WASTED HEALTH-CARE DOLLARS - ROUTINE CORD-BLOOD TYPE AND COOMBS TESTING

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 t he common practice of routine blood type and Coombs' NCBT. Two 12-mont h study arms, retrospective and prospective, were conducted. Hemolytic disease of the newborn was studied retrospectively under an unrestric ted NCBT policy. Then, HDN was studied after a policy change that rest ricted NCBT to patients in new-Hobel risk scores for clinical severity of newborn hospitalization, duration of hospitalizations, and peak se rum bilirubin levels. Participants: All newborns (N=8501) at the Metro -Health Medical Center, Cleveland, Ohio, were studied (retrospective a rm, all 1989 admissions; prospective arm, all July 1990 to June 1998 a dmissions). Outcome Measures: Blood type and Coombs' NCBT, maternal bl ood type and antibody screening, Hobel risk scores for clinical severi ty of newborn hospitalization, duration of hospitalizations, and peak serum bilirubin levels. Results: No quantitative or qualitative increa ses in morbidity from jaundice were detected by retrospective analysis with unrestricted NCBT, or prospectively after selective testing on 4 498 newborns. Each study arm resulted in 15 readmissions for jaundice; these included two patients with ABO HDN. Furthermore, selective test ing resulted in performance of NCBTs on only 390 infants in the ''norm al'' nursery (24% of the original sample). Estimates projected on 1991 US births (4 111 000) showed that selective NCBT offers potential yea rly savings above $30.8 million of patient charges, savings above $11. 3 million of hospital costs, and the reassignment of more than 112 per sonnel full-time equivalents. Conclusion: Selective NCBT decreases the use of resources and costs without apparent additional patient morbid ity from HDN.