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Routine Testing on Newborns


ffriesen

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I would like to hear from everyone about the routine testing you perform on newborns and/or cord bloods. When do you perform ABO/Rh testing and/or direct antiglobulin testing? We have been only doing an ABO/Rh on those babies who were born to Rh negative mothers and only doing a direct antiglobulin when HDN was suspected due to jaundice. Now we have a new pediatric hospitalist who wants us to go back to testing the babies of group O mom's as well in case there is an ABO incompatibility. We discontinued this practice about 10 years ago. Thanks for your comments.

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1 hour ago, fanilhas said:

Now we have a new pediatric hospitalist who wants us to go back to testing the babies of group O mom's as well in case there is an ABO incompatibility.

It would be interesting to hear exactly why the new paediatrician wants to go back to this testing regime, considering that it has been known for decades that the DAT in a case of ABO HDN can be negative for a couple of days from birth, and only then become positive.  May I respectfully suggest that this new paediatrician relies on his or her ability to look at the baby's symptoms, rather than his or her ability to read laboratory results.  This way, more babies may survive.

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We perform cord blood workups on EVERY baby born here. For the longest time we did the workups on all babies then it was decided that we would only do it on babies with O moms and babies with Rh negative moms, then out of the blue the neonatologist that pushed the limited testing decided that he needed ALL babies again so he pushed his agenda thru the MEC and suddenly we are doing ALL babies again. Our cord workup consists of a ABO/Rh and DAT. If the DAT is positive, a heelstick is performed on the baby for repeat DAT (including IgG). If the repeat is still positive and the mother has a significant antibody, we do a Lui Freeze elution (but those are few and far between).

 

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18 minutes ago, MAGNUM said:

We perform cord blood workups on EVERY baby born here. For the longest time we did the workups on all babies then it was decided that we would only do it on babies with O moms and babies with Rh negative moms, then out of the blue the neonatologist that pushed the limited testing decided that he needed ALL babies again so he pushed his agenda thru the MEC and suddenly we are doing ALL babies again. Our cord workup consists of a ABO/Rh and DAT. If the DAT is positive, a heelstick is performed on the baby for repeat DAT (including IgG). If the repeat is still positive and the mother has a significant antibody, we do a Lui Freeze elution (but those are few and far between).

 

How many more babies with clinically significant haemolytic disease have you discovered with your more expanded testing (i.e.every baby), as compared with your more restrictive testing, and, perhaps more to the point, how many more (if any) that were not recognisable by overt symptoms?

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We only routinely get cords on Rh negative moms & moms w/ a clinically significant antibodies.  Occasionally a physician will request one on an O mom who has had a previously affected infant, but it’s not very common.  If a baby didn’t have a cord performed, and there are concerns of jaundice later, we have a separate test order for the ABO/Rh/DAT  drawn via venipuncture or heel stick.

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We had graduated to doing ABO/Rh and DAT only on babies born to Rh neg moms. Then...........a new Family Medicine doc came to town and became the head of the OB committee and now we are doing ABO/Rh and DAT on babies born to all O moms as well. The new pediatrician head of the pediatric committee is perfectly OK with testing only the babies born to Rh neg moms - all our newborns are scanned for evidence of elevated bili before discharge, so a high bili is not going to be missed. We are hoping he can eventually win the day and we can go back to testing only the Rh neg babes. One category that we don't automatically get cord bloods on is the moms with clinically significant alloantibodies. I would like to see that change. If a pediatrician doesn't order a DAT on those babies, I find a hemo sample and run one - if it's positive, I would take that info to the medical director for followup with the attending.

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2 hours ago, AMcCord said:

One category that we don't automatically get cord bloods on is the moms with clinically significant alloantibodies. I would like to see that change. If a pediatrician doesn't order a DAT on those babies, I find a hemo sample and run one - if it's positive, I would take that info to the medical director for followup with the attending.

I simply could NOT agree with you more AMcCord.

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We also store all cord blood specimens in the blood bank.  We routinely get orders for cord workups (ABO/Rh, DAT) on babies of O Positive and all Rh negative mothers.  I have tried to push the issue that just because the mom is O Positive it doesn't mean the baby is at risk.  Is the cord workup medically indicated if the baby does not have jaundice?  Anyway, whenever we get a positive DAT that we think is ABO, we do a heat elution.  For other antibodies, we use an acid elution (Immucor Elu-Kit II).  We work up all positive DATs on babies.

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6 minutes ago, TreeMoss said:

Anyway, whenever we get a positive DAT that we think is ABO, we do a heat elution.  For other antibodies, we use an acid elution (Immucor Elu-Kit II).

Why use the heat elution for possible ABOs, but the acid elution for all others?  I can understand if you are trying to sort out an adult ABO type by adsorption and elution (although I would have still have thought that the Lui method would be more sensitive), but if it is HDFN, it is bound to be IgG, even if it is ABO HDFN, so I can't see the point.  I'm happy to be told I am wrong!

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I have just been debating our cord policy to test for incompatible antigen on all babies of O or Rh neg moms (ABO test for O moms, Rh test for Rh neg moms) and do a DAT if baby has an incompatible antigen.  The neonatologist wants to keep doing it this way because it helps identify babies at higher risk "without doing another test" which I think means without sticking the baby for another test.  They are now going to scan for elevated bili rather than run a T bili so I think he also wants to know if the baby is higher risk for jaundice because he is not entirely trusting of the scans.  The algorithm is to scan them at 18 hours instead of 24 if they are incompatible with mom.

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  • 3 weeks later...
On ‎12‎/‎6‎/‎2016 at 10:55 AM, Malcolm Needs said:

Why use the heat elution for possible ABOs, but the acid elution for all others?  I can understand if you are trying to sort out an adult ABO type by adsorption and elution (although I would have still have thought that the Lui method would be more sensitive), but if it is HDFN, it is bound to be IgG, even if it is ABO HDFN, so I can't see the point.  I'm happy to be told I am wrong!

We find the heat elution to be less time consuming, and the results are good, so we use that for the cord elutions since we do more of those.  Yes, we could just utilize the acid elution method but find that what we're doing works for us.

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