{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T06:47:17Z","timestamp":1788850037796,"version":"build-2803163510"},"reference-count":21,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Preventive efforts in pregnancy-related alloimmunization have considerably decreased the prevalence of hemolytic disease of the fetus and newborn (HDFN). International studies are therefore essential to obtain a deeper understanding of the postnatal management and outcomes of HDFN. Taken together with numerous treatment options, large practice variations among centers may exist.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To assess variations in postnatal management and outcomes of HDFN among international centers and to identify opportunities to improve care.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n In this international, retrospective, cohort study, 31 expert centers from 22 countries retrieved data on neonates with HDFN managed between January 1, 2006, and July 1, 2021. Statistical analysis was performed from July 19, 2023, to October 28, 2024.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Main outcomes included the frequency of exchange transfusions, administration of intravenous immunoglobulin, administration of erythropoiesis-stimulating agents, and red blood cell transfusions, as well as the association of gestational age at birth with exchange transfusion frequency and risk factors for adverse neonatal outcomes.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The study included 1855 neonates (median gestational age at birth, 36.4 weeks [IQR, 35.0-37.3 weeks]; 1034 boys [55.7%]), of whom 1017 (54.8%) received any form of antenatal treatment. Most neonates (1447 [78.0%]) had anti-D antibodies. Exchange transfusions were performed in 436 neonates (23.5%), with proportions in exchange transfusion frequency varying from 0% to 78% among centers. Intravenous immunoglobulin was administered to 429 of 1743 neonates (24.6%), with proportions varying from 0% to 100% among centers. A higher gestational age at birth was associated with a reduction in exchange transfusion frequency in neonates with intrauterine transfusion, decreasing from approximately 38.2% (13 of 34) at 34 weeks to 16.8% (18 of 107) after 37 weeks and 0 days. A weekly increase in gestational age at birth was associated with a 43.3% decrease (95% CI, 36.1%-49.7%) in the likelihood of adverse neonatal outcomes, and neonates who received an exchange transfusion were 1.55 (95% CI, 1.10-2.18) times more likely to experience unfavorable outcomes.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study of neonates with HDFN managed at 31 centers in 22 countries, significant practice variations in the postnatal management of HDFN were identified, highlighting the lack of, and need for, consensus. The study suggests that there is a potential beneficial clinical association of waiting for delivery until after 37 weeks and 0 days with frequency of exchange transfusions among neonates with HDFN. The framework to implement international guidelines is provided.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.54330","type":"journal-article","created":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T11:31:18Z","timestamp":1736508678000},"page":"e2454330","source":"Crossref","is-referenced-by-count":15,"title":["Variations and Opportunities in Postnatal Management of Hemolytic Disease of the Fetus and Newborn"],"prefix":"10.1001","volume":"8","author":[{"given":"Derek P.","family":"de Winter","sequence":"first","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Willem-Alexander Children\u2019s Hospital, Leiden University Medical Center, Leiden, the Netherlands"},{"name":"Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands"},{"name":"Department of Immunohematology Diagnostic Services, Sanquin Diagnostic Services, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. J. T. (Joanne)","family":"Verweij","sequence":"additional","affiliation":[{"name":"Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Debeer","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration, KU Leuven, Leuven, Belgium"},{"name":"Department of Neonatology, University Hospitals Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Devlieger","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration, KU Leuven, Leuven, Belgium"},{"name":"Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liesbeth","family":"Lewi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Verbeeck","sequence":"additional","affiliation":[{"name":"Department of Neonatology, University Hospitals Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Maurice","sequence":"additional","affiliation":[{"name":"French National Referral Center in Perinatal Hemobiology and Fetal Medicine Department, Trousseau Hospital, AP-HP, Sorbonne University, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Marie","family":"Jouannic","sequence":"additional","affiliation":[{"name":"French National Referral Center in Perinatal Hemobiology and Fetal Medicine Department, Trousseau Hospital, AP-HP, Sorbonne University, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Gabrielle","family":"Guillemin","sequence":"additional","affiliation":[{"name":"French National Referral Center in Perinatal Hemobiology and Fetal Medicine Department, Trousseau Hospital, AP-HP, Sorbonne University, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agn\u00e8s","family":"Mailloux","sequence":"additional","affiliation":[{"name":"French National Referral Center in Perinatal Hemobiology, Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Cristina","family":"Pessoa dos Santos","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Sa\u00fade da Mulher, da Crian\u00e7a e do Adolescente Fernandes Figueira (IFF\/Fiocruz), Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Amaral de Moura S\u00e1 Pacheco","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Sa\u00fade da Mulher, da Crian\u00e7a e do Adolescente Fernandes Figueira (IFF\/Fiocruz), Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Elisabeth","family":"Lopes Moreira","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Sa\u00fade da Mulher, da Crian\u00e7a e do Adolescente Fernandes Figueira (IFF\/Fiocruz), Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcella","family":"Martins de Vasconcelos Vaena","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Sa\u00fade da Mulher, da Crian\u00e7a e do Adolescente Fernandes Figueira (IFF\/Fiocruz), Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kajsa","family":"Bohlin","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonor","family":"Tiblad","sequence":"additional","affiliation":[{"name":"Division of Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Obstetrics and Gynecology, Ume\u00e5 University Hospital, Ume\u00e5, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilie","family":"Thorup","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Fertility and Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark"},{"name":"Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olav Bj\u00f8rn","family":"Petersen","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Fertility and Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark"},{"name":"Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Sanchez-Holgado","sequence":"additional","affiliation":[{"name":"Department of Neonatology, La Paz University Hospital, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurora","family":"Viejo Llorente","sequence":"additional","affiliation":[{"name":"Department of Hematology and Hemotherapy, La Paz University Hospital, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Borna","family":"Poljak","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Liverpool Women\u2019s Hospital NHS Foundation Trust, Liverpool, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asma","family":"Khalil","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit, Liverpool Women\u2019s Hospital NHS Foundation Trust, Liverpool, United Kingdom"},{"name":"Fetal Medicine Unit, St George\u2019s Hospital, St George\u2019s University of London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K\u00e9vin","family":"Le Duc","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Universit\u00e9 de Lille, CHU Lille, Lille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Ghesquiere","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Universit\u00e9 de Lille, CHU Lille, Lille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jana","family":"Lozar Krivec","sequence":"additional","affiliation":[{"name":"Department of Neonatology, University Children\u2019s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia"},{"name":"Faculty of Medicine, University of Ljubljana, Ljubljana, 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Dritter Orden, Klinikums Dritter Orden, M\u00fcnchen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Saxonhouse","sequence":"additional","affiliation":[{"name":"Wake Forest School of Medicine, Charlotte, North Carolina"},{"name":"Atrium Healthcare Levine Children\u2019s Hospital, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ngina K.","family":"Connors","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Atrium Healthcare Carolinas Medical Center, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annegret","family":"Geipel","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Rath","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and 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