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Improving Timely Evaluation of Newborns at Risk for Hemolytic Disease From a Positive Maternal Antibody
Athena T Samaras1, Alison E Sweeney, Emilee C Lewis
1Author Affiliations: Department of Pediatrics, Division of Hospital Pediatrics, University of North Carolina Hospital, Chapel Hill, North Carolina (Drs Samaras, Sweeney, and Lewis); Duke University School of Nursing, Durham, North Carolina (Dr Thompson); The University of North Carolina at Chapel Hill School of Nursing, Chapel, North Carolina; and Duke University School of Nursing, Durham, North Carolina (Dr Waldrop).
Background:
Hemolytic disease of the newborn (HDN) is a rare condition with the potential for high morbidity.
Local Problem:
Practice at a large maternity care center did not align with the American Academy of Pediatrics (AAP) revised hyperbilirubinemia guidelines.
Methods:
A pre/post-implementation design with Plan-Do-Study-Act cycles was used.
Interventions:
A clinical pathway was implemented to improve timely evaluation of newborns at risk for HDN due to a positive maternal antibody using cord blood.
Results:
Cord blood testing increased among the subset of newborns who did not meet collection criteria prior to the practice change (pre: 0% n = 7, post: 39% n = 23). Missed opportunities to test cord blood occurred less frequently post (35 versus 26 days between missed opportunities). Feasibility data identified the need for educational and clinical tools.
Conclusions:
A clinical pathway and tailored tools support the AAP recommendation. Electronic health record supports could bolster future efforts.
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