In Reply.—Dr Novak and Mr Martin are concerned with the potential for clerical errors to occur in the nursery, especially with the original "cow" technique that used both types A and O blood; the original system, however, insisted on a detailed written protocol, proper training of nursing personnel, the use of medication nurses to give the blood, continual monitoring of the records by hospital blood-bank personnel, and a refrigerator with a temperature recorder and alarm system that was also monitored by blood-bank personnel. The advantage of drawing the blood in the nursery is that it can be immediately transfused into the infant without awaiting transportation from the blood bank. Lacking the strict controls demanded by our protocol, drawing blood from units in the blood bank would be preferable.
As noted in our article, to make the system most efficient we have recently supplied only types 0, Rh-positive and 0,