Case 1: Cardiac Arrest in a 2-month-old Boy with a Prenatal Course Complicated by Alloimmunization

Millie R. Chang; Andrew H. Chon; Jacquelyn Baskin; Ali Nael; Ramen H. Chmait

doi:10.1542/pir.2018-0004

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Millie R. Chang, MD*
Andrew H. Chon, MD^†
Jacquelyn Baskin, MD^‡,^§
Ali Nael, MD*,^¶
Ramen H. Chmait, MD^†

^*Department of Pediatrics,
^§Children’s Center for Cancer and Blood Disease,
^¶Department of Pathology, Children’s Hospital Los Angeles, Los Angeles, CA
^†Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology,
^‡Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA

AUTHOR DISCLOSURE
Drs Chang, Chon, Baskin, Nael, and Chmait have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

EDITOR’S NOTE

Children face a daily balancing act between antigens, allergy, and immunity. Sometimes, that balance turns pathologic. Either the antigen can “win” or the immune response can end up hurting the host. In the review articles and case reports this month, we are reminded of immune reactions gone awry, and we learn how to care for affected children.

Philip R. Fischer, MD

Associate Editor, Index of Suspicion

Presentation

A 30-year-old gravida 2, para 1 woman with an intrauterine pregnancy at 29 1/7 weeks' gestation was referred for suspected fetal anemia secondary to rhesus (D) (Rh[D]) alloimmunization. The fetus received 3 intrauterine transfusions (IUTs) during the pregnancy (Table). The patient delivered vaginally at 37 1/7 weeks' gestation. The birthweight was 2,680 g, and Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. On postnatal day 1, phototherapy was initiated for hyperbilirubinemia. On postnatal day 2, a complete blood cell count showed a white blood cell count of 2,500/μL (2.5 × 10⁹/L), a hemoglobin (Hb) level of 16.7 g/dL (167 g/L), a hematocrit level of 46.6%, and a platelet count of 68 × 10³/μL (68 × 10⁹/L). The baby was discharged on postnatal day 3 when phototherapy was discontinued. Repeated bilirubin levels were within normal limits at an outpatient follow-up visit on postnatal day 4. The baby was seen in the clinic on postnatal day 10 for a health supervision visit, and a follow-up appointment was scheduled for 2 months of age.

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