Abstract
Objective: To show concordance between heel stick and placental blood sample pairs for newborns' pre-transfusion testing and to validate placental blood's tube and gel methodology.Methods: Placental samples were collected for pre-transfusion testing at birth from 78 singleton and twin newborns admitted to our Mother–Baby Unit to compare with the results of heel stick samples taken from same newborns. Gestational age ≥35 weeks, weight ≥2,000 g. The study was approved by the Institutional Review Board (IRB). Informed consent was obtained from newborn parents. ABO blood group, Rhesus factor (Rh), direct antiglobulin test (DAT), and antibody screen were performed. Ortho ProVue Analyzer was used for tube and gel methods. McNemar's test for paired categorical data was performed.Results: One hundred percent concordance in 78 pairs for ABO and Rh. Seventy-four pairs were tested for antibodies, 72 were both negative, 1 was both positive, and 1 gave discordant result. Ninety-nine percent concordance, p = 0.999. Sixty-five pairs were both DAT negative, seven were both DAT positive, and six gave discordant results. Ninety-two percent concordance, p = 0.68. Placental blood gave identical results comparing tube with gel methods.Conclusions: Placental blood is suitable for pre-transfusion testing and can replace heel sticks. Placental blood tube and gel methods are validated.
Highlights
Heel stick is the main source of blood testing in term and premature newborns
It is an invasive and painful procedure that affects newborn’s future developmental and behavioral expressions. It has long-term effects on their pain response when compared to infants who did not have such an invasive procedure [1, 2]
1 (1%) sample pair gave a discordant result. This occurred when the placental sample was positive for the presence of an antibody, while the heel stick sample was negative; p = 0.999 for discordance
Summary
Heel stick is the main source of blood testing in term and premature newborns. It is an invasive and painful procedure that affects newborn’s future developmental and behavioral expressions. One example was the creation of the sepsis risk calculator [5], which has minimized the need for workup in infants at risk for early onset sepsis. Another example is the use of non-invasive transcutaneous bilirubin which has replaced infant’s serum bilirubin when screening for neonatal jaundice [6]
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