Improving Timely Evaluation of Newborns at Risk for Hemolytic Disease From a Positive Maternal Antibody

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.