Wasted health care dollars. Routine cord blood type and Coombs' testing
E. A. Leistikow, M. F. Collin, G. D. Savastano, T. M. de Sierra and B. N. Leistikow
Department of Pediatrics, University of North Carolina, Chapel Hill, USA.
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 newborn 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 Metro-Health 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.
