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Hemolytic Disease of Newborn Medication

  • Author: Sameer Wagle, MBBS, MD; Chief Editor: Ted Rosenkrantz, MD  more...
 
Updated: Jan 02, 2016
 

Immunomodulators

Class Summary

These agents normalize antibody levels in patients with primary defective antibody synthesis. They prevent and treat certain bacterial and viral infections and reduce the immune-mediated hemolysis and phagocytosis.

Intravenous immunoglobulin (Gamimune, Gammagard, Sandoglobulin, Gammar-P)

 

Several studies have reported success in minimizing the need for exchange transfusion in severe HDN with IVIG. Effective adjunct to phototherapy. Mechanism of action appears to be related to blockage of Fc receptors in the neonatal reticuloendothelial system. Studies have also documented decreased hemolysis after administration of IVIG using carboxyhemoglobin levels. Administration in doses of 500-1000 mg/kg in the first few hours of life to a newborn with severe hemolysis should be considered. However, efficacy depends on timing of administration, duration of treatment, and severity of hemolysis. Should be prepared by and dispensed from pharmacy and should not be mixed with normal saline. Dispensed as either 3% or 6% solution.

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Colony-stimulating Factor

Class Summary

These agents may be required to correct anemia.

Epoetin alfa, recombinant (Epogen, Procrit)

 

Purified glycoprotein produced from mammalian cells modified with gene coding for human erythropoietin (EPO). Amino acid sequence is identical to that of endogenous EPO. Biological activity mimics human urinary EPO, which stimulates division and differentiation of committed erythroid progenitor cells and induces release of reticulocytes from bone marrow into the blood stream.

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Competitive heme oxygenase inhibitor

Class Summary

Phase III clinical trials have been completed in the United States on stannsoporfin, a competitive heme oxygenase inhibitor. The drug is currently available via a compassionate use protocol.

Stannsoporfin (SnMP, Stanate)

 

Also known as tin-mesoporphyrin. Investigational in the United States. Phase III clinical trials completed. Structural analog of heme that blocks heme oxygenase (HO-1), a rate-limiting enzyme in bilirubin production, thereby preventing the conversion of heme to bilirubin. Heme is excreted unchanged in bile and is not stored in tissue. It is inert and does not enter the brain or interact with DNA. It does not affect previously formed bilirubin conjugation or excretion in liver. Several randomized, controlled and, when possible, blinded studies over the last decade that involved >700 neonates with all principle forms of neonatal jaundice have shown SnMP to be effective in preventing and blocking jaundice progression. Phototherapy was eliminated in 97% of treated infants.

Also inhibits nitric oxide synthase and soluble guanylyl cyclase. Repeated doses lead to inhibition of intestinal heme oxygenase involved in iron absorption and may lead to anemia. It also stimulates HO-1 transcription and protein levels. The half-life as measured in healthy adult volunteers is 3.8 h.

Available under the rules of a compassionate use protocol by WellSpring Pharmaceutical and InfaCare Pharmaceutical Corporations. For details, contact Dr Benjamin Levinson (732) 938-5885 ext 224, or by email at blevin@wellsringpharm.com.

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Contributor Information and Disclosures
Author

Sameer Wagle, MBBS, MD Consulting Staff, Division of Neonatology, Northwest Medical Center of Springdale and Willow Creek Women’s Hospital

Sameer Wagle, MBBS, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Prashant G Deshpande, MD Attending Pediatrician, Department of Pediatrics, Christ Hospital Medical Center and Hope Children's Hospital; Assistant Clinical Professor of Pediatrics, Midwestern University

Prashant G Deshpande, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Telemedicine Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

David A Clark, MD Chairman, Professor, Department of Pediatrics, Albany Medical College

David A Clark, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Pediatric Society, Christian Medical and Dental Associations, Medical Society of the State of New York, New York Academy of Sciences, Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Ted Rosenkrantz, MD Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine

Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Eastern Society for Pediatric Research, American Medical Association, Connecticut State Medical Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Oussama Itani, MD, FAAP, FACN Clinical Associate Professor of Pediatrics and Human Development, Michigan State University; Medical Director, Department of Neonatology, Borgess Medical Center

Oussama Itani, MD, FAAP, FACN is a member of the following medical societies: American Academy of Pediatrics, American Association for Physician Leadership, American Heart Association, American College of Nutrition

Disclosure: Nothing to disclose.

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Liley curve. This graph illustrates an example of amniotic fluid spectrophotometric reading of 0.206, which when plotted at 35 weeks' gestation falls into zone 3, indicating severe hemolytic disease.
Modified Liley curve for gestation of less than 24 weeks showing that bilirubin levels in amniotic fluid peak at 23-24 weeks' gestation.
Queenan Curve: Modified Liley curve that shows delta-OD 450 values at 14-40 weeks' gestation.
Slopes for peak systolic velocity in middle cerebral artery (MCA) for normal fetuses (dotted line), mildly anemic fetuses (thin line), and severely anemia fetuses (thick line).
Management of first affected pregnancy.
Management of pregnant women with previously affected fetus.
Table. Comparison of Rh and ABO Incompatibility
Characteristics Rh ABO
Clinical aspects First born 5% 50%
Later pregnancies More severe No increased severity
Stillborn/hydrops Frequent Rare
Severe anemia Frequent Rare
Jaundice Moderate to severe, frequent Mild
Late anemia Frequent Rare
Laboratory findings Direct antibody test Positive Weakly positive
Indirect Coombs test Positive Usually positive
Spherocytosis Rare Frequent
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