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Updated: Nov 3, 2025

Biochemical Measurement of Neonatal Hypoxia
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An Initiative to Decrease Laboratory Testing in a NICU.

Christopher J Klunk1, Renee E Barrett2, Steven M Peterec2

  • 1Yale School of Medicine, Yale University, New Haven, Connecticut; christopher_klunk@mednax.com.

Pediatrics
|June 5, 2021
PubMed
Summary
This summary is machine-generated.

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Reducing tracheal intubation adverse events and severe desaturations by increasing intubation premedication use in infants <1500 g: a quality improvement initiative.

Journal of perinatology : official journal of the California Perinatal Association·2025

Reducing routine laboratory testing in the neonatal intensive care unit (NICU) significantly decreased test volumes, blood loss, and costs. This quality improvement project achieved sustained reductions without adverse effects.

Area of Science:

  • Neonatal Intensive Care Unit (NICU) Quality Improvement
  • Clinical Laboratory Science
  • Pediatric Healthcare Management

Background:

  • Frequent laboratory testing in the NICU can lead to increased costs, blood loss, and pain.
  • These factors may negatively impact infant growth and neurodevelopmental outcomes.
  • A 20% reduction in routine laboratory testing was targeted over 24 months.

Purpose of the Study:

  • To implement a quality improvement project aimed at reducing routine laboratory testing in a NICU.
  • To decrease the number of laboratory tests performed per 1000 patient days by 20% within a 24-month timeframe.
  • To assess the impact on secondary outcomes including blood volume, costs, and patient safety.

Main Methods:

  • A multifaceted quality improvement project utilizing the Institute for Healthcare Improvement's Model for Improvement.

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  • Baseline data analysis to prioritize interventions, including guideline development and EMR optimization.
  • Primary outcome: laboratory tests per 1000 patient days; Secondary outcomes: blood glucose, bilirubin, blood volume, cost; Balancing measure: extreme laboratory values.

    • Main Results:

    • Achieved a 26.8% reduction in laboratory tests per 1000 patient days (approximately 51,000 fewer tests).
    • Significant decreases observed in secondary measures: nearly 8 liters of blood saved and $258,000 cost savings.
    • Reductions were sustained for at least 7 months post-intervention, with no adverse events linked to the changes.

    Conclusions:

    • Multifaceted interventions, including guideline development and technology optimization, effectively reduced NICU laboratory testing.
    • The project demonstrated a significant and sustained decrease in testing volume, blood draw volume, and associated costs.
    • The implemented strategies proved safe and effective, leading to sustained improvements without compromising patient safety.