EARLY NEWBORN SPECIMEN - SURVEY OF PRACTICES AMONG NEWBORN SCREENING PROGRAMS IN THE UNITED-STATES

Introduction: Hospital discharge of mothers and their infants within 24 h after delivery is becoming very frequent in the United States as part of the effort to constrain rising costs of health care, This poses a potential problem in newborn screening since the newborn blood specimen is most certainly and most efficiently collected prior to nursery discharge. We surveyed newborn screening programs about current practices in regard to these early specimens. Methods: Two survey forms were sent to the programs. The first requested information about recommendations and regulations for collection of specimens from early discharged infants, for collection of repeat specimens and the responsible agent for these collections, The second form asked which disorders were screened in the first and repeat specimens. Results: All programs recommend collection of a newborn screening specimen before discharge, regardless of how early that occurs, and all but one program recommends a repeat specimen for infants initially screened less than 24 h after birth. The agents designated as responsible for collecting the newborn specimen included hospital administrator and/or attending physician and/or physician following infant. Most of the programs gave written notification for a repeat specimen on early discharged infants but some notified the birth facility and follow-up physician, a few notified only one or the other and several notified the parents. All programs re-tested the repeat specimen for PKU and most re-tested for congenital hypothyroidism and the other disorders screened in the initial specimen. Discussion: Balancing the physiological suitability of early specimens against logistical issues encountered by delaying specimen collection until after discharge is a concern for newborn screening programs. This survey provides background information for guidelines on specimen collection in the early discharged infant.