Managing Newborn Screening Repeat Collections for Sick and Preterm Neonates

Area of Science:

• Neonatal care
• Biochemical screening
• Public health initiatives

Background:

• Altered biochemical profiles in preterm and sick neonates necessitate follow-up newborn screening (NBS) collections.
• Victorian NBS program historically had separate, less optimal repeat collection guidelines for low birth weight (<1500g) and transfused infants.
• Adherence to these guidelines was suboptimal, with over 20% of eligible infants missing follow-up collections.

Purpose of the Study:

• To audit adherence to existing Victorian NBS repeat collection guidelines for preterm and sick neonates.
• To review and optimize NBS guidelines, particularly regarding timing of repeat collections for transfused infants.
• To implement and evaluate a new combined protocol to improve NBS follow-up compliance.

Main Methods:

• Audited NBS data for 348,584 infants between January 2018 and June 2022.
• Filtered for infants with recorded birth weight between 200-1499g (n=2647).
• Reviewed literature, professional society guidelines, and tertiary hospital practices to inform protocol changes; implemented a new "sick-prem protocol" and assessed compliance after one year.

Main Results:

• Only 77% (2036/2647) of infants with birth weight <1500g had a second NBS sample collected.
• The Victorian program's 3-week post-transfusion follow-up timing was longer than other Australasian jurisdictions.
• The new "sick-prem protocol" achieved 95% compliance for repeat collections within one year of implementation.

Conclusions:

• Current NBS protocols require auditing to ensure appropriate follow-up for preterm and sick neonates.
• Standardizing and simplifying NBS repeat collection guidelines, supported by visual aids, significantly enhances compliance.
• NBS laboratories should adopt improved protocols and educational tools to maximize the effectiveness of screening programs.