24 - Evaluating Policies Promoting Timely Collection and Transport of Newborn Metabolic Screens

Publication Number: 2021.24

Charis Kasler, Charleston Area Medical Center Institute for Academic Medicine, Charleston, WV, United States; Aryon Marshall, West Virginia University School of Medicine, Charleston, WV, United States; Samantha Weaver, CAMC, Morgantown, WV, United States; Susan Ayoubi, Charleston Area Medical Center Institute of Academic Medicine, Charleston, WV, United States; Stephanie Thompson, Charleston Area Medical Center, Charleston, WV, United States; Robin Zuniga-Dixon, Charleston Area Medical Center, Charleston, WV, United States; Elizabeth A. Copenhaver, West Virginia University School of Medicine, Charleston, WV, United States

Background: Newborn metabolic screens are collected in all 50 states, but the diseases included and methods for collection are not universal. In West Virginia, the screen is required before a newborn is discharged from the hospital, but a valid sample is unable to be collected until the newborn is 24-hours old. Lack of standardized policy for sample collection and delivery methods can lead to delays in diagnosis and ultimately poor outcomes.

Objective: This study aims to evaluate the impact of clinical practice changes at a tertiary children’s hospital to decrease the time between birth, sample collection, and delivery to the state lab.

Design/Methods: A retrospective observational study using chart review examined newborns over a 2-year period (1/1/2023-12/31/2024) to determine the impact of newborn screening practice changes. Interventions in order of implementation included 1.) standardized collection time at 24-hours old, 2.) nursing reeducation on timing of sample collection, 3.) direct communication with lab about potential documentation errors, and 4.) use of a courier service for sample delivery to state lab instead of postal service. Primary outcomes of interest were newborn age at time of sample collection, number of unacceptable samples, and number of abnormal results. Newborns were excluded if admitted to NICU, expired prior to 24-hours old, or if missing documentation. Frequencies and medians with interquartile ranges are reported, and the pre-intervention period was compared to time after implementation of all four interventions. Total number of newborns included in analysis was 4338.

Results: Prior to standardized policy, median age at collection was 28 [25-33] hours old. After all four interventions, median age at collection decreased to 24 [24-25] hours old, p< 0.001. Prior to use of a courier, 141 of 3052 (4.6%) samples were unacceptable due to sample being > 7 days old upon arrival at state lab. After use of a courier, a total of 1286 specimens were processed with none being unacceptable due to age of the sample, p< 0.001. Rate of abnormal screens prior to interventions (6.2%) vs. after the four interventions (6.9%) remained steady (p=0.55).

Conclusion(s): A standardized policy for collection of newborn screens decreased the age at time of collection without increasing the rate of false positive screens. Once mail delivery of samples was replaced with courier service, the risk of old samples was eliminated. These practice changes could be implemented in newborn nurseries to decrease the time to diagnosis, the need for repeat samples, and financial cost of repeat testing.