6159 Is it necessary to follow up all babies with weakly positive direct antiglobulin test (DAT)?

Objectives Unnecessary neonatal appointments cause inconvenience and anxiety for families and are a poor use of resources. Our 2019 local guideline recommended that all asymptomatic DAT+ babies should have a full blood count (FBC) and reticulocyte count checked at 2–3 and 6–8 weeks to exclude anaemia. Two Plan-Do-Study-Act (PDSA) cycles were conducted in 2019 and 2023 to determine: If infants with weakly positive DAT could be safely excluded from follow-up. If any infants requiring transfusion were missed after changing the guideline. Any associated cost savings. Methods Infants aged less than 1 month who were DAT-positive from 1 January 2017 to 15 December 2018 (cycle 1) and from 1 January 2021 to 31 December 2022 (cycle 2) were identified by the laboratory. Data regarding jaundice, anaemia, treatment received and follow-up were extracted from electronic patient records. The project was registered in the Trust's Quality and Safety Information System. Results In PDSA cycle 1, 143 DAT+ neonates were identified. Sixteen infants developed anaemia (haemoglobin <100 g/L), of which five required transfusion. Anaemia was uncommon in infants with weakly positive DAT (figure 1). Based on our data, additional risk factors for anaemia were identified, including prematurity, need for intravenous immunoglobulin/exchange transfusion and presence of other haemolytic anaemia. Consequently, we determined that it was safe to exclude DAT 0.5/1+ term infants with no features of active haemolysis or other known reasons for haemolysis from follow-up. This would equate to 95 infants in this cohort. The guideline was changed accordingly. In PDSA cycle 2, 108 neonates with positive DAT at any grade were identified. Seven developed anaemia of which two required transfusion. All infants with DAT 2+ or above were followed up (figure 2). Sixty-five infants in this cohort did not require follow-up due to the change in the guideline which previously each would have required at least 2 reviews. Over 2 years, we avoided at least 130 phlebotomy appointments and 130 telephone appointments: a cost saving of over £31,500 according to our Trust's tariff payment system. No infants who developed anaemia requiring transfusion were missed. Conclusion It is safe to exclude term infants with 0.5/1+ DAT and no other risk factors for haemolysis/anaemia from follow-up. This reduces the financial burden of follow-up and increases the availability of clinic time. Additionally, many babies were spared from painful procedures and unnecessary travel which also reduced carbon footprint.