Leiden University Scholarly Publications

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Winter, D.P. de (2026)

Hemolytic disease of the fetus and newborn: awareness precedes change

Doctoral Thesis
Hemolytic disease of the fetus and newborn (HDFN) is a potentially life-threatening disease caused by the destruction of fetal and neonatal red blood cells (RBC) due to maternal alloantibodies directed against blood group antigens. Developments have increased perinatal survival rates and decreased morbidity rates in affected patients over the past century, creating an overall stance of some experts in the international fetal-medicine community that the management of HDFN had reached an ‘as good as it gets’ state, especially in high-income countries. However, without continuous monitoring of the performance of the state-of-the-art in an (inter)national perspective one might either drift from a high level of care or may miss opportunities to improve. We strongly believe that fostering a culture of continuous improvement for the benefit of our patients is something we should prioritize. This can be achieved by raising awareness through education, critically evaluating our current...Show moreHemolytic disease of the fetus and newborn (HDFN) is a potentially life-threatening disease caused by the destruction of fetal and neonatal red blood cells (RBC) due to maternal alloantibodies directed against blood group antigens. Developments have increased perinatal survival rates and decreased morbidity rates in affected patients over the past century, creating an overall stance of some experts in the international fetal-medicine community that the management of HDFN had reached an ‘as good as it gets’ state, especially in high-income countries. However, without continuous monitoring of the performance of the state-of-the-art in an (inter)national perspective one might either drift from a high level of care or may miss opportunities to improve. We strongly believe that fostering a culture of continuous improvement for the benefit of our patients is something we should prioritize. This can be achieved by raising awareness through education, critically evaluating our current standards of care, enhancing multidisciplinary and international collaborations, addressing global health disparities, optimizing personalized care through improved diagnostic tools, refining the use of existing treatments, researching adjunctive or novel treatments, and monitoring long-term outcomes to help refine clinical management strategies. With these objectives in mind, the research in this thesis aims to enhance our understanding of the disease and its management and provide recommendations to ultimately improve the outcomes for those affected.
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Rhesus
Alloimmunisation
Fetal anemia
Intrauterine transfusion
Hyperbilirubinemia
Exchange transfusion
Neonatal anemia
All authors
Winter, D.P. de
Supervisor
Lopriore, E.; Haas, M. de
Co-supervisor
Verweij, E.J.T.
Committee
Ridder, L. de; Devlieger, R.; Dijk, P.H.; Bredius, R.G.M.
Qualification
Doctor (dr.)
Awarding Institution
Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
Date
2026-03-31
ISBN (print)
9789465371054

Funding

Sponsorship
The research described in this thesis was partially supported by Momenta Pharmaceuticals, which was acquired by Johnson & Johnson. Financial support for printing this thesis was kindly provided by Universitaire Bibliotheken Leiden, the Willem-Alexander Kinderziekenhuis, Leiden University Medical Center, Stichting IDB (Intrauteriene Diagnostiek en Behandeling) and Canon Medical Systems Nederland.