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CC BY-NC-ND 4.0 · Am J Perinatol 2025; 42(07): 924-932
DOI: 10.1055/a-2444-2314
Original Article

Identifying Hemolytic Disease of the Fetus and Newborn within a Large Integrated Health Care System

Fagen Xie 
1   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Michael J. Fassett
2   Department of Obstetrics and Gynecology, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, California
3   Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
,
Jiaxiao M. Shi
1   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Vicki Y. Chiu
1   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Theresa M. Im
1   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Sunhea Kim
1   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Nana A. Mensah
1   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Nehaa Khadka
1   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Daniella Park
1   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Carol Mao
4   Janssen Global Services LLC, a Johnson & Johnson company, Horsham, Pennsylvania
,
Matthew Molaei
4   Janssen Global Services LLC, a Johnson & Johnson company, Horsham, Pennsylvania
,
Iris Lin
5   Janssen Scientific Affairs LLC, a Johnson & Johnson company, Horsham, Pennsylvania
,
Darios Getahun 
1   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
6   Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
› Institutsangaben
Funding This study was supported by Johnson & Johnson, PA. The opinions expressed are solely the responsibility of the authors and do not necessarily reflect the official views of the funding agency.
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Abstract

Objective

This study aims to identify hemolytic disease of the fetus and newborn (HDFN) pregnancies using electronic health records (EHRs) from a large integrated health care system.

Study Design

A retrospective cohort study was performed among pregnant patients receiving obstetrical care at Kaiser Permanente Southern California health care system between January 1, 2008, and June 30, 2022. Using structured (diagnostic/procedural codes, medication, and laboratory records) and unstructured (clinical notes analyzed via natural language processing) data abstracted from EHRs, we extracted HDFN-specific “indicators” (maternal positive antibody test and abnormal antibody titer, maternal/infant HDFN diagnosis and blood transfusion, hydrops fetalis, infant intravenous immunoglobulin [IVIG] treatment, jaundice/phototherapy, and first administrated Rho[D] Immune Globulin) to identify potential HDFN pregnancies. Chart reviews and adjudication were then performed on select combinations of indicators for case ascertainment. HDFN due to ABO alloimmunization alone was excluded. The HDFN frequency and proportion of each combination were fully analyzed.

Results

Among the 464,711 eligible pregnancies, a total of 136 pregnancies were confirmed as HDFN pregnancies. The percentage of the HDFN-specific indicators ranged from 0.02% (infant IVIG treatment) to 34.53% (infant jaundice/phototherapy) among the eligible pregnancies, and 32.35% (infant IVIG treatment) to 100% (maternal positive antibody test) among the 136 confirmed HDFN pregnancies. Four combination groups of four indicators, four combination groups of five indicators, and the unique combination of six indicators showed 100% of HDFN pregnancies, while 80.88% of confirmed HDFN pregnancies had the indicator combination of maternal positive antibody test, maternal/infant HDFN diagnosis, and infant jaundice/phototherapy.

Conclusion

We successfully identified HDFN pregnancies by leveraging a combination of medical indicators extracted from structured and unstructured data that may be used in future pharmacoepidemiologic studies. Traditional indicators (positive antibody test results, high titers, and clinical diagnosis codes) alone did not accurately identify HDFN pregnancies, highlighting an unmet need for improved practices in HDFN coding.

Key Points

  • A case ascertainment method was developed to identify HDFN from structured and unstructured data.

  • The method used in this study may be used in future pharmacoepidemiologic studies.

  • The study highlighted an unmet need for improved practices in HDFN coding.

Keywords

hemolytic disease of the fetus and newborn - antibody test - titer - transfusion - intravenous immunoglobulin - jaundice - phototherapy - electronic health record - natural language processing

Supplementary Material



Publikationsverlauf

Eingereicht: 18. März 2024

Angenommen: 15. Oktober 2024

Artikel online veröffentlicht:
12. November 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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