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October 1995

Wasted Health Care Dollars: Routine Cord Blood Type and Coombs' Testing

Author Affiliations

From the Department of Pediatrics, University of North Carolina, Chapel Hill, and the Area Health Education Center, Wilmington, NC (Dr E. A. Leistikow); the Department of Pediatrics, Case Western Reserve University at MetroHealth Medical Center (Dr Collin) and the American Red Cross, Northern Ohio Region (Mr Savastano), Cleveland; the Department of Pediatrics, Hospital Infantil de Mexico, Mexico City (Dr de Sierra); and the Occupational/Environmental Medicine Division, Department of Internal Medicine, University of California–Davis (Dr B. N. Leistikow).

Arch Pediatr Adolesc Med. 1995;149(10):1147-1151. doi:10.1001/archpedi.1995.02170230101015

Objective:  To determine if selective newborn cord blood testing (NCBT) could contain costs without increasing morbidity of hemolytic disease of the newborn (HDN).

Design:  A national telephone survey confirmed the common practice of routine blood type and Coombs' NCBT. Two 12-month study arms, retrospective and prospective, were conducted. Hemolytic disease of the newborn was studied retrospectively under an unrestricted NCBT policy. Then, HDN was studied after a policy change that restricted NCBT to patients in new-born intensive care units and normal newborns with clinical jaundice or Rh-negative mothers, and/or positive maternal antibody screenings, or unavailable maternal blood testing.

Participants:  All newborns (N=8501) at the MetroHealth Medical Center, Cleveland, Ohio, were studied (retrospective arm, all 1989 admissions; prospective arm, all July 1990 to June 1991 admissions).

Outcome Measures:  Blood type and Coombs' NCBT, maternal blood type and antibody screening, Hobel risk scores for clinical severity of newborn hospitalization, duration of hospitalizations, and peak serum bilirubin levels.

Results:  No quantitative or qualitative increases in morbidity from jaundice were detected by retrospective analysis with unrestricted NCBT, or prospectively after selective testing on 4498 newborns. Each study arm resulted in 15 readmissions for jaundice; these included two patients with ABO HDN. Furthermore, selective testing resulted in performance of NCBTs on only 390 infants in the "normal" nursery (24% of the original sample). Estimates projected on 1991 US births (4 111 000) showed that selective NCBT offers potential yearly savings above $30.8 million of patient charges, savings above $11.3 million of hospital costs, and the reassignment of more than 112 personnel full-time equivalents.

Conclusion:  Selective NCBT decreases the use of resources and costs without apparent additional patient morbidity from HDN.(Arch Pediatr Adolesc Med. 1995;149:1147-1151)