DAT on newborns

[pbaker]

Wondering what everyone's policy is on automatically doing a DAT on cord blood.  Our current policy is DAT on all babies of Group O and/or Rh negative moms.

[Deny Morlino]

OB's policy is a DAT on every newborn (regardless of the ABO of mom).  I have attempted to redirect the physicians to appropriate ordering, but to no avail.

[goodchild]

They draw a specimen for every baby. With Rh neg mother's it's labeled as cord evaluation, otherwise it's labeled as a hold cord blood. They can call and add on a cord evaluation at their discretion. We verify that ordering was done correctly when we receive the hold cord bloods (LIS will easily pull the mother's results) and we will change it to cord eval if they ordered it incorrectly or if the mother has any sort of antibody history.

[Liz0316]

We are about to implement cord holds on cord samples, unless the mother is group O, Rh neg, or has known atypical antibodies. A DAT on done on an infant is more valuable than an antibody screen, so yes, do the DAT  when the mother is group O or Rh negative.  

[pstruik]

We used to automatically perform a DAT on every cord sample (several thousand deliveries per annum) and in over 20 years I can only remember one or two cases where an unexpected positive result was clinically helpful.

 

We ceased (as an experiment, without telling anyone*) so doing about three months before the introduction of routine antenatal anti-D prophylaxis in the lght of reports from other hospitals of the utter confusion caused for ward staff by the significant number of totally clinically irrrelevant postive DATs so caused.

 

In my subsequent training sessions when I asked what post natal tests we routinely carried out they always included DAT.

 

So the overnight cessation of this test not only did not cause the sky to fall but no-one even noticed.

 

There is much to be said for only performing tests when they are necessary as too much information can sometimes (often ?) cause confusion .

 

(* This is technically very naughty and not to be encouraged. Do not try this at work)

[LAS]

_{Our policy is DATs on infants of group O moms, Rh neg moms, or infants of moms with antibody history. We recently impleted a cord hold policy similiar to Liz H above.}

[MAGNUM]

We only do Cord workups on O moms, Rh neg moms, and moms with atypical antibodies. The workup includes the ABO/Rh and the DAT. We still collect a cord specimen on all babies, and the workup can be ordered at the physicians discretion, all others are cancelled. The cords are spun, separated, and stored for 7 days after the baby has been discharged (hospital rule, not mine).

[Sandy L]

We do ABO/Rh and DAT if the Mom is Rh Neg.  If Mom is group O Rh Pos we do ABO only on the cord. When resulted the Cord ABO will reflex order a DAT if the result is other than O (even though the DAT has a low predictive value).  Any other mom blood type, we do no testing.

Edited June 10, 2013 by Sandy L

[tbostock]

We do cords for moms that are type O, Rh Neg, or have clinically significant alloantibodies. The OB unit sends us all cords and they are automatically ordered on every newborn. We evaluate in the BB if a cord is needed based on the above criteria, and cancel the ones that do not qualify.

A little convoluted, but they could never remember which ones to order and we were previously making phone calls all day. So this works for us.

[aafrin]

We do DAT on all cord samples, but report only the ones from mothers with group O or Rh negative.

[Dansket]

Consider doing a survey in your facility of all newborns treated with phototherapy prior to discharge.  Note the mothers and babys ABO/Rh, DAT results, and Bilirubin levels for each newborn.  Look for associations between DAT results, how many newborns treated with phototherapy had a positive DAT, negative DAT?  How many newborns were ABO incompatible with mom?  How many were ABO compatible?  How many infants had no ABO, Rh or DAT testing done but were treated for hyperbilirubinemia with phototherapy? 

 

I did this on 1350 newborns of whom 26 were treated with phototherapy.  There was no correlation between ABO, Rh and DAT results.  13 newborns were treated who had a negative DAT. 

 

My conclusion was that routine ABO and DAT testing on all newborns had no predictive value identifying infants who would ultimately require phototherapy to treat hyperbilirubinemia.  Bilirubin levels do!

[Mabel Adams]

John Judd's perinatal guidelines agrees with Dansket's findings.  He recommends Rh testing only on baby's of Rh neg moms for RhIG determination and Type and DAT on babies showing signs/symptoms of HDFN.

 

We haven't convinced our neonatologists of this and have a convoluted process of testing Rh on babies of Rh neg moms, ABO on babies of O moms, both on babies of O neg moms.  We can gets orders for ABO/Rh & DAT if the mom has no records with us. We do DATs only if the baby is positive for Rh in the case of Rh neg moms or is ABO incompatible with the mom.  We created four tests in CPOE: Cord blood O pos mom, Cord blood O neg mom, Cord blood Rh neg non O mom, and cord blood mom type unknown.  These come to us with the right tests ordered, the nurses don't have to remember which tests to order and we know that we need to reflex a DAT manually because it a cord order, not just an infant blood type order.