Haemolytic Disease of the Newborn

Two well-known authorities on hemolytic disease undertake in this paper to determine the causes for what they consider to be an excessive mortality from this disease in England and Wales at the present time. They state that with correct use of exchange transfusion a mortality of not more than 5% of infants with hemolytic disease born alive should be expected. The authors express the opinion that the deaths at present are at least three times as numerous as should be expected with modern treatment. Analysis of the reported deaths seem to indicate two principal causes for this: (1) failure to anticipate the disease before birth or to recognize the disease early after birth, and (2) either failure to undertake an exchange transfusion or to employ satisfactory technique in the exchange transfusion, particularly to give an adequate exchange. They point out that the best results are to be expected in hospitals where a large number of cases are treated and considerable experience is acquired. In hospitals where the number of cases seen is small it is difficult for the staff to gain the necessary experience and familiarity with the technique of exchange transfusion and the general principles of diagnosis and management. A full discussion of the essential points in prediction and diagnosis of the disorder and of the indications for exchange transfusion, with emphasis on the volumes of blood to be exchanged, are given.