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The value of routine laboratory screening in the neonatal intensive care unit
S H Kazmi1, M Caprio1, H Boolchandani1
1Department of Pediatrics, Division of Neonatology, New York University School of Medicine, NY, USA.
Insights
Routine laboratory testing in preterm infants may be unnecessary for those 32-34 weeks gestation, as no interventions followed testing. Further research is needed to determine if routine testing impacts neonatal outcomes.
Area of Science:
- Neonatal Medicine
- Pediatric Laboratory Medicine
- Healthcare Economics
Background:
- Rising healthcare costs and increasing annual costs of prematurity necessitate evaluating healthcare resource utilization.
- Routine laboratory testing in neonatal intensive care units (NICUs) represents a significant component of healthcare spending.
- The clinical utility and cost-effectiveness of routine laboratory tests in preterm infants require careful examination.
Purpose of the Study:
- To investigate the frequency of medical interventions following routine laboratory testing in preterm infants.
- To determine if gestational age influences the rate of intervention after hemogram and hepatic panel testing.
- To assess the potential for de-escalating routine laboratory monitoring in specific preterm infant populations.
Main Methods:
- Retrospective study of preterm infants (≤34 weeks gestation) admitted to a NICU.
- Data collection included demographics, laboratory results, and subsequent interventions.
- Interventions were defined based on specific laboratory panels (hemogram, hepatic panel) and stratified by gestational age (<28, 28-31 6/7, 32-34 weeks).
Main Results:
- A statistically significant difference in intervention frequency after hemogram testing was observed across gestational age groups (p=0.02).
- Infants <28 weeks gestation had the highest intervention rate (8.4%) after hemogram, while those 32-34 weeks had 0% intervention.
- No statistically significant differences in intervention rates were found after hepatic panel testing across gestational age groups.
Conclusions:
- Routine laboratory testing yielded no interventions in preterm infants aged 32-34 weeks gestation.
- Routine laboratory testing may be unnecessary for infants 32-34 weeks gestation, suggesting potential for cost savings and reduced iatrogenic burden.
- Further research is warranted to explore the impact of routine laboratory testing on neonatal outcomes and to refine testing protocols.
Background:
Healthcare spending is expected to grow faster than the economy over the next decade, and the cost of prematurity increases annually. The aim of this study was to investigate the frequency of intervention after routine laboratory testing in preterm infants.
Methods:
This was a retrospective study of preterm infants (≤34 weeks) admitted to the NYU Langone Health NICU from June 2013 to December 2014. Data collected included demographics, results of laboratory tests, and resulting interventions. Intervention after a hemogram was defined as a blood transfusion. Intervention after a hepatic panel was defined as initiation or termination of ursodiol or change in dose of vitamin D. Subjects were stratified into 3 groups based on gestation (<28 weeks, 28-31 6/7 weeks, 32-34 weeks). Chi-square analysis was used to compare the frequency of intervention between the groups.
Results:
A total of 135 subjects were included in the study. The frequency of intervention after a hemogram was 8.4% in infants <28 weeks, 4.6% in infants 28-31 6/7 weeks, and 0% in infants 32-34 weeks; this difference was found to be statistically significant (p = 0.02). The frequency of intervention after a hepatic panel was 4.2% in infants <28 weeks, 5.7% in infants 28-31 6/7 weeks, and 0% in infants 32-34 weeks, which was not found to be a statistically significant different.
Conclusion:
No interventions were undertaken post-routine laboratory testing in any infant 32-34 weeks and routine testing in this population may be unnecessary. Further studies are needed to elucidate if routine testing affects neonatal outcomes.
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