{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T05:51:16Z","timestamp":1779256276213,"version":"3.51.4"},"reference-count":25,"publisher":"Georg Thieme Verlag KG","issue":"07","license":[{"start":{"date-parts":[[2024,11,12]],"date-time":"2024-11-12T00:00:00Z","timestamp":1731369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>This study aims to identify hemolytic disease of the fetus and newborn (HDFN) pregnancies using electronic health records (EHRs) from a large integrated health care system.<\/jats:p><jats:p>A retrospective cohort study was performed among pregnant patients receiving obstetrical care at Kaiser Permanente Southern California health care system between January 1, 2008, and June 30, 2022. Using structured (diagnostic\/procedural codes, medication, and laboratory records) and unstructured (clinical notes analyzed via natural language processing) data abstracted from EHRs, we extracted HDFN-specific \u201cindicators\u201d (maternal positive antibody test and abnormal antibody titer, maternal\/infant HDFN diagnosis and blood transfusion, hydrops fetalis, infant intravenous immunoglobulin [IVIG] treatment, jaundice\/phototherapy, and first administrated Rho[D] Immune Globulin) to identify potential HDFN pregnancies. Chart reviews and adjudication were then performed on select combinations of indicators for case ascertainment. HDFN due to ABO alloimmunization alone was excluded. The HDFN frequency and proportion of each combination were fully analyzed.<\/jats:p><jats:p>Among the 464,711 eligible pregnancies, a total of 136 pregnancies were confirmed as HDFN pregnancies. The percentage of the HDFN-specific indicators ranged from 0.02% (infant IVIG treatment) to 34.53% (infant jaundice\/phototherapy) among the eligible pregnancies, and 32.35% (infant IVIG treatment) to 100% (maternal positive antibody test) among the 136 confirmed HDFN pregnancies. Four combination groups of four indicators, four combination groups of five indicators, and the unique combination of six indicators showed 100% of HDFN pregnancies, while 80.88% of confirmed HDFN pregnancies had the indicator combination of maternal positive antibody test, maternal\/infant HDFN diagnosis, and infant jaundice\/phototherapy.<\/jats:p><jats:p>We successfully identified HDFN pregnancies by leveraging a combination of medical indicators extracted from structured and unstructured data that may be used in future pharmacoepidemiologic studies. Traditional indicators (positive antibody test results, high titers, and clinical diagnosis codes) alone did not accurately identify HDFN pregnancies, highlighting an unmet need for improved practices in HDFN coding.<\/jats:p>","DOI":"10.1055\/a-2444-2314","type":"journal-article","created":{"date-parts":[[2024,11,12]],"date-time":"2024-11-12T23:57:57Z","timestamp":1731455877000},"page":"924-932","source":"Crossref","is-referenced-by-count":5,"title":["Identifying Hemolytic Disease of the Fetus and Newborn within a Large Integrated Health Care System"],"prefix":"10.1055","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1565-0490","authenticated-orcid":false,"given":"Fagen","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J.","family":"Fassett","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, California"},{"name":"Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiaxiao M.","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vicki Y.","family":"Chiu","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theresa M.","family":"Im","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunhea","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nana A.","family":"Mensah","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nehaa","family":"Khadka","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniella","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carol","family":"Mao","sequence":"additional","affiliation":[{"name":"Janssen Global Services LLC, a Johnson & Johnson company, Horsham, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Molaei","sequence":"additional","affiliation":[{"name":"Janssen Global Services LLC, a Johnson & Johnson company, Horsham, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iris","family":"Lin","sequence":"additional","affiliation":[{"name":"Janssen Scientific Affairs LLC, a Johnson & Johnson company, Horsham, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3610-8841","authenticated-orcid":false,"given":"Darios","family":"Getahun","sequence":"additional","affiliation":[{"name":"Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California"},{"name":"Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,11,12]]},"reference":[{"issue":"07","key":"ref1","doi-asserted-by":"crossref","first-page":"e0235807","DOI":"10.1371\/journal.pone.0235807","article-title":"Hemolytic disease of the fetus and newborn due to Rh(D) incompatibility: A preventable disease that still produces significant morbidity and mortality in children","volume":"15","author":"V Pegoraro","year":"2020","journal-title":"PLoS One"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.cll.2020.10.009","article-title":"Hemolytic disease of the fetus and newborn: historical and current state","volume":"41","author":"M E Jackson","year":"2021","journal-title":"Clin Lab Med"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1182\/asheducation-2015.1.146","article-title":"Hemolytic disease of the fetus and newborn: managing the mother, fetus, and newborn","volume":"2015","author":"M Delaney","year":"2015","journal-title":"Hematology (Am Soc Hematol Educ Program)"},{"issue":"11","key":"ref4","doi-asserted-by":"crossref","first-page":"e27619","DOI":"10.1371\/journal.pone.0027619","article-title":"Constructing a population-based research database from routine maternal screening records: a resource for studying alloimmunization in pregnant women","volume":"6","author":"B K Lee","year":"2011","journal-title":"PLoS One"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1053\/j.semperi.2011.02.009","article-title":"Diagnostic laboratory technologies for the fetus and neonate with isoimmunization","volume":"35","author":"S M Geaghan","year":"2011","journal-title":"Semin Perinatol"},{"issue":"09","key":"ref6","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1016\/S1701-2163(16)30995-1","article-title":"Prevention of Rh alloimmunization","volume":"25","author":"K Fung Kee Fung","year":"2003","journal-title":"J Obstet Gynaecol Can"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"267","DOI":"10.2146\/ajhp140288","article-title":"Rh(O)D immune globulin products for prevention of alloimmunization during pregnancy","volume":"72","author":"S L Aitken","year":"2015","journal-title":"Am J Health Syst Pharm"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"429","DOI":"10.2147\/IJWH.S15165","article-title":"Rh isoimmunization in Sub-Saharan Africa indicates need for universal access to anti-RhD immunoglobulin and effective management of D-negative pregnancies","volume":"2","author":"E Osaro","year":"2010","journal-title":"Int J Womens Health"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s40748-021-00129-3","article-title":"Prevalence of rhesus D-negative blood type and the challenges of rhesus D immunoprophylaxis among obstetric population in Ethiopia: a systematic review and meta-analysis","volume":"7","author":"A A Ayenew","year":"2021","journal-title":"Matern Health Neonatol Perinatol"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1111\/vox.12265","article-title":"Haemolytic disease of the fetus and newborn","volume":"109","author":"M de Haas","year":"2015","journal-title":"Vox Sang"},{"key":"ref11","volume-title":"Erythroblastosis fetalis","author":"G N Nassar","year":"2021"},{"issue":"09","key":"ref12","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/j.earlhumdev.2011.07.010","article-title":"Hematological morbidity and management in neonates with hemolytic disease due to red cell alloimmunization","volume":"87","author":"M E Rath","year":"2011","journal-title":"Early Hum Dev"},{"issue":"07","key":"ref13","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1080\/17474086.2017.1331124","article-title":"Neonatal management and outcome in alloimmune hemolytic disease","volume":"10","author":"I MC Ree","year":"2017","journal-title":"Expert Rev Hematol"},{"issue":"04","key":"ref14","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.tmrv.2016.05.008","article-title":"Hemolytic disease of the fetus and newborn: modern practice and future investigations","volume":"30","author":"J E Hendrickson","year":"2016","journal-title":"Transfus Med Rev"},{"issue":"05","key":"ref15","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1097\/AOG.0b013e31826d7dc1","article-title":"Management and prevention of red cell alloimmunization in pregnancy: a systematic review","volume":"120","author":"K J Moise Jr","year":"2012","journal-title":"Obstet Gynecol"},{"issue":"02","key":"ref16","doi-asserted-by":"crossref","first-page":"138.e1","DOI":"10.1016\/j.ajog.2006.10.890","article-title":"Combined plasmapheresis and intravenous immune globulin for the treatment of severe maternal red cell alloimmunization","volume":"196","author":"M S Ruma","year":"2007","journal-title":"Am J Obstet Gynecol"},{"issue":"02","key":"ref17","doi-asserted-by":"crossref","first-page":"100203","DOI":"10.1016\/j.xagr.2023.100203","article-title":"Live birth prevalence of hemolytic disease of the fetus and newborn in the United States from 1996 to 2010","volume":"3","author":"D Yu","year":"2023","journal-title":"AJOG Glob Rep"},{"issue":"11","key":"ref18","doi-asserted-by":"crossref","first-page":"2684","DOI":"10.1111\/trf.15987","article-title":"Red blood cell alloimmunization prevalence and hemolytic disease of the fetus and newborn in Israel: a retrospective study","volume":"60","author":"N Rahimi-Levene","year":"2020","journal-title":"Transfusion"},{"key":"ref19","volume-title":"Hemolytic diseases of the newborn","author":"V Hall","year":"2021"},{"issue":"24","key":"ref20","doi-asserted-by":"crossref","first-page":"3270","DOI":"10.1001\/jama.1991.03460240066029","article-title":"Epidemiology of Rh hemolytic disease of the newborn in the United States","volume":"265","author":"G F Ch\u00e1vez","year":"1991","journal-title":"JAMA"},{"issue":"02","key":"ref21","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1136\/jamia.1994.95236146","article-title":"A general natural-language text processor for clinical radiology","volume":"1","author":"C Friedman","year":"1994","journal-title":"J Am Med Inform Assoc"},{"issue":"03","key":"ref22","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1136\/jamia.2009.002295","article-title":"caTIES: a grid based system for coding and retrieval of surgical pathology reports and tissue specimens in support of translational research","volume":"17","author":"R S Crowley","year":"2010","journal-title":"J Am Med Inform Assoc"},{"issue":"09","key":"ref23","doi-asserted-by":"crossref","first-page":"e37896","DOI":"10.2196\/37896","article-title":"Identification of preterm labor evaluation visits and extraction of cervical length measures from electronic health records within a large integrated health care system: algorithm development and validation","volume":"10","author":"F Xie","year":"2022","journal-title":"JMIR Med Inform"},{"issue":"04","key":"ref24","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1007\/s42979-022-01175-0","article-title":"Identifying spontaneous abortion from clinical notes within a large integrated healthcare system","volume":"3","author":"F Xie","year":"2022","journal-title":"SN Comput Sci"},{"issue":"03","key":"ref25","doi-asserted-by":"crossref","first-page":"37","DOI":"10.7812\/TPP\/12-031","article-title":"Sociodemographic characteristics of members of a large, integrated health care system: comparison with US Census Bureau data","volume":"16","author":"C Koebnick","year":"2012","journal-title":"Perm J"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2444-2314.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T22:31:59Z","timestamp":1745274719000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2444-2314"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,12]]},"references-count":25,"journal-issue":{"issue":"07","published-online":{"date-parts":[[2025,4,21]]},"published-print":{"date-parts":[[2025,5]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2444-2314","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,12]]}}}