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New study strengthens the case for reduced blood draws in NICU babies 

“Every time a sleeping baby is disrupted for a heel prick, a vein poke, or other blood draw, it impacts that baby’s quality of life during their course of stay,” said Marta Kenney RN, NICU, Yale New Haven Children’s Hospital (YNHCH). Ms. Kenney has been caring for babies in the Neonatal Intensive Care Unit (NICU) for over a decade. From the moment she shadowed a nurse in high school she was in love with the profession. Her primary responsibility, as she puts it, is to provide the best care for the babies. 

This is why she is honored to be a part of the NICU team, which recently created infrastructure to ensure routine screenings match each baby’s risk profile, resulting in a nearly 30 percent reduction in these screenings, a new study revealed

“This study is so important because it proved we can reduce screenings in the NICU to improve a baby's experience while continuing to monitor the babies appropriately,” said Kenney. “We have always taken great care when working with the babies, but our thought process behind lab work has shifted to where each test holds more significance and requires a team discussion.”

Since introduced in the 1960’s, and pioneered at Yale New Haven Hospital, NICUs have been the setting for life-saving treatments for newborns, decreasing infant mortality across the nation and leaving a legacy of healthy NICU “graduates.”  During their stay in the NICU babies are subject to a variety of screenings that include blood draws. However, the frequency of screenings is often inconsistent from provider to provider, potentially leading to more testing than is necessary. 

“In caring for premature infants, NICUs across the nation do vital screenings to closely monitor every baby,” said Matthew Bizzarro MD, regional medical director, NICU Network, Yale New Haven Children’s Hospital who led the study after learning about the adverse short and long-term effects of pain on the developing neonatal brain at a conference. “We were able to collect baseline data and establish guidelines for routine screening tests in an effort to safely go beyond a one size fits all model and ensure all screenings specifically speak to the needs of each baby, thereby potentially reducing pain, stress and blood loss.” 

Medical literature suggests that too many routine screenings can potentially impact a baby’s stress response and development. Additionally, in the short term, frequent blood sampling may be correlated with anemia and in some cases the need for blood transfusions.  To address the issue of inconsistent screening criteria, the NICU team created a data dashboard to track and analyze screenings for common blood tests in the NICU including bilirubin and blood sugar, typically measured via a heel stick blood test.
 
From this data, the team created a new approach to routine lab screenings that takes each baby’s medical history and condition into account. Blood panels were grouped together so less blood would be needed overall and, when possible, blood draws were replaced with less invasive tools such as handheld machines that monitor bilirubin through the skin and an adhesive sensor placed on the skin that can measure the amount of carbon dioxide in the babies’ blood.

These changes reduced laboratory screenings by 26.8 percent (~51,000 fewer tests) over a 24 month period. Additionally, the team saved 8L of blood drawn over a 24 month period of time. 

Balancing measures such as tracking for abnormal lab test values were reviewed and showed the interventions had no correlation with adverse effects.  

“Any opportunity to safely pay attention to our babies’ quality of life, allow them to sleep longer and leave our care as strong as possible, we welcome,” said Kenney.