Clinicians

Rh disease

Jaundice is the yellow color seen in the skin of many newborns. Jaundice happens when a chemical called bilirubin builds up in the baby’s blood. During pregnancy, the mother’s liver removes bilirubin for the baby, but after birth the baby’s liver must remove the bilirubin. In some babies, the liver might not be developed enough to efficiently get rid of bilirubin. When too much bilirubin builds up in a new baby’s body, the skin and whites of the eyes might look yellow. This yellow coloring is called jaundice.

When severe jaundice goes untreated for too long, it can cause a condition called kernicterus. Kernicterus is a type of brain damage that can result from high levels of bilirubin in a baby’s blood. It can cause athetoid cerebral palsy and hearing loss. Kernicterus also causes problems with vision and teeth and sometimes can cause intellectual disabilities. Early detection and management of jaundice can prevent kernicterus.

What causes Rh disease?

Jaundice can develop when red blood cells break down and bilirubin is left. It is normal for some red blood cells to die every day. In the womb, the mother’s liver removes bilirubin for the baby, but after birth the baby’s liver must remove the bilirubin. In some babies, the liver might not be developed enough to efficiently get rid of bilirubin. When too much bilirubin builds up in a new baby’s body, the skin and whites of the eyes might look yellow. This yellow coloring is called jaundice.



Training and Resources


Standardised guidelines for prevention of Rh disease

No baby should develop brain damage from untreated jaundice.

When being treated for high bilirubin levels, the baby will be undressed and put under special lights. The lights will not hurt the baby. This can be done in the hospital or even at home. The baby’s milk intake may also need to be increased. In some cases, if the baby has very high bilirubin levels, the doctor will do a blood exchange transfusion. Jaundice is generally treated before brain damage is a concern.

Putting the baby in sunlight is not recommended as a safe way of treating jaundice.


Possible side effects of Rh immune globulin shot

  • Difficulty breathing
  • Hives
  • Swelling of your face, lips, tongue, or throat
  • Fever, chills, or shaking

Symptoms of Rh disease

Jaundice usually appears first on the face and then moves to the chest, belly, arms, and legs as bilirubin levels get higher. The whites of the eyes can also look yellow. Jaundice can be harder to see in babies with darker skin color. The baby’s doctor or nurse can test how much bilirubin is in the baby’s blood.

  • Is very yellow or orange (skin color changes start from the head and spread to the toes).
  • Is hard to wake up or will not sleep at all.
  • Is not breastfeeding or sucking from a bottle well.
  • Is very fussy.
  • Does not have enough wet or dirty diapers.

Major Risk Factors

  • Jaundice within first 24 hours after birth.
  • A sibling who was jaundiced as a neonate.
  • Unrecognized hemolysis such as ABO blood type incompatibility or Rh incompatibility.
  • Nonoptimal sucking/nursing.
  • Deficiency in glucose-6-phosphate dehydrogenase, a genetic disorder.
  • Infection.
  • Cephalohematomas/bruising.
  • East Asian or Mediterranean descent.

Management of Rh disease in newborn infant

From the American Academy of Pediatrics Practice Guidelines, 2004 These guidelines provide a framework for the prevention and management of hyperbilirubinemia in newborn infants of 35 or more weeks of gestation. In every infant, we recommend that clinicians

  1. promote and support successful breastfeeding;
  2. perform a systematic assessment before discharge for the risk of severe hyperbilirubinemia;
  3. provide early and focused follow-up based on the risk assessment; and
  4. when indicated, treat newborns with phototherapy or exchange transfusion to prevent the development of severe hyperbilirubinemia and, possibly, bilirubin encephalopathy (kernicterus).

Severe Rh disease Care

  1. Promote and support successful breastfeeding.
  2. Establish nursery protocols—include circumstances in which nurses can order a bilirubin.
  3. Measure TSB or TcB if jaundice occurs in the first 24 hours.
  4. Do not rely on visual estimation of jaundice. This can lead to errors, particularly in darkly pigmented infants.
  5. Interpret bilirubin levels according to the infant’s age in hours. Note that infants <38 weeks, particularly if breastfed, are high risk.
  6. Perform risk assessment before discharge.
  7. Give parents written and oral information about jaundice.
  8. Provide appropriate follow-up based on time of discharge and risk assessment.
  9. Treat newborns, when indicated, with phototherapy or exchange transfusion.

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Where to procure Rh Immune Globulin

 

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