At autopsy, such babies display evidence of bilirubin staining of the basal gangia. This is most pronounced in babies who did not require an exchange transfusion. This process is exacerbated by acidosis, which favours dissociation and precipitation of bilirubin into lipid-rich tissues such as cell membranes and brain. 4 Details of the procedure are provided in the Nursing Manual . Phototherapy is normally started as soon as the baby reaches the nursery, in the hope that the need for exchange transfusion may be reduced or eliminated.
Exchange transfusion removes bilirubin, removes hemolytic antibody, and corrects anaemia.
Due to fetal transfusion, sick hydropic babies are uncommon these days. Continue to monitor Hb until about 3 months of age. Babies who received intrauterine transfusions are born with most of their RBC's being Rh-negative, and these babies occasionally do not require exchanging on the basis of their SBR level. Antibodies similar to anti-D but much less common may cause a similar clinical picture to rhesus isoimmunisation. They are usually managed along similar lines to rhesus disease.