Neonatal hyperbilirubinemia and Rhesus disease of the newborn: incidence and impairment estimates for 2010 at regional and global levels.

BACKGROUND: Rhesus (Rh) disease and extreme hyperbilirubinemia (EHB) result in neonatal mortality and long-term neurodevelopmental impairment, yet there are no estimates of their burden. METHODS: Systematic reviews and meta-analyses were undertaken of national prevalence, mortality, and kernicterus due to Rh disease and EHB. We applied a compartmental model to estimate neonatal survivors and impairment cases for 2010. RESULTS: Twenty-four million (18% of 134 million live births ≥ 32 wk gestational age from 184 countries; uncertainty range: 23-26 million) were at risk for neonatal hyperbilirubinemia-related adverse outcomes. Of these, 480,700 (0.36%) had either Rh disease (373,300; uncertainty range: 271,800-477,500) or developed EHB from other causes (107,400; uncertainty range: 57,000-131,000), with a 24% risk for death (114,100; uncertainty range: 59,700-172,000), 13% for kernicterus (75,400), and 11% for stillbirths. Three-quarters of mortality occurred in sub-Saharan Africa and South Asia. Kernicterus with Rh disease ranged from 38, 28, 28, and 25/100,000 live births for Eastern Europe/Central Asian, sub-Saharan African, South Asian, and Latin American regions, respectively. More than 83% of survivors with kernicterus had one or more impairments. CONCLUSION: Failure to prevent Rh sensitization and manage neonatal hyperbilirubinemia results in 114,100 avoidable neonatal deaths and many children grow up with disabilities. Proven solutions remain underused, especially in low-income countries.

Cyril Clarke and the prevention of rhesus haemolytic disease of the newborn.

Cyril Clarke was an outstanding general physician and lepidopterist. Late in his career, and stimulated by his work on the genetics of mimicry in butterflies, he became interested in the evolving field of medical genetics. His work on the relationship of blood groups to particular diseases led him and his team in Liverpool to evolve a remarkably successful approach to the prevention of Rhesus haemolytic disease of the newborn.

Isoinmunización RH: manejo actual / Isoinmunización RH: present handling

La incompatibilidad rh materno fetal es un factor que complica aproximadamente 1 de cada 1000 embarazos en los EE.UU, constituye la principal causa de muerte fetal o neonatal por enfermedad hemolítica. Nuevas técnicas como la cordocentesis, transfusión intrautterina han mejorado el pronóstico en estas pacientes. En la presente revisión comentaremos los avances acerca del manejo de la isoinmunización Rh.

[Rhesus prophylaxis--history and current status]. / Die Rhesusprophylaxe--Geschichte und aktueller Stand.

The varying symptoms of rhesus incompatibility were recognized and described approximately sixty years ago. Jörg Schneider, then at the Freiburg University Hospital in Germany, had been the very first investigator to perform rhesus prophylaxis in pregnant women. The exact date of this achievement is August 9, 1963. One year later, Schneider could report on nine women, who-following delivery of a rhesus-positive child-did not develop rhesus antibodies during a subsequent pregnancy with a rhesus-positive fetus. Since the late sixties, rhesus prophylaxis has been an integral part of prenatal care in Germany. In the meantime, the role of ante-partum prophylaxis has also been established. Since the introduction of post-partum rhesus prophylaxis, fetal morbidity and mortality has been reduced by 90 percent.

Erythroblastosis fetalis--the discovery and partial elimination of rhesus incompatibility--the origins of exchange transfusion in Australia.

The first 2 exchange transfusions in Australia for Rhesus-induced erythroblastosis (hemolytic disease of the newborn) were conducted in the 9 mth period from December 1945 to August 1946. These pioneering endeavours in medical research were undertaken by 3 transfusionists who were, or had been, directors of the Red Cross Blood Transfusion Service in Australia. Called "substitution transfusion" or "exsanguination transfusion" they were conducted prior to the international publication of the first case series of exchange transfusions for "Rhesus Disease". The first successful exchange transfusion in Australia, and one of the first in the world, was performed by Dr George Kelsall at the King Edward Memorial Hospital for Women, in Perth. Dr Kelsall had monitored pregnancies with serum raised himself from blood from a Rhesus monkey in the Perth Zoo. The second exchange transfusion, and the first with volume-monitoring, was successfully undertaken in Brisbane by Dr Eric Shaw, pathologist and Director of the Queensland Red Cross Blood Transfusion Service, and Dr Noel Gutteridge, a former Director and senior pathologist of Brisbane. Dr Kelsall's pioneering transfusion in Perth was a direct non-anticoagulated transfusion which was undertaken within minutes of birth and was completed within 5 min. The first volume-controlled exchange transfusion, in which the input-discard volumes were matched, used a plastic tube obtained from the Telephone Branch of the Postmaster General's Department, and employed citrated blood. These heroic exchanges (heroic for the infants and families concerned as well as for the operators) form a significant milestone in the history of blood transfusion, serology and preventive medicine in Australia.

[The circumstances and background of the discovery of the Rh-factors]. / Az Rh-vércsoportok felfedezésének körulményei es háttere.

We can hardly meet references in the literature to the various circumstances and factors that played an important role in scientific discoveries, although interesting conclusions could be driven from them. So, e.g., in the case of Landsteiner it is sure, that his idea, to investigate the reason of the mechanism and of the formation of a phenomenon, came from the phenomenon itself: namely, from the agglutination called forth by the fortuitous mixing of the cadavers' blood in the dissecting room. The present paper deals with certain circumstances that played a role in the discovery of the Rh-Factors, resulting not only scientific, but practical consequences as well. The data used here were collected primarily from the memoirs of professors Wiener, Levine, Dahr and from those of Speiser (Vienna). The authors were helped in their research also by their personal contact with professor Dahr (Cologne) established in the sixties. Landsteiner was compelled to emigrate from Austria mainly by the vivid anti-Semitism of the early 20s. Supposedly, without his emigration the Rh Factors would have been discovered much later. Working in the Rockefeller Institute (New York) Landsteiner was provided with everything that was needed for his research. He had organised a team and, helped by his colleagues, he succeeded to open a new field in immunserology. Unfortunately, before he could have completed his scientific project, he had died--already as a Nobel-Prize winner--in 1943. His project was resumed by his colleagues. The method of Rh-examination, exceeding the field of medicine, quickly won a greater significance, in anthropology, genetics and in biology. It is worth to mention, that Landsteiner, had already indicated shortly after his discovery the fields, on which the Rh-examinations later played a significant role.