618:
1617:
1610:
1599:
1598:
1580:
1556:
1550:
1549:
1520:
1514:
1513:
1484:
1478:
1477:
1467:
1457:
1433:
1424:
1423:
1387:
1381:
1380:
1343:
1337:
1336:
1317:10.1002/uog.1882
1300:
1294:
1293:
1283:
1258:
1249:
1248:
1212:
1206:
1201:
1195:
1185:
1179:
1178:
1141:
1135:
1134:
1124:
1114:
1090:
1084:
1083:
1073:
1049:
1036:
1025:
1014:
1003:
990:
979:
966:
965:
929:
920:
909:
903:
902:
892:
860:
854:
853:
817:
811:
810:
800:
768:
762:
761:
725:
716:
715:
705:
681:
672:
671:
643:
628:
627:
599:
593:
592:
564:
558:
557:
521:
515:
514:
504:
472:
435:Hemolytic anemia
160:Hemolytic Anemia
155:Thrombocytopenia
74:
64:
57:
53:
50:
44:
24:
23:
16:
2748:
2747:
2743:
2742:
2741:
2739:
2738:
2737:
2708:
2707:
2706:
2701:
2658:
2642:Neonatal sepsis
2589:
2558:Musculoskeletal
2552:
2529:
2510:
2501:
2473:
2428:Hydrops fetalis
2379:
2370:
2347:
2320:Pleural disease
2278:
2240:Cephalohematoma
2219:
2181:
2154:
2149:
2122:
2117:
2096:
2091:
2064:
2056:
2054:
2048:
2038:
2008:
2003:
2002:
1968:
1954:
1933:
1931:Further reading
1928:
1927:
1881:
1880:
1873:
1860:
1856:
1812:
1811:
1807:
1769:
1768:
1764:
1730:
1729:
1720:
1703:
1697:
1695:
1691:
1684:
1682:"Archived copy"
1680:
1679:
1675:
1637:
1636:
1632:
1625:
1621:
1612:
1611:
1602:
1558:
1557:
1553:
1532:(2): 138.e1–6.
1522:
1521:
1517:
1486:
1485:
1481:
1435:
1434:
1427:
1389:
1388:
1384:
1345:
1344:
1340:
1302:
1301:
1297:
1260:
1259:
1252:
1223:(11): 2126–33.
1214:
1213:
1209:
1202:
1198:
1186:
1182:
1143:
1142:
1138:
1092:
1091:
1087:
1051:
1050:
1039:
1026:
1017:
1004:
993:
980:
969:
931:
930:
923:
910:
906:
862:
861:
857:
819:
818:
814:
770:
769:
765:
727:
726:
719:
683:
682:
675:
645:
644:
631:
601:
600:
596:
566:
565:
561:
523:
522:
518:
474:
473:
458:
453:
431:
422:
404:
365:
360:
337:
323:
321:Early pregnancy
315:
297:
288:
263:
254:
239:
225:
187:
176:
121:
116:
72:
65:
54:
48:
45:
38:
33:Manual of Style
25:
21:
12:
11:
5:
2746:
2744:
2736:
2735:
2730:
2725:
2720:
2710:
2709:
2703:
2702:
2700:
2699:
2694:
2689:
2688:
2687:
2682:
2672:
2666:
2664:
2660:
2659:
2657:
2656:
2651:
2650:
2649:
2639:
2634:
2633:
2632:
2627:
2622:
2620:herpes simplex
2617:
2607:
2601:
2599:
2595:
2594:
2591:
2590:
2588:
2587:
2586:
2585:
2580:
2568:
2562:
2560:
2554:
2553:
2551:
2550:
2545:
2539:
2537:
2535:Nervous system
2531:
2530:
2528:
2527:
2522:
2516:
2514:
2503:
2502:
2500:
2499:
2494:
2489:
2483:
2481:
2475:
2474:
2472:
2471:
2466:
2465:
2464:
2454:
2448:
2447:
2446:
2445:
2440:
2430:
2425:
2424:
2423:
2418:
2413:
2408:
2403:
2392:
2391:
2385:
2383:
2372:
2371:
2369:
2368:
2363:
2357:
2355:
2353:Cardiovascular
2349:
2348:
2346:
2345:
2340:
2335:
2334:
2333:
2328:
2316:
2311:
2306:
2301:
2295:
2293:
2284:
2280:
2279:
2277:
2276:
2275:
2274:
2269:
2259:
2258:
2257:
2252:
2247:
2242:
2229:
2227:
2221:
2220:
2218:
2217:
2212:
2203:
2193:
2191:
2187:
2186:
2183:
2182:
2180:
2179:
2174:
2169:
2163:
2161:
2151:
2150:
2148:
2147:
2142:
2137:
2131:
2129:
2125:umbilical cord
2119:
2118:
2116:
2115:
2109:
2107:
2093:
2092:
2090:
2089:
2084:
2079:
2073:
2071:
2058:
2050:
2049:
2039:
2037:
2036:
2029:
2022:
2014:
2005:
2004:
2001:
2000:
1985:
1969:
1964:
1963:
1961:
1960:Classification
1953:
1952:External links
1950:
1949:
1948:
1945:
1932:
1929:
1926:
1925:
1871:
1854:
1805:
1778:(9): 1059–61.
1762:
1743:(1): 297–316.
1718:
1673:
1630:
1619:
1600:
1551:
1515:
1479:
1425:
1382:
1338:
1295:
1250:
1207:
1196:
1180:
1153:(11): 1340–8.
1136:
1105:(5): 346–353.
1085:
1037:
1015:
991:
967:
921:
904:
875:(5): 346–353.
855:
812:
763:
717:
673:
629:
610:(6): 693–705.
594:
559:
516:
455:
454:
452:
449:
448:
447:
442:
437:
430:
427:
421:
418:
417:
416:
412:
408:
403:
400:
399:
398:
394:
391:
388:
385:
382:
378:
370:
369:
364:
361:
359:
356:
355:
354:
351:
348:
345:
336:
333:
332:
331:
328:
322:
319:
314:
311:
295:
287:
284:
279:
278:
275:
272:
262:
259:
253:
250:
238:
235:
224:
221:
191:red blood cell
186:
183:
175:
172:
171:
170:
163:
157:
152:
147:
142:
140:Cerebral Palsy
137:
134:
128:
120:
117:
115:
112:
91:
90:
85:
79:
78:
70:
67:
66:
28:
26:
19:
13:
10:
9:
6:
4:
3:
2:
2745:
2734:
2731:
2729:
2726:
2724:
2721:
2719:
2716:
2715:
2713:
2698:
2695:
2693:
2690:
2686:
2683:
2681:
2678:
2677:
2676:
2673:
2671:
2668:
2667:
2665:
2661:
2655:
2652:
2648:
2645:
2644:
2643:
2640:
2638:
2635:
2631:
2628:
2626:
2623:
2621:
2618:
2616:
2613:
2612:
2611:
2608:
2606:
2603:
2602:
2600:
2596:
2584:
2581:
2579:
2576:
2575:
2574:
2573:
2569:
2567:
2564:
2563:
2561:
2559:
2555:
2549:
2546:
2544:
2541:
2540:
2538:
2536:
2532:
2526:
2523:
2521:
2518:
2517:
2515:
2513:
2508:
2504:
2498:
2495:
2493:
2490:
2488:
2485:
2484:
2482:
2480:
2476:
2470:
2467:
2463:
2460:
2459:
2458:
2455:
2453:
2450:
2449:
2444:
2441:
2439:
2436:
2435:
2434:
2431:
2429:
2426:
2422:
2419:
2417:
2414:
2412:
2409:
2407:
2404:
2402:
2399:
2398:
2397:
2394:
2393:
2390:
2387:
2386:
2384:
2382:
2377:
2373:
2367:
2364:
2362:
2359:
2358:
2356:
2354:
2350:
2344:
2341:
2339:
2336:
2332:
2329:
2327:
2324:
2323:
2322:
2321:
2317:
2315:
2312:
2310:
2307:
2305:
2302:
2300:
2297:
2296:
2294:
2292:
2288:
2285:
2281:
2273:
2270:
2268:
2265:
2264:
2263:
2260:
2256:
2253:
2251:
2248:
2246:
2243:
2241:
2238:
2237:
2236:
2235:
2231:
2230:
2228:
2226:
2222:
2216:
2213:
2211:
2207:
2206:Preterm birth
2204:
2202:
2198:
2195:
2194:
2192:
2188:
2178:
2175:
2173:
2170:
2168:
2165:
2164:
2162:
2159:
2158:
2152:
2146:
2143:
2141:
2138:
2136:
2133:
2132:
2130:
2127:
2126:
2120:
2114:
2111:
2110:
2108:
2105:
2104:
2100:
2094:
2088:
2085:
2083:
2080:
2078:
2075:
2074:
2072:
2069:
2068:
2062:
2059:
2051:
2047:
2046:fetal disease
2043:
2035:
2030:
2028:
2023:
2021:
2016:
2015:
2012:
1999:
1995:
1994:
1990:
1986:
1984:
1980:
1979:
1975:
1971:
1970:
1967:
1962:
1958:
1951:
1946:
1943:
1942:0-19-262826-7
1939:
1935:
1934:
1930:
1921:
1917:
1912:
1907:
1902:
1897:
1893:
1889:
1885:
1878:
1876:
1872:
1869:
1865:
1864:
1858:
1855:
1850:
1846:
1841:
1836:
1832:
1828:
1824:
1820:
1816:
1809:
1806:
1801:
1797:
1793:
1789:
1785:
1781:
1777:
1773:
1766:
1763:
1758:
1754:
1750:
1746:
1742:
1738:
1734:
1727:
1725:
1723:
1719:
1714:
1708:
1694:on 2021-03-09
1690:
1683:
1677:
1674:
1669:
1665:
1661:
1657:
1653:
1649:
1646:(6): 814–20.
1645:
1641:
1634:
1631:
1628:
1623:
1620:
1615:
1609:
1607:
1605:
1601:
1596:
1592:
1588:
1584:
1579:
1574:
1570:
1566:
1562:
1555:
1552:
1547:
1543:
1539:
1535:
1531:
1527:
1519:
1516:
1511:
1507:
1503:
1499:
1495:
1491:
1483:
1480:
1475:
1471:
1466:
1461:
1456:
1451:
1448:(1): 98–101.
1447:
1443:
1439:
1432:
1430:
1426:
1421:
1417:
1413:
1409:
1405:
1401:
1397:
1393:
1386:
1383:
1378:
1374:
1370:
1366:
1362:
1358:
1354:
1350:
1342:
1339:
1334:
1330:
1326:
1322:
1318:
1314:
1311:(4): 323–30.
1310:
1306:
1299:
1296:
1291:
1287:
1282:
1277:
1273:
1269:
1265:
1257:
1255:
1251:
1246:
1242:
1238:
1234:
1230:
1226:
1222:
1218:
1211:
1208:
1205:
1200:
1197:
1194:
1190:
1184:
1181:
1176:
1172:
1168:
1164:
1160:
1156:
1152:
1148:
1140:
1137:
1132:
1128:
1123:
1118:
1113:
1108:
1104:
1100:
1096:
1089:
1086:
1081:
1077:
1072:
1067:
1063:
1059:
1055:
1048:
1046:
1044:
1042:
1038:
1035:
1031:
1030:
1024:
1022:
1020:
1016:
1013:
1009:
1008:
1002:
1000:
998:
996:
992:
989:
985:
984:
978:
976:
974:
972:
968:
963:
959:
955:
951:
947:
943:
939:
935:
928:
926:
922:
919:
915:
914:
908:
905:
900:
896:
891:
886:
882:
878:
874:
870:
866:
859:
856:
851:
847:
843:
839:
835:
831:
827:
823:
816:
813:
808:
804:
799:
794:
790:
786:
782:
778:
774:
767:
764:
759:
755:
751:
747:
743:
739:
736:(4): 328–33.
735:
731:
730:Vox Sanguinis
724:
722:
718:
713:
709:
704:
699:
696:(2): 236–43.
695:
691:
687:
680:
678:
674:
669:
665:
661:
657:
653:
649:
642:
640:
638:
636:
634:
630:
625:
621:
617:
613:
609:
605:
598:
595:
590:
586:
582:
578:
575:(2): 117–25.
574:
570:
563:
560:
555:
551:
547:
543:
539:
535:
531:
527:
520:
517:
512:
508:
503:
498:
494:
490:
486:
482:
478:
471:
469:
467:
465:
463:
461:
457:
450:
446:
443:
441:
438:
436:
433:
432:
428:
426:
419:
413:
409:
406:
405:
401:
395:
392:
389:
386:
383:
379:
376:
375:
374:
367:
366:
362:
357:
352:
349:
346:
343:
339:
338:
334:
329:
325:
324:
320:
318:
312:
310:
308:
304:
299:
293:
285:
283:
276:
273:
269:
268:
267:
260:
258:
251:
249:
246:
243:
236:
234:
231:
228:
222:
220:
217:
215:
211:
208:
204:
200:
196:
192:
184:
182:
179:
173:
168:
164:
161:
158:
156:
153:
151:
148:
146:
143:
141:
138:
135:
133:
129:
127:
123:
122:
119:Complications
118:
113:
111:
109:
105:
101:
97:
89:
86:
84:
80:
75:
63:
60:
52:
42:
36:
34:
27:
18:
17:
2570:
2410:
2326:Pneumothorax
2318:
2232:
2225:Birth trauma
2167:Breech birth
2157:presentation
2155:
2123:
2097:
2065:
1987:
1972:
1891:
1887:
1861:
1857:
1825:(1): F6–10.
1822:
1818:
1808:
1775:
1771:
1765:
1740:
1736:
1696:. Retrieved
1689:the original
1676:
1643:
1639:
1633:
1622:
1571:(3): 13–17.
1568:
1564:
1554:
1529:
1525:
1518:
1496:(2): 131–6.
1493:
1489:
1482:
1445:
1441:
1398:(6): 183–5.
1395:
1391:
1385:
1352:
1348:
1341:
1308:
1304:
1298:
1271:
1267:
1220:
1216:
1210:
1199:
1183:
1150:
1146:
1139:
1102:
1098:
1088:
1061:
1057:
1027:
1005:
981:
940:(2): 113–6.
937:
933:
911:
907:
872:
868:
858:
828:(2): 112–5.
825:
821:
815:
783:(3): 201–3.
780:
776:
766:
733:
729:
693:
689:
651:
647:
607:
603:
597:
572:
568:
562:
529:
525:
519:
487:(2): F83–8.
484:
480:
423:
415:transfusion.
371:
316:
300:
289:
280:
264:
255:
247:
244:
240:
232:
229:
226:
218:
188:
180:
177:
114:Presentation
99:
95:
94:
55:
46:
39:Please help
30:
2670:Miscarriage
2572:muscle tone
2438:Kernicterus
2291:Respiratory
2267:Erb's palsy
2172:Asynclitism
2140:Nuchal cord
1355:(1): 85–8.
1274:(1): 9–14.
1217:Transfusion
1064:(2): 25–7.
532:(1): 54–9.
397:conditions.
358:After Birth
292:transfusion
165:Late onset
150:Neutropenia
145:Kernicterus
2712:Categories
2680:Stillbirth
2637:Omphalitis
2598:Infections
2507:Integument
1894:(1): 3–7.
1737:Pediatrics
1698:2017-02-15
1614:"UpToDate"
451:References
381:anti-Kell.
307:Rh disease
286:Prevention
214:Rh disease
207:alloimmune
199:antibodies
130:Prolonged
104:Rh disease
88:Hematology
2406:Anti-Kell
2044:period /
2042:perinatal
1868:eMedicine
1420:206013087
1034:eMedicine
1012:eMedicine
988:eMedicine
918:eMedicine
402:Treatment
313:Treatment
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