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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Newborn screening in Singapore
Insights
Singapore
Area of Science:
- Neonatal screening programs
- Public health initiatives in Singapore
- Genetic disorder screening
Background:
- Neonatal screening for G6PD deficiency began in Singapore in 1965.
- Congenital hypothyroidism screening initiated as a pilot in 1981, nationwide by 1990.
- Screening involves TSH measurement in cord serum, with treatment initiated within a week of life.
Purpose of the Study:
- To report on the outcomes and incidence of neonatal screening programs in Singapore.
- To assess the effectiveness of preventive measures for G6PD deficiency and congenital hypothyroidism.
- To explore future directions in neonatal screening, including PKU screening.
Main Methods:
- TSH measurement in cord serum for congenital hypothyroidism screening.
- Semi-quantitative rapid screening tests for G6PD activity in cord blood.
- Analysis of screening data from over 400,000 newborns, including specific data from 22,830 newborns at National University Hospital.
Main Results:
- Screening rates for congenital hypothyroidism are approximately 99.95%, with an incidence of 1 in 3,000.
- G6PD deficiency incidence: 1.62% overall, 3.15% in males, 0.11% in females.
- Higher G6PD deficiency incidence observed in Chinese and Malay males compared to Indian males; no kernicterus reported in 20 years.
Conclusions:
- Preventive measures have successfully eliminated kernicterus in newborns over the past two decades.
- Ongoing efforts focus on optimizing screening recall rates and reducing hospitalization for G6PD deficiency.
- Consideration is being given to introducing Phenylketonuria (PKU) screening in Singapore.
Abstract:
Neonatal screening in Singapore for G6PD deficiency started in 1965. Screening for congenital hypothyroidism started in 1981 as a pilot research program and by 1990, it became nationwide. Screening for congenital hypothyroidism is by the measurement of TSH in the cord serum with recall of those exceeding the 99th percentile, by about 3-4 days of life. Treatment is usually started within a week of life. Over 400,000 newborns have been screened and the screening rate has been about 99.95%. The incidence rate is about 1 in 3,000. G6PD activity in the cord blood is measured using semi-quantitative rapid screening tests. Those identified are physically protected from environmental triggers by keeping them in hospital for a variable period of time. Parents are counseled. Data obtained from 22,830 newborns from the National University Hospital revealed incidence rates of 1.62% in all newborns, 3.15% in males and 0.11% in females. The Chinese and Malay males had a higher (3.94% and 2.95%) incidence respectively when compared to the Indian males with (0.66% incidence). The application of the preventive measures has resulted in no report of kernicterus in the last 20 years. Our efforts are now focused on minimizing the recall rate in the case of hypothyroidism screening, reducing the period of stay in hospital in those with G6PD deficiency and considering the introduction of a PKU screening program in Singapore.
