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The Rh Factor and YouAwake!—1994 | December 8
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Is there any treatment for a baby once it gets Rh disease?
Yes. Though hemolytic disease of the newborn is a serious illness, there is good evidence supporting treatments that do not involve exchange blood transfusions for the baby. The most feared complication of this disease involves the buildup of a chemical called bilirubin, which results from the breakdown of red blood cells. This produces jaundice and can in some instances cause damage to the baby’s organs. (Incidentally, a mild jaundice may be caused when there is an ABO incompatibility between the mother’s blood and the baby’s blood, but this is usually not as serious.)
For some years doctors thought that a specific level of jaundice was indication for exchange blood transfusion in these babies, but further research has revealed various alternative treatments. Early delivery or cesarean section, phototherapy (blue light), and medications such as phenobarbital, activated charcoal, and other treatments have proved helpful and have dramatically decreased the push to resort to transfusion. In fact, some recent reports have highlighted the futility and even the danger of exchange transfusions in babies with Rh disease.—See box, page 26.
Nevertheless, there are extreme cases when doctors still insist that exchange transfusion is the only acceptable treatment. Therefore, some parents feel that it is better to avoid the whole problem with a shot that will prevent the disease and thus the jaundice.
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The Rh Factor and YouAwake!—1994 | December 8
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[Box on page 26]
Elevated Bilirubin—Reason for Transfusion?
Doctors have long been fearful of the consequences of elevated bilirubin in babies, so much so that when the bilirubin begins to rise—especially toward the number 20 mg/100 ml—doctors often insist on exchange transfusion “to prevent brain damage” (kernicterus). Is their fear, and the value of blood transfusion, justified?
Notes Dr. Anthony Dixon: “Several studies of such infants have been unable to detect any consequences, whether short or longterm, of bilirubin levels between 18 mg-51 mg per 100 ml.” Dr. Dixon goes on to discuss “vigintiphobia: the fear of 20.” Though no advantage has been proved from treating these elevated bilirubin levels, Dr. Dixon concludes: “The dilemma is clear. Aggressive treatment of elevated serum bilirubin levels is now standard practice. Standard practice should not be challenged until it has been proved to be wrong, yet any attempt to demonstrate that it is wrong is unethical!”—Canadian Family Physician, October 1984, page 1981.
On the other hand, an Italian authority, Dr. Ersilia Garbagnati, has written about a protective role of bilirubin and the “potential unexpected dangers from inappropriately low serum bilirubin levels.” (Italics ours.) (Pediatrics, March 1990, page 380) Going a step further, Dr. Joan Hodgman writes in Western Journal of Medicine: “Exchange transfusion will not prevent bilirubin staining of the brain at low levels of bilirubin and, in view of the experimental work quoted above, may actually be harmful.”—June 1984, page 933.
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