Utilizing Placental Blood to Reduce Phlebotomy Losses During NICU Admission
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Authors
Ricklefs, Lindsey
Issue Date
2023-05-11
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Abstract
Background: Newborns admitted to the neonatal intensive care unit (NICU) frequently endure their greatest volume of blood loss on the day of birth secondary to admission laboratory testing. For extremely preterm and very-low birth weight infants, large phlebotomy losses can negatively affect circulating blood volume to a degree that requires early blood transfusion, an intervention strongly associated with the development of intraventricular hemorrhage. Multiple studies have demonstrated the use of placental blood as an alternative source to neonatal specimen at delivery and the subsequent benefits of minimizing initial phlebotomy losses for preterm infants.
Purpose: The purpose of this project was to implement and assess the process for drawing blood for culture directly from the placenta in place of a neonatal blood sample to minimize initial phlebotomy losses for preterm infants during NICU admission.
Methods: A procedural protocol was developed and NICU nurses were trained to draw from placental vessels. Though this practice change was implemented for all infants requiring sepsis evaluation at birth, data collection was limited to infants less than 32 weeks of gestation for which an adequate specimen was obtained. A review of electronic medical records (EMR) from pre- and post-implementation infants was conducted to compare mean hematocrit and hemoglobin levels at day of life (DOL) 1, time to first blood transfusion, and frequency and severity of IVH in preterm infants before and after the practice change.
Results: Twenty-eight infants were evaluated pre-implementation, and four infants were evaluated post-implementation. Mean gestational age and birthweight were similar between the pre-implementation group (GA 29.3 weeks, BW 1120 grams) and post-implementation group (GA 28.6 weeks, BW 1135 grams). In the pre-implementation group, mean hematocrit was 44.8% and mean hemoglobin was 15.3 g/dL on DOL 1. The post-implementation group demonstrated slightly higher mean hematocrit and mean hemoglobin values at 49.1% and 16.2 g/dL, respectively. Time to first blood transfusion was delayed to DOL 5 for the only infant who received a transfusion post-implementation. Eight infants in the pre-implementation group received an early blood transfusion with the mean time to first transfusion 0.6 days. The diagnosis of any grade IVH was documented for 6 of the 28 infants in the pre-implementation group with two of these infants diagnosed with severe IVH (grade III or IV). None of the post-implementation group infants had a diagnosis of IVH at discharge.
Implications for Practice: Literature review suggests the utilization of placental blood as a substitute for initial admission laboratory may help to improve clinical outcomes for preterm infants. In addition to blood cultures, placental blood has been used for genetic testing, complete blood cell counts (CBC), blood-typing, and metabolic screening tests. Obtaining placental blood for sepsis evaluation immediately after delivery may also positively impact Golden Hour metrics with a decreased time to antibiotic administration.
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Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University