a. This is considered a hemolytic disease of the fetus and newborn, which stems from an incompatibility of fetal and maternal blood which results in maternal antibody activity against fetal red blood cells (RBCs).

This disease usually is a result from Rh isoimmunization.

During her first pregnancy, an Rh-negative female becomes sensitized by exposure to Rh-positive fetal blood antigens inherited from the father. A subsequent pregnancy with an Rh-positive fetus provokes increasing amounts of maternal agglutinating antibodies to cross the placental barrier, attach to Rh-positive cells in the fetus, and cause hemolysis and anemia.

To compensate for this, the fetus steps up the production of RBCs, and erythroblasts appear in the fetal circulation. Extensive hemolysis results in the release of large amounts of unconjugated bilirubin, which the liver is unable to modify and excrete, causing hyperbilirubinemia and hemolytic anemia.

b. Signs and symptoms include:

(1) Jaundice – usually not present at birth but may appear as soon as 30 minutes later or within 24 hours after birth.

(2) Edema.

(3) Petechiae.

(4) Grunting respirations.

(5) Neurologic unresponsiveness.

(6) Bile-stained umbilical cord.

c. Treatment depends on the degree of maternal sensitization and the effects of hemolytic disease on the fetus or newborn.

(1) Intrauterine-intraperitoneal transfusion.

(a) This is performed when amniotic fluid analysis suggests the fetus is severely affected and delivery is inappropriate due to fetal immaturity.

(b) A transabdominal puncture into the fetal peritoneal cavity allows infusion of group O, Rh-negative blood.

(c) This may be repeated every two weeks until the fetus is mature enough for delivery.

(2) Exchange transfusion. This removes antibody-coated RBCs and prevents hyperbilirubinemia through removal of the infant’s blood and replacement with fresh group O, Rh-negative blood.

(3) Albumin infusion. This aids in the binding of bilirubin, reducing the chances of hyperbilirubinemia.

d. Nursing interventions.

(1) Reassure parents, explain procedures, and allow them time to ventilate.

(2) Provide patient teaching.

(3) Maintain baby’s temperature.

(4) Keep resuscitative equipment available.

(5) Watch for complications of transfusion.

(a) Muscular twitching.

(b) Convulsions.

(c) Dark urine.