THE EFFECT OF INTRAUTERINE TRANSFUSION TO THE FETUS ON THE INDICATORS OF THE NEWBORN'S INNATE HUMORAL IMMUNITY
Abstract
Fetal hemolytic disease is caused by the transplacental passage of maternal antibodies that target and destroy fetal red blood cells. These antibodies are produced following maternal exposure to fetal erythrocytes, typically occurring around 16–18 weeks of gestation, upon recognition of fetal red blood cell antigens. At the turn of the millennium, hemolytic disease of the fetus and newborn (HDFN) was still largely equated with Rh incompatibility. However, the introduction of active postpartum immunoprophylaxis in the 1970s led to a decrease in maternal Rh sensitization rates from 14% to 1–2%. The subsequent implementation of antenatal immunoprophylaxis in Rh-negative pregnant women has further reduced this incidence to approximately 0.1%. The aim of the study: to investigate parameters of innate humoral immunity—specifically immunoglobulins G, M, and A—in the umbilical cord blood of newborns with hemolytic disease who underwent advanced fetal surgical intervention during gestation. Study materials. A total of 60 newborns were enrolled and categorized into three groups. The first (main) group included 20 newborns diagnosed with hemolytic disease who underwent intrauterine intravascular fetal blood transfusion during the antenatal period. The second (comparison) group consisted of 20 newborns with hemolytic disease who did not receive any fetal surgical intervention prenatally. The third (control) group comprised 20 healthy newborns. Immunologic methods of research: evaluation of the immune status of newborns was performed on umbilical cord blood collected on the first day of life, in the Laboratory of Fundamental Immunology at the Institute of Human Immunology and Genomics of the Academy of Sciences of the Republic of Uzbekistan. Statistical analysis of the data was performed using both parametric and non-parametric methods. Data collection, correction, systematization, and visualization were conducted using Microsoft Office Excel 2018 spreadsheets. The statistical computations were carried out using IBM SPSS Statistics v.26 (IBM Corporation). All investigations were conducted at the Institute of Immunology of the Academy of Sciences of the Republic of Uzbekistan. Conclusions. Intrauterine transfusion has demonstrated a beneficial effect on fetal hematological parameters and on the humoral immune status of the neonate after birth. Notably, it has been associated with a reduction in immunoglobulin G, A, and M levels. These findings suggest a diminished inflammatory potential and indicate a preventative effect against the development of immunodeficiency at birth.