title: Outcome and cost analysis of implementing selective Coombs testing in the newborn nursery.
abstract: OBJECTIVE
  (1) To determine whether infants born to O+ mothers who had selective cord-blood testing would have higher rates of clinically significant hyperbilirubinemia compared with those newborns who had routine cord-blood testing. (2) To determine the amount of cost savings by implementing a policy of selective cord-blood testing in newborns born to O+ mothers.
  
  
  METHODS
  We conducted a retrospective pre/post intervention chart review on all infants in the normal newborn nursery at Loyola, born to blood type O+ women between 1 April 2008 and 1 April 2009. The pre-intervention group (routine testing) included infants born within 6 months before implementation of a new policy. The post-intervention group (selective testing) included infants born within 6 months following the implementation of a new policy. Data were collected for each of these groups regarding clinically significant hyperbilirubinemia.
  
  
  RESULTS
  All 250 of the infants in the routine testing group had a cord-blood type and Coombs done, whereas 42 of 164 (25%) infants in the selective group had testing done. By the end of the 6 months following the policy change, only 8% of infants were undergoing cord testing. When comparing routine vs selective testing, there was no statistically significant difference in the 24-h serum bilirubin, rate of phototherapy during the birth hospitalization, rate of readmission for hyperbilirubinemia or peak serum bilirubin level at readmission. The 92% reduction of cord-blood typing and Coombs testing would lead to a cost saving of $4100 per year to our hospital and $18 900 per year to our patients, and 95 h per year of technician time to perform these tests. When extrapolated to Illinois births in 2008, this would lead to an annual cost saving of almost $800 000 to Illinois hospitals and about $3.6 million to patients.
  
  
  CONCLUSIONS
  Selective newborn cord testing of infants born to O+ mothers can decrease the use of resources and costs without increasing the risk of clinically significant hyperbilirubinemia.
authors.affiliation: Department of Pediatrics, Loyola University Medical Center, Maywood, IL 60153, USA. rshahid@lumc.edu
authors.forename: R
authors.initials: R
authors.lastname: Shahid
authors.forename: S
authors.initials: S
authors.lastname: Graba
mesh_terms: D000017:ABO Blood-Group System; D001787:Blood Group Incompatibility / Q000097:blood* / Q000175:diagnosis; D015331:Cohort Studies; D003298:Coombs Test / Q000191:economics* / Q000706:statistics & numerical data*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D005312:Fetal Blood; D006801:Humans; D006932:Hyperbilirubinemia / Q000097:blood* / Q000175:diagnosis; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening / Q000379:methods; D009725:Nurseries, Hospital; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D014481:United States
chemical_list: D000017:ABO Blood-Group System