A RECENT international cohort study has revealed significant variations in the postnatal management and outcomes of haemolytic disease of the foetus and newborn (HDFN) across 31 expert centres in 22 countries. The study, which included data from 1,855 neonates managed between 2006 and 2021, found wide discrepancies in the frequency of exchange transfusions and the use of intravenous immunoglobulins (IVIg), two common treatments for HDFN.
Exchange transfusion, a procedure to replace a baby’s blood with healthy blood, was performed in 23.5% of cases, but the frequency varied dramatically among centres, ranging from 0% to 78%. Similarly, 24.6% of neonates received IVIg, but this figure ranged from 0% to 100% depending on the centre.
The study also identified a potential link between gestational age at birth and reduced frequency of exchange transfusions. Babies born after 37 weeks had fewer transfusions, with the likelihood of adverse outcomes decreasing by 43.3% for each additional week of gestational age. Neonates who received an exchange transfusion were more likely to experience unfavourable outcomes.
The findings suggest that the timing of delivery and postnatal interventions, such as exchange transfusions, could be optimised. The study calls for international guidelines to address the significant practice variations and improve HDFN care worldwide. These results provide a crucial foundation for building consensus and enhancing global healthcare standards for managing this condition.
Helena Bradbury, EMJ
Reference
Winter DP et al. Variations and opportunities in postnatal management of hemolytic disease of the fetus and newborn. 2025;8(1):e2454330.
