Delayed cord clamping in red blood cell alloimmunization: safe, effective, and free?

Hemolytic disease of the newborn (HDN) is an alloimmune disorder caused by transplacentally transmitted maternal immunoglobulin (Ig) G antibodies that bind to paternally inherited antigens present on fetal red blood cells (RBCs) resulting in hemolysis, which leads to elevated bilirubin levels (1). After delivery, without placental clearance, hyperbilirubinemia may develop from ongoing RBC hemolysis, which places neonates at increased risk for central nervous system damage. Moderate hyperbilirubinemia may result in symptoms of bilirubin-induced neurologic dysfunction, a disorder associated with long-term developmental delay, cognitive problems, executive function impairment, and behavioral and psychiatric disorders (2). More severe hyperbilirubinemia has been associated with the development of kernicterus, an irreversible condition characterized by choreoathetoid cerebral palsy, impaired upward gaze, and sensorineural hearing loss (2)