Rhesus alloimmunization is correlated to necrotizing enterocolitis and respiratory distress: A tertiary center experience

Abstract

Background Rh alloimmunization occurs in pregnant women who do not express the red blood cell Rh antigen phenotype but carry a fetus that does. The mainstay of treatment is intrauterine blood transfusion (IUT). Necrotizing enterocolitis (NEC) is a rapidly progressive and life-threatening emergency that most commonly affects preterm neonates. It has been noticed that NEC has a predilection toward neonates with rhesus hemolytic disease (RHD) compared to neonates without RHD, particularly among the late preterm to near-term population with a moderate to severe grade of RHD. Methodology This is a retrospective cohort study that included all neonates delivered in our hospital between January 2015 and December 2021,who received IUT due to Rh-isoimmunization, and the control group consisted of neonates, who did not have Rh-isoimmunization and no history of IUT. Neonates were excluded from the study if they met our exclusion criteria. Results During a 7-year study period, a total of 144 neonates were included in the study. Of those, 72 neonates had RHD and received IUT (group 1), while 72 neonates did not have RH isoimmunization and did not receive IUT (group 2). Maternal and neonatal demographic data were similar between the two groups, except for birth weight, which was higher in group 1 (2.49 vs. 2.31 kg, P = 0.025). Ten cases developed NEC (13.89%) in group 1, while there were no cases of NEC in the other group (P = 0.001). We also found that the initial hemoglobin level was lower in group 1 (135.4 vs. 174.3 g/dL) with a P value of <0.001. The duration of respiratory support was significantly higher in group 1 (2.27 vs. 0.319 days; P = 0.006). Neonatal sepsis was more in group 1 (19.44 vs. 1.39%; P = 0.002). There was no significant difference between the two groups in terms of respiratory distress syndrome, intraventricular hemorrhage, and retinopathy of prematurity. Conclusion Neonates with rheus hemolytic disease (RHD) who undergo IUT are at a higher risk of developing NEC and prolonged course of respiratory support. Extra cautions may be necessary when advancing feeding in these patients. A well-designed multicenter prospective trial with an adequate sample size is recommended to validate our result.