A term neonate born to a Rh-negative mother with anti-D titer of 1:128 presents at birth with severe hydrops fetalis, hemoglobin 6 g/dL, and total bilirubin 9 mg/dL at 2 hours of life. The SINGLE most important initial intervention is:

• A Intensive phototherapy with bili-blanket
• B Intravenous immunoglobulin (IVIG) 1 g/kg
• C Double-volume exchange transfusion with O-negative blood ✓
• D Packed cell transfusion followed by furosemide

Explanation

Severe hemolytic disease of the newborn with hydrops and critically low hemoglobin requires emergency double-volume exchange transfusion, which simultaneously corrects anemia, removes antibody-coated red cells, and lowers bilirubin load. IVIG reduces ongoing hemolysis but cannot address the acute severe anemia or already-elevated bilirubin. Phototherapy alone is insufficient in hydrops with such profound anemia.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.