How the management of erythroblastosis fetalis has changed

Article Abstract:

Erythroblastosis fetalis (EF) is a complication of pregnancy where the blood types of the fetus and the mother are incompatible. It occurs when the fetus carries blood group antigens from the father that the mother lacks. The mother produces antibodies against the fetal blood, causing red blood cells of the fetus to be destroyed. The most common blood group incompatibility occurs when an Rh negative mother is carrying an Rh positive fetus. The Rh negative mother produces antibodies to attack the Rh positive blood of the fetus. The incidence of erythroblastosis fetalis caused by Rh incompatibility has decreased since the introduction of anti-D immunoglobulin injections, which prevent this reaction. However, other blood group antigen incompatibilities can cause EF. Diagnosis of blood group incompatibilities can be made by fetal blood sampling, where a small amount of blood is taken from the fetus during pregnancy and examined for fetal anemia (reduced red blood cells). Measurements of hematocrit (percentage of red blood cells in the entire blood volume) or hemoglobin (oxygen carrying portion of the red blood cell) can be used to assess the severity of the condition. Doppler ultrasonography, the use of high frequency sound to study the movement of blood through arteries, can determine the thickness of placental tissue and the size and diameter of the fetus. Although less reliable, spectrophotometric studies can detect bilirubin in the fluid surrounding the fetus, which indicates excessive red blood cell destruction. An analysis of red blood cells obtained from chorionic villi sampling (CVS) can determine the exact blood type of the fetus very early in the pregnancy. However, blood from the fetus may mix with blood of the mother to accelerate the production of antibodies. In cases where EF occurs, new techniques allow blood to be transfused directly into the fetal circulation (intravascular) or into the abdominal space of the fetus (intraperitoneal) during pregnancy to correct fetal anemia. Although 90 percent of the affected fetuses survive this procedure, miscarriage, hemorrhage, and fetal death can result. The use of high-dose immunoglobulins G therapy is currently being investigated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Diagnosis, Erythroblastosis fetalis, editorial

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Medical management of postobstructive polyuria

Article Abstract:

Many cases of urinary tract obstruction are followed by a period of polyuria, or secretion of large amounts of urine. Defective ability to concentrate urine results in the loss of large amounts of water and salts; this condition is also referred to as diabetes insipidus. A case is described of a male newborn with congenital obstruction of the urethral valves who developed polyuria after the obstruction was relieved. The infant was hospitalized when six days old due to abdominal distention, low urinary output, penile and scrotal swelling, and poor feeding. Examination revealed the cause of the obstruction, reflux of urine into the kidneys, and urinary tract infection. After drainage of the urinary tract and administration of fluids, the infant's urine output increased, with accompanying weight loss and dehydration. Both hydrochlorothiazide and indomethacin were necessary to reduce urine output and stabilize the infant's weight. (Hydrochlorothiazide is a diuretic that actually decreases urine volume in such cases of diabetes insipidus, and indomethacin inhibits prostaglandins, which are locally produced hormones that affect function of the kidneys and many other tissues.) Discontinuation of the medications resulted in recurrence of polyuria, weight loss and dehydration. Therapy was reinstituted and again reduced urine output and stabilized the infant's condition. Hydrochlorothiazide was discontinued after one week with good results. The patient developed normally for two months, and indomethacin was then discontinued without problems. A number of factors can contribute to postobstructive polyuria. This report illustrates the usefulness of both thiazide diuretics and prostaglandin inhibitors in the treatment of nephrogenic (kidney-related) diabetes insipidus in infants as well as older patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Case studies, Causes of, Drug therapy, Diseases, Infants (Newborn), Prostaglandins, Neonatal diseases, Urinary organs, Urologic diseases, Diabetes insipidus, Hydrochlorothiazide, Urination disorders, Pediatric urology

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