Should We Screen Cord Blood For ABO Incompatibility?

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ESPR337
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Background: ABO incompatibility is one of the leading causes of unconjugated hyperbilirubinemia in infants. Routine performance of blood group and direct coombs test (DCT) on cord blood is controversial. Performing blood group and DCT in cord blood may help in early identification of risk for hyperbilirubinemia but may increase healthcare cost. At our institution, routine cord blood type and DCT was stopped in 2013. 


Objective: The goal of our study was to determine if there was a change in NICU admissions for management of hyperbilirubinemia when routine cord blood group and DCT was obtained compared to when not obtained at delivery. 


Methods: This is a retrospective analysis of all neonates admitted to the NICU from the newborn nursery between 1/2007 and 2/2020 with hyperbilirubinemia. Clinical characteristics, including age at first bilirubin level, first and peak bilirubin level, need for intensive phototherapy, IVIG, and blood transfusion were compared between the cohort with blood group and DCT obtained at delivery (2007-2013) and the cohort with no labs obtained at delivery (2014-2020). 


Results: A total of 29,447 infants were born and 1,684 infants were admitted to NICU from nursery during the study period.  Significantly more newborns, with and without ABO incompatibility, were admitted to the NICU from the newborn nursery for hyperbilirubinemia requiring intensive phototherapy when no labs were obtained at birth (Table 1). For newborns with ABO incompatibility, significantly more infants had peak bilirubin at exchange blood transfusion level and required IVIG when no labs were obtained at delivery. There was also a significant difference in time of and the level of the first bilirubin, with initial bilirubin levels collected later and initial bilirubin higher in the cohort who did not have labs at delivery (Table 2). 


Conclusions: Not obtaining blood group and DCT at delivery has led to a significant increase in NICU admissions from the newborn nursery for hyperbilirubinemia and ABO incompatibility. Initiating policy to obtain blood group and DCT at birth for infants born to O+ mothers will prevent NICU admissions for higher level of care and potential long-term complications in newborns with ABO incompatibility.

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Thomas Jefferson Sidney Kimmel Medical College
Thomas Jefferson University
Thomas Jefferson University

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