Maternal-fetal medicine (Wolters Kluwer Health, Inc.) · 2026
Clinical Characteristics of Early-Onset Severe Hemolytic Disease of the Fetus and Newborn and Treatment Efficacy of Serial Intrauterine Transfusions: A 10-Year Single-Center Experience in China.
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Liu Quanrui, Zhao Jingya, Liu Jingyu, Li Danlun, He Zhiming, Luo Yanmin, Zhou Yi
Аннотация
OBJECTIVE: To summarize the clinical characteristics of early-onset severe hemolytic disease of the fetus and newborn (HDFN) in a Chinese cohort and identify factors influencing intrauterine transfusion (IUT) frequency and pregnancy outcomes.
METHODS: This retrospective cohort study included cases managed between 2013 and 2022. Factors affecting IUT efficacy were analyzed with regard to subsequent IUT risk and adverse pregnancy outcomes. Survival analysis for recurrent events was performed to assess subsequent IUT risk.
RESULTS: Of the 97 cases included, 38 were identified as early-onset severe HDFN. Compared with non-early-onset severe HDFN, early-onset severe HDFN was characterized by higher anti-D titer (1:1024 vs. 1:512, respectively, P = 0.006), multiple alloantibodies (50.00% vs. 20.34%, respectively, P = 0.002), and an earlier gestational age at initial IUT (22.4 ± 3.2 vs. 29.0 ± 3.5 weeks, respectively, P < 0.001). In addition, early-onset severe HDFN correlated with increased IUT frequency (hazard ratio (HR): 2.01, 95% confidence interval (CI): 1.26-3.20, P = 0.003). Factors prolonging IUT intervals included transfused volume (HR: 0.99, 95% CI: 0.97-0.99; P < 0.001), hematocrit after IUT (HR: 0.96, 95% CI: 0.95-0.98; P < 0.001), and immunotherapy (HR: 0.59, 95% CI: 0.38-0.93; P = 0.024).
CONCLUSION: The characteristics of early-onset severe HDFN in Chinese patients are different from those observed in western cohorts. These patients frequently present with higher anti-D titers and a more complex spectrum of multiple alloantibodies. The occurrence of early-onset severe HDFN is associated with an increased frequency of IUT and lower live birth rates. Therefore, exploring effective interventions to delay the first IUT is critical to optimizing the timing and efficacy of intrauterine management for these high-risk cases.
METHODS: This retrospective cohort study included cases managed between 2013 and 2022. Factors affecting IUT efficacy were analyzed with regard to subsequent IUT risk and adverse pregnancy outcomes. Survival analysis for recurrent events was performed to assess subsequent IUT risk.
RESULTS: Of the 97 cases included, 38 were identified as early-onset severe HDFN. Compared with non-early-onset severe HDFN, early-onset severe HDFN was characterized by higher anti-D titer (1:1024 vs. 1:512, respectively, P = 0.006), multiple alloantibodies (50.00% vs. 20.34%, respectively, P = 0.002), and an earlier gestational age at initial IUT (22.4 ± 3.2 vs. 29.0 ± 3.5 weeks, respectively, P < 0.001). In addition, early-onset severe HDFN correlated with increased IUT frequency (hazard ratio (HR): 2.01, 95% confidence interval (CI): 1.26-3.20, P = 0.003). Factors prolonging IUT intervals included transfused volume (HR: 0.99, 95% CI: 0.97-0.99; P < 0.001), hematocrit after IUT (HR: 0.96, 95% CI: 0.95-0.98; P < 0.001), and immunotherapy (HR: 0.59, 95% CI: 0.38-0.93; P = 0.024).
CONCLUSION: The characteristics of early-onset severe HDFN in Chinese patients are different from those observed in western cohorts. These patients frequently present with higher anti-D titers and a more complex spectrum of multiple alloantibodies. The occurrence of early-onset severe HDFN is associated with an increased frequency of IUT and lower live birth rates. Therefore, exploring effective interventions to delay the first IUT is critical to optimizing the timing and efficacy of intrauterine management for these high-risk cases.