The study aimed to develop structured, expert-based clinical guidance on the prenatal and postnatal management of hemolytic disease of the fetus and newborn. A Delphi procedure was conducted among an international panel of experts in fetal medicine, neonatology, and hematology. Experts were selected based on their expertise, relevant publications, and affiliations. The domains were (i) prenatal workup, (ii) prenatal monitoring and management, (iii) intrauterine transfusion (IUT), (iv) delivery, and (v) postnatal management. The predefined cut-off for consensus was ≥70% agreement. One hundred-seven experts representing 25 countries across 6 continents completed the first round, and 100 (93.5%) completed the subsequent rounds. 75.3% agreed on using cfDNA to determine fetal antigen status, particularly for RhD, Kell, and Rhc antigens. The critical titer, requiring fetal monitoring via ultrasound, is considered when the threshold of ≥16 is for non-Kell antigens. 70.0% agreed on the use of maternal IVIg in pregnancies with prior IUT <24 weeks or fetal/neonatal death due to HDFN. The minimum GA for IUT is 16 to 18 weeks, and the maximum is 350/7 to 356/7 weeks. Postnatal management consensus was reached for the following: anemia labs should be investigated in the affected neonates before hospital discharge (92.0% agreement), and if they received IUT, the labs should be repeated within 1 week of discharge (84.0% agreement). 96.0% agreed that exchange transfusions should be centralized in hospitals with sufficient exposure and experience, and 92.0% agreed that the hemoglobin cut-off level to consider transfusion following hospital discharge is 7 g/dL, and the newborns need to be monitored until 2 to 3 months of age (96.0% agreement).

中文翻译：

---

基于国际专家 Delphi 共识的胎儿和新生儿溶血性疾病的监测和管理


该研究旨在为胎儿和新生儿溶血性疾病的产前和产后管理制定结构化的、基于专家的临床指导。在胎儿医学、新生儿学和血液学的国际专家小组中进行了 Delphi 手术。专家是根据他们的专业知识、相关出版物和隶属关系来选择的。这些领域是 （i） 产前检查，（ii） 产前监测和管理，（iii） 宫内输血 （IUT），（iv） 分娩和 （v） 产后管理。共识的预定义临界值为 ≥70% 的一致性。来自 6 大洲 25 个国家/地区的 107 名专家完成了第一轮培训，100 名 （93.5%） 专家完成了后续轮次培训。75.3% 的人同意使用 cfDNA 来确定胎儿抗原状态，特别是 RhD、Kell 和 Rhc 抗原。当 ≥16 的阈值是针对非 Kell 抗原时，应考虑需要通过超声监测胎儿的临界滴度。70.0% 同意在既往 IUT <24 周或因 HDFN 导致胎儿/新生儿死亡的妊娠中使用母体 IVIg。IUT 的最低 GA 为 16 至 18 周，最高为 350/7 至 356/7 周。在以下方面达成了产后管理共识： 出院前应检查受累新生儿的贫血实验室 （92.0% 一致性），如果接受 IUT，应在出院后 1 周内重复实验室检查 （84.0% 一致性）。96.0% 的人同意换血疗法应集中在有足够接触和经验的医院进行，92.0% 的人同意出院后考虑输血的血红蛋白临界水平为 7 g/dL，新生儿需要监测到 2 至 3 个月大 （96.0% 同意）。