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Infants affected by Rh sensitization: A 2-year Canadian National Surveillance Study
Jillian M Baker1,2,3, Douglas M Campbell1,2,3, Katerina Pavenski1,4
1Faculty of Medicine, University of Toronto, Toronto, Ontario.
Paediatrics & Child Health
|May 3, 2021
Summary
Rh disease, a preventable condition, still occurs in Canada, affecting infants born to Rh-negative mothers. Increased awareness and prevention efforts are crucial to minimize severe outcomes like jaundice and anemia.
Area of Science:
- Neonatal Medicine
- Immunology
- Public Health
Background:
- Rh sensitization in Rh(D)-negative women can lead to Rh disease in infants, causing serious complications like jaundice, anemia, and neurological impairment.
- While rare in countries with routine Rh Immune Globulin (RhIg) use, Canadian rates of Rh sensitization and disease were previously unknown.
- This study addresses the knowledge gap regarding the incidence and characteristics of Rh disease in Canada.
Purpose of the Study:
- To determine the current rates and clinical features of Rh disease in infants across Canada.
- To identify the sequelae of Rh disease in affected neonates.
- To inform future prevention strategies for Rh disease in the Canadian context.
Main Methods:
- A survey-based study utilizing the Canadian Paediatric Surveillance Program questionnaire.
- Data collected from Canadian paediatricians and paediatric subspecialists on Rh-positive infants born to Rh-negative mothers with RhD sensitization from May 2016 to June 2018.
- Inclusion criteria: infants ≤ 60 days of age with confirmed RhD sensitization.
Main Results:
- Sixty-two cases of Rh(D) sensitization in infants were reported nationwide.
- Affected infants presented with a median hemoglobin of 137.5 g/L and peak bilirubin of 280 µmol/L, requiring phototherapy (median 124 hours).
- Treatments included Intravenous immune globulin (IVIG) in 48% of cases, simple transfusions in 27%, and exchange transfusions in 16%; 10% presented with acute bilirubin encephalopathy.
Conclusions:
- Rh disease remains a present concern in Canada, despite the availability of preventative measures.
- Enhanced public and professional awareness of Rh disease is necessary to improve prevention and management.
- Future prevention efforts should consider the global burden of Rh disease and potential challenges like Rh immunoglobulin refusal.
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