Читать книгу Protocols for High-Risk Pregnancies - Группа авторов - Страница 157

When possible, delivery of a fetus at risk for severe thrombocytopenia due to FNAIT should ideally be coordinated with experienced neonatology and pediatric hematology subspecialists. Newborn evaluation should involve a thorough newborn physical and neurological examination, platelet count determination, and head ultrasound if the birth platelet count is under 100 000/mL³ or any neurological abnormalities are detected. Untreated, FNAIT‐associated thrombocytopenia typically resolves within the first two weeks of life. Rarely, thrombocytopenia can persist for months after delivery, and require prolonged care.

For newborns with severe thrombocytopenia (under 30 000/mL³) or clinical signs of bleeding, controversy exists as to the optimal source for platelet transfusion. The mother can serve as a platelet donor so long as she donates platelets a few days prior to planned delivery intervention. This allows for “washing” to remove disease‐causing antibodies. Alternatively, use of donor platelets negative for the offending HPA antigen is a commonly recommended practice. Finally, limited evidence supports the safety and efficacy of using donor platelets unmatched for the offending HPA antigen, especially in situations in which matched platelets are unavailable. This approach might even theoretically shorten the postnatal disease course by hastening the neonatal clearance of maternal alloantibodies. Decisions regarding platelet sources for potential fetal and neonatal transfusions should ideally involve input from obstetrics and pediatric care providers.

The most important predictor of long‐term neurological outcomes is whether an ICH occurred. Children who are successfully treated with noninvasive therapy appear to have normal neurological development.