FAILURE TO SCREEN NEWBORNS FOR INBORN DISORDERS - A POTENTIAL CONSEQUENCE OF CHANGES IN NEWBORN CARE

Objectives: To determine how changes in the structure of the hospital care of infants, such as shortened post-natal stays, affect the comple teness of newborn screening. Design: Cohort. Setting: Two large matern ity hospitals. Participants: 8751 consecutive births at the study hosp itals during 1993. Main outcome measure: The completeness of initial s pecimen collection and processing as determined by matching of birth a nd screening records. Results: At least one specimen was received by t he screening program for 8675 (99.1%) of the births. Most non-screened patients (71/76, 93%) had been admitted to the neonatal intensive car e unit (NICU). Of these, 53/71 (75%) were low birth weight infants who died within 48 h of birth. Even after excluding these non-survivors, NICU patients were 37 times more likely to be unscreened than their he althy counterparts (22 vs. 0.6 per 1000 infants, 95% C.I. 12.8, 92.8 P < 0.01). A common characteristic of non-screened NICU survivors, (12/ 18) was interhospital transfer for sub-specialty care. Among patients in the healthy-baby nursery, early discharge (i.e. < 24 h of age) acco unted for 2/5 (40%) of the cases of non-screening. The non-screening r ate among patients discharged early was 25 times higher than for those discharged after 24 h (9.8 vs. 0.4 per 1000 infants, 95% C.I. 4.2, 14 9 P < 0.01). Conclusions: Although the overall rate of screening was h igh, NICU patients, especially those requiring transfer, are dispropor tionately at risk for non-screening. Early discharge of healthy newbor ns was also significantly associated with non-screening. This latter f inding is of special importance given the current trend toward shorter hospital stays for newborns. Increased attention to ensuring the coll ection of specimens from these two high-risk populations is warranted. (C) 1997 Elsevier Science Ireland Ltd.