Are Placental Blood Samples a Proxy for Infant Blood Samples When Comparing Lab

Background: Neonatal anemia is a common problem faced by infants admitted to the NICU. Admission labs to the NICU typically required 3-4 mL of blood for diagnostic purposes. Blood losses from phlebotomy draws increases the likelihood of anemia in preterm infants less than 32 weeks gestation and may increase transfusion rates for neonates. Placental lab draws have been shown to decrease anemia in this patient population. Placental lab draw protocols are a standard of care throughout the Intermountain West region. A level III Newborn intensive care unit (NICU) in Ogden, Utah, was not using alternative sources for initial laboratory evaluation. Before this protocol could be implemented the laboratory required verification that the infant complete blood count (CBC) samples and placental CBC samples were equivalent. Methods: A retrospective chart review of NICU admissions was needed to assess for phlebotomy losses and anemia. An evidence based placental lab draw protocol was adapted and modified to meet the needs of the facility. An educational presentation was given to the key stake holders regarding the placental lab draw protocol and demonstration for obtaining paired samples was provided. Pre- and post-education surveys were completed by participants to first establish baseline knowledge of stake holders and acquired knowledge following educational sessions. Post implementation chart review was used to gather infant CBC and placental CBC information for comparison and analysis. Paired samples from the infant and its cord/placenta were obtained and sent to the institution's lab for analysis of equivalency using a paired samples t-test (p < 0.5).Results: Retrospective chart reviews found that 100% of infants admitted to the NICU had a CBC drawn on admission. Of the 50 infants reviewed, three (6%) developed anemia and required blood transfusion. All key stake holders agreed that premature and extremely low birth weight (ELBW) infants were at higher risk for anemia and blood transfusion secondary to phlebotomy draws. During the four-month collection period 17 paired samples were obtained and evaluated. Statistical comparisons of the WBC, RBC, hematocrit and hemoglobin were conducted and significant differences between the infant and placental samples was found in all but HCT (p=0.60) and platelet (0.820) values, therefore sample equivalency for infant and placental CBCs could not be established.Conclusion: This project revealed system inefficiencies, barriers, communication failures and procedural problems with the initial protocol. With stakeholder input, the protocol was revised and approved. The institution will move forward with data collection slated to begin in April 2020.