NEONATAL DEATH IN BABIES WITH RHESUS ISOIMMUNIZATION

  • 1 January 1979
    • journal article
    • research article
    • Vol. 48  (190) , 211-225
Abstract
In the 27 yr, from 1951-1977, 4315 babies weighing over 1 kg were born alive in Newcastle upon Tyne [England, United Kingdom] suffering from hemolytic disease of the newborn due to Rhesus isoimmunization; 197 (4.5%) died within 4 wk of delivery. Many babies with severe anemia (cord Hb .ltoreq. 8 g/dl) died of cerebral and/or pulmonary hemorrhage as a result of coagulation failure; others with hydrops had a chance of recovery with intensive care as long as there was no associated pulmonary hypoplasia. Hyaline membrane disease was no more common in babies with hemolytic disease than in other preterm babies of comparable birthweight, but incorrect assessment of gestational age prior to the induction of labor increased the risk of death from hyaline membrane disease. The introduction of closed chest cardiac massage virtually eliminated the risk of sudden unexpected death during exchange transfusion but there was still a 1.5% chance of sudden circulatory collapse during exchange transfusion. Affected babies of less than 36 wk gestation with respiratory problems face a substantial risk of kernicterus when the indirect serum bilirubin level exceeds 270 .mu.mol/l (15 mg/100 ml). The establishment of a single referral center for Rhesus isoimmunization reduced neonatal mortality in the area to 1/2 the national average in the early 1950''s; this superiority was maintained throughout the next decade.