Infants affected by Rh sensitization: A 2-year Canadian National Surveillance Study
Author:
Baker Jillian M123, Campbell Douglas M123, Pavenski Katerina14, Gnanalingam Aasha56, Hollamby Kathleen25, Jegathesan Thivia25, Zipursky Alvin3, Bhutani Vinod7, Sgro Michael125, Allen Rachael, de Almeida M F, Antwi Jeffrey, Baker Jillian, Baleswaran Shangari, Barozzino Matthew, Barozzino Tony, Belncowe Hannah, Casalino Maria, Cheema Sohail, Chitayat David, Danayan Karoon, Debono Mary, Ebbesen Fin, Fahmy Nahed, Ghobrial Maria, Gnanalingam Aasha, Grenier Danielle, Guttman Bell J, Jhaveri Aaditeya, Khanna Rajesh, Kumar Praveen, Kandasamy Sharmilaa, Lawn Joey E, Librach Melissa, Mateo Patrocinio C, Mori Rintaro, Ogbonna Nkemakolam, Anne Okolo Angela, Olusanya Bolajoko, Paul Vinod K, Prajapati Dishaben, Rasiah Saisujani, Reynolds Cole, Selvakumaran Sureka, Sheth Heet, Sethi Tavpritesth, Slusher Tina M, Sritharan Ashvinie, Travis Geoffrey, Twiss Jennifer, Visvanathaiyer Gayathri, Zipursky Alvin,
Affiliation:
1. Faculty of Medicine, University of Toronto, Toronto, Ontario 2. Department of Pediatrics, St. Michael’s Hospital, Toronto, Ontario 3. Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario 4. Department of Laboratory Medicine, St. Michael’s Hospital, Toronto, Ontario 5. Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario 6. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario 7. Department of Pediatrics, Standford School of Medicine, Stanford, California, USA
Abstract
Abstract
Introduction
Rh sensitization occurs when Rh(D)-negative women develop anti-Rh(D) antibodies following exposure through pregnancy or transfusion. Rh disease may cause jaundice, anemia, neurological impairment, and death. It is rare in countries where Rh Immune Globulin (RhIg) is used. Canadian Rh sensitization and disease rates are unknown.
Methods
This survey-based study was conducted using a Canadian Paediatric Surveillance Program questionnaire sent to Canadian paediatricians and paediatric subspecialists to solicit Rh disease cases from May 2016 to June 2018. Paediatricians reported Rh-positive infants ≤ 60 days of age, born to Rh-negative mothers with RhD sensitization.
Results
Sixty-two confirmed cases of infants affected by Rh(D) sensitization were reported across Canada. The median gestational age of neonates was term, age at presentation was 2 hours, and hemoglobin at presentation was 137.5 g/L (33 to 203 g/L). The median peak bilirubin and phototherapy duration were 280 µmol/L (92 to 771 µmol/L), and 124 hours, respectively. Thirty (48%) infants received Intravenous immune globulin (IVIG) (median two doses). Seventeen (27%) received one to three simple transfusions; 10 (16%) required exchange transfusions. Six (10%) infants presented with acute bilirubin encephalopathy, and less than five presented with seizures. Fourteen mothers with affected infants were born outside of Canada.
Discussion
Rh disease continues to exist in Canada. Additional efforts are needed to raise awareness of Rh disease, prevent disease, and minimize sequelae when it does occur. The ongoing global burden of Rh Disease, as well as the possibility of emerging Rh immunoglobulin refusal are among factors that could be taken into consideration in future prevention efforts.
Funder
Canadian Paediatric Surveillance Program Canadian Paediatric Society and Public Health Agency of Canada
Publisher
Oxford University Press (OUP)
Subject
Pediatrics, Perinatology, and Child Health
Reference27 articles.
1. Management of rhesus alloimmunization in pregnancy;Moise;Obstet Gynecol,2002 2. Systematic review of screening for bilirubinencephalopathy in neonates;Trikalinos;Pediatrics,2009 3. Chapter 26 - Bilirubin.;Perlman,2018 4. Prevention of Rh alloimmunization;Fung Kee Fung;J Obstet Gynaecol Can,2003 5. Anti-D administration in pregnancy for preventing rhesus alloimmunisation;Crowther;Cochrane Database Syst Rev,2000
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