Yea or nay for cord blood workups

[MAGNUM]

At this time we are trying to decide whether to perform cord blood workups on all babies born at our facility or not perform them. Also, whether to perform select workups such as babies from Rh negative mothers and O mothers. What are the comments and concerns out in BB land about this? Do you perform them or not? Do you only do select testing for select babies?

[David Saikin]

Cords from Rh= moms always; all others at the discretion of the neonatologists.

[adiescast]

We do cords from babies of Rh negative mothers (this is for the mother's RhIg status) and type O mothers (for possible ABO incompatibility). We also do them on orders. I really am becoming less convinced that doing babies of type O mothers is beneficial to anyone. I don't think they use the information for anything. That is just my observation and not confirmed.

[Deny Morlino]

Currently we do workups on about 95% of babies born here. My preference would be the method David uses or Julie's method as a backup. We do far to many cord blood workups that are a waste of medical dollars, in my opinion, with little or no benefit.

[KKidd]

I'm with Adiecast. Since it is a standing order, if a cord workup order is not received on babies of Rh neg moms, we call the nursery to remind them. The pediatricians order on the O pos cords, but must write the order on each individual. Others are as needed. My favorite is when the mother is AB positive and has a negtive antibody screen. Like good little soldiers, we do the testing after having a little chuckle over it. ( And, Yes, I do realize there might be other reasons to perform the DAT)

:haha::haha:

[ElinF]

We do them on all RH negative moms and O Positive Moms. I wish we could drop the O positive moms because I too don't think they really do anything if the DAT is positive on a baby due to ABO incompatiblity.

But definitely on cords of all RH= moms.

[AMcCord]

We do them for all Rh negative mothers. None were being ordered on O pos moms, that is until a new family practice doc came to town about 3 years ago. He wants them on all O moms AND he talked one of his new partners into backsliding back to the same ordering pattern (Ducky!). Fortunately, those two don't deliver a high percentage of the babies born here. So, for the most part, we do them only on Rh neg moms. On occasion we will do a baby blood type/DAT on a cap sample, a day or two post delivery, for one of the Peds docs. Saves a great deal of work with questionable value.

[KarenJ]

We do them on Rh negative Moms only. Occasionally a doctor will order one that isn't Rh neg, and we do it, although we may grumble a bit.

[GilTphoto]

We do them on all cord bloods. The reason is because there be a low incidence antibody that we did not detect on the mother.

The doctors have gotten into trouble for discharging the babies too soon, that have complications. It usually takes a few days for the bilirubin to rise, so they could miss a potential problem.

[KarenJ]

We looked at our patient population and history of positives and decided the odds of a low incidence antibody are too slim to justify doing complete work ups on all cord bloods. The nursery has transdermal bilirubin monitors and if the baby's bili goes up or there are signs of problems they will order a workup on the cord. We keep all our samples for 2 weeks and have had less than 2% come back with jaundice and orders for the workup. It seems to work pretty well for us and the physicians are happy with it.

[lateonenite]

We do all Rh neg and O positive mums and prems; but if the likelihood is an ABO, we don't elute if we have mum's history (meaning we have performed her antenatal screens and they're clear).

I don't think it matters whether they act on the workup from our end of it (because presumably if they don't, the jaundice, if any, is mild); a lot of docs use the group and Coombs as exclusion of other things. Hmm, will ask resident brain box, however.

[Malcolm Needs ☆]

We looked at our patient population and history of positives and decided the odds of a low incidence antibody are too slim to justify doing complete work ups on all cord bloods. The nursery has transdermal bilirubin monitors and if the baby's bili goes up or there are signs of problems they will order a workup on the cord. We keep all our samples for 2 weeks and have had less than 2% come back with jaundice and orders for the workup. It seems to work pretty well for us and the physicians are happy with it.

Seems emminently sensible. I take it you do it on all Rh D Negative Mum's with Rh D Positive babies though?

[KarenJ]

We do---and we have an extra step built in. We have a test called CBH, cord blood hold. It must be resulted with Mom's name and Rh type. Helps us make sure the nursery orders the cord ABO/Rh. Sometimes they forget.

[tupton]

We just discontinued doing all cord blood specimens this summer. We are currently only doing them on Rh negative and O mothers.