MANAGEMENT OF DIRECT ANTIGLOBULIN TEST (DAT) POSITIVE INFANTS NEONATAL CLINICAL GUIDELINE

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1 MANAGEMENT OF DIRECT ANTIGLOBULIN TEST (DAT) POSITIVE INFANTS NEONATAL CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline 1.1. To provide monitoring and treatment guidance for medical and nursing staff caring for infants with a DAT (Coombs) positive blood test who are at risk from haemolytic jaundice and anaemia. This guidance should be read with cross reference to RCHT guidelines for management of neonatal jaundice, neonatal echange transfusion and Blood Transfusion Policy 2. The Guidance 2.1. Due to blood group ABO or Rhesus factor incompatibility, maternal antibodies can cross the placenta. Activated by surface antigens epressed on the baby s red blood cells, maternal IgG immunoglobulin enters the baby s blood stream and can cause severe haemolysis with subsequent jaundice and anaemia Mother s who are Rhesus negative have a cord sample of blood sent after delivery to determine the baby s rhesus factor. The transfusion laboratory do not routinely process a DAT/ Direct Coombs test as false positive results may occur from maternal Anti D prophylais 2.3. Any blood sample tube sent to blood transfusion should be handwritten with the accuracy of the baby s details checked between two staff members as per RCHT Blood Transfusion Policy 2.4. If the maternal antenatal antibody titre is known to be high cord blood should also be sent for serum bilirubin level (SBR) and Hb level and the Blood Transfusion lab requested to urgently process a DAT in addition to the baby s blood group and Rhesus type as echange transfusion may be needed 2.5. Any baby with severe haemolysis with rapidly rising bilirubin levels should be considered for immunoglobulin treatment which may reduce the rate of rise 2, Any baby with visible jaundice in the first 24 hours should also have an urgent Group and DAT request. If the mother is Rhesus negative the lab can further process the cord blood they have rather than needing a new sample 2.7. As per RCHT neonatal jaundice guideline any baby who reaches phototherapy treatment level should also be investigated with a Group and DAT test Page 1 of 7

2 2.8. In addition to jaundice monitoring any baby with DAT positive status should have (as a minimum) a FBC with reticulocyte count and SBR at 1 week and at 5 weeks old 2.9. All DAT positive babies should be prescribed 500mcg Folic Acid daily for 6 weeks/ until a rising trend of Hb over 90g/l is achieved. It is the responsibility of the person discharging the baby to ensure that the first follow up appointment for the NNU Outpatient Clinic has been made and details given to the parents in addition to the TTO for Folic Acid prescription Page 2 of 7

3 3. Monitoring compliance and effectiveness Element to be monitored Lead Tool Frequency Reporting arrangements Acting on recommendations and Lead(s) Do DAT Test positive babies receive folic acid at discharge and have repeat FBC and SBR at 1 week and 5 weeks Neonatal Consultants Audit pro-forma to identify number of DAT positive babies over a set period eg 1 year. Outcome monitor whether blood tests were done at 1 and 5 weeks, whether baby received Folic acid TTO Every 3 years Child Health Audit and Governance meeting Neonatal Lead to act upon any deficiency to improve induction programme in liaison with Obstetric Governance Lead to inform midwifery staff of any deficiencies in the process This should occur after the 3 yearly audit Change in practice and lessons to be shared Any changes in practice required will be incorporated/amended into new guideline for new Paediatric Doctor induction which is reviewed annually 4. Equality and Diversity 4.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement Equality Impact Assessment The Initial Equality Impact Assessment Screening Form is at Appendi 2. Page 3 of 7

4 Appendi 1. Governance Information Document Title Date Issued/Approved: November 2014 Management of Direct Antiglobulin Test (DAT) Positive infants Neonatal Clinical Guideline Date Valid From: November 2014 Date Valid To: November 2017 Directorate / Department responsible (author/owner): Judith Clegg. ANNP, NNU Child Health Directorate Contact details: (01872) Brief summary of contents Clinical management, treatment, blood tests. Folic acid supplement. Follow up for DAT positive infants jaundiced in neonatal period Suggested Keywords: Target Audience Eecutive Director responsible for Policy: DAT. Coombs Positive. Neonate. Neonatal. Jaundice. Folic Acid. RCHT PCH CFT KCCG Eecutive Director Date revised: 23 April 2014 This document replaces (eact title of previous version): Approval route (names of committees)/consultation: New Document RCH Neonatal Guidelines Group approval Neonatal Consultants approval Divisional Manager confirming approval processes Name and Post Title of additional signatories Signature of Eecutive Director giving approval Publication Location (refer to Policy on Policies Approvals and Ratification): Document Library Folder/Sub Folder Links to key eternal standards Related Documents: Sheena Wallace Not required {Original Copy Signed} Internet & Intranet Intranet Only Clinical, Neonatal Guidelines, Haematology, jaundice None 1.Murray,N.,Roberts,I.(2007) Haemolytic disease of the newborn Archives of Disease in Childhood Fetal Neonatal Ed. 92;83-88 Page 4 of 7

5 2.Mundy, CA (2005) Intravenous immunoglobulin in the management of hemolytic disease of the newborn Neonatal Network 2005 Nov-Dec;24(6): Training Need Identified? 3.Schwartz HP1, Haberman BE, Ruddy RM (2011) Hyperbilirubinemia: current guidelines and emerging therapies Pediatric Emergency Care Sep;27(9):884-9 no Version Control Table Date Versio n No Summary of Changes Changes Made by (Name and Job Title) 12:11: Initial Guideline for Document Library Judith Clegg, ANNP 12:11: Document reviewed and formatted Reviewer: Dr Paul Munyard. Consultant Paediatrician and Neonatologist Formatted by: Kim Smith. Staff nurse All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of epiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the epress permission of the author or their Line Manager. Page 5 of 7

6 Appendi 2. Initial Equality Impact Assessment Form Name of the strategy to be assessed: Management of Direct Antiglobulin Test DAT positive infant s Neonatal Clinical Guideline Directorate and service area: Child Health. Neonatal Name of individual completing assessment: Judith Clegg. ANNP, Child Health Directorate. Neonatal Unit Is this a new or eisting Policy? New Telephone: Policy Aim* Who is the strategy / policy / proposal / service function aimed at? Medical and Nursing staff managing babies with a DAT positive blood test 2. Policy Objectives* To ensure monitoring, management, and appropriate follow up for neonates with DAT positive blood test 3. Policy intended Outcomes* 4. *How will you measure the outcome? 5. Who is intended to benefit from the policy? 6a) Is consultation required with the workforce, equality groups, local interest groups etc. around this policy? To clarify process for investigation, management and follow up Number of babies attending for follow up in Neonatal OP Clinic Newborn babies Clinical staff No. Neonatal Guideline Group consultant approved guideline b) If yes, have these *groups been consulted? C). Please list any groups who have been consulted about this procedure. 7. The Impact Please complete the following table. Are there concerns that the policy could have differential impact on: Equality Strands: Yes No Rationale for Assessment / Eisting Evidence Age Page 6 of 7

7 Se (male, female, transgender / gender reassignment) Race / Ethnic communities /groups Disability - learning disability, physical disability, sensory impairment and mental health problems Religion / other beliefs Marriage and civil partnership Pregnancy and maternity No impact No impact Seual Orientation, Biseual, Gay, heteroseual, Lesbian You will need to continue to a full Equality Impact Assessment if the following have been highlighted: You have ticked Yes in any column above and No consultation or evidence of there being consultation- this ecludes any policies which have been identified as not requiring consultation. or Major service redesign or development 8. Please indicate if a full equality analysis is recommended. No 9. If you are not recommending a Full Impact assessment please eplain why. Positive impact for all newborns tested Signature of policy developer / lead manager / director Paul Munyard Date of completion and submission 12:11:2014 Names and signatures of members carrying out the Screening Assessment Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead, c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD A summary of the results will be published on the Trust s web site. Signed Kim Smith Date 12:11:2014 Page 7 of 7

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