Skip to main content
Log in

Quality performance of newborn screening systems: Strategies for improvement

  • Newborn Screening
  • Published:
Journal of Inherited Metabolic Disease

Summary

Newborn metabolic screening is a public health activity with the potential to realize significant health gains for infants affected with a range of congenital conditions. Many of these are inborn errors of metabolism. The activities required to achieve the gains are diverse and carried out by a number of organizations, by families and by many health care professionals. Laboratories have the best-developed quality strategies, which include quality assurance programmes, guidelines, protocols and standards. Two-tier testing and use of multiple markers improve sensitivity and specificity. There are international initiatives to harmonize assay materials and definitions to allow better benchmarking between programmes. Outside the laboratory, standards, education and protocols improve the quality of specimen collection, diagnosis and treatment, which together produce the health gains.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • AAP (2006) Update of Newborn Screening and Therapy for Congenital Hypothyroidism. American Academy of Pediatrics Susan R Rose MD and the Section on Endocrinology and Committee on Genetics American Thyroid Association Rosalind S Brown MD and the Public Health Committee Lawson Wilkins Pediatric Endocrine Society. Pediatrics 117: 2290–2303.

    Article  Google Scholar 

  • ACMG (2006a) Newborn Screening ACT sheets and confirmatory algorithms. Bethesda MD: American College of Medical Genetics. www.acmg.net.

  • ACMG (2006b) Newborn screening: toward a uniform panel and system. Genet Med 8: 1s–252s.

    Google Scholar 

  • Adam BW, Alexander JR, Smith SJ, et al (2000) Recoveries of phenylalanine from two sets of dried-blood-spot reference materials: prediction from hematocrit, spot volume, and paper matrix. Clin Chem 46: 26–28.

    Google Scholar 

  • Angelini C, Federico A, Reichmann H, Lombes A, Chinnery P, Turnbull D (2006) Task force handbook: EFNS guidelines on diagnosis and management of fatty acid mitochondrial disorders. Eur J Neurol 13: 923–929.

    Article  PubMed  CAS  Google Scholar 

  • Bhattacharya K, Khalili V, Wiley V, Carpenter K, Wilcken B (2006) Newborn screening may fail to identify intermediate forms of maple syrup urine disease. J Inherit Metab Dis 29: 586.

    Article  PubMed  CAS  Google Scholar 

  • Bollbach R, Becker M, Rotthauwe H (1985) Serum immunoreactive trypsin and pancreatic lipase in cystic fibrosis. EurJ Pediatr 144: 167–170.

    Article  CAS  Google Scholar 

  • Borrajo G, Pistaccio L, Gomez F, Di Carlo C, Castillo P, Dietz M (2006) Definition of a 17OH-progesterone birth weight adjusted cut-off value using the autodelfia method version B015. 6th ISNS International Meeting, Awaji/Tokoshima, Japan, Abstract WS23.

  • Briard ML (2003) Neonatal screening: definitions and criteria. [In French]. Arch Pediatr 10: 19s–21s.

    Article  PubMed  Google Scholar 

  • Brosco J, Seider M, Dunn A (2006) Universal newborn screening and adverse medical outcomes: a historical note. Ment Retard Dev Disabil Res Rev 12: 262–269.

    Article  PubMed  Google Scholar 

  • CDC (2007) Quality Assurance and Proficiency Testing for Newborn Screening. Bethesda, MD Centers for Disease Control. www.cdc.gov.

  • Chiang SH, Wu KF, Liu TT, Wu SJ, Hsiao KJ (2003) Quality assurance program for neonatal screening of glucose-6-phosphate dehydrogenase deficiency. Southeast Asian J Trop Med Public Health 34: 130–134.

    PubMed  Google Scholar 

  • CLSI (2006) Newborn Screening Followup; Approved Guideline. Clinical and Laboratory Standards Institute. www.nccls.org.

  • Como A, Accurso F, White T, et al (2007) Guidelines for implementation of cystic fibrosis newborn screening programs: Cystic Fibrosis Foundation Workshop report. Pediatrics 119: e495–518.

    Article  Google Scholar 

  • Copeland S, Berberich S, Valbrecht M, Piper K (2006) Minimising risk to newborns. A system to minimise the interval from specimen collection to test result in newborn screening; 24/7 testing and delivery by courier. 6th ISNS International Meeting, Awaji/Tokoshima, Japan, Abstract P105.

  • Dhondt JL, Paux E, Farriaux J (1996) Need for a standardized procedure in the preparation of phenylalanine calibrators. Early Hum Dev 45: 277–285.

    Article  PubMed  CAS  Google Scholar 

  • Dhondt JL, Loeber G, Elvers LH, Paux E (1998) Preparation of the first European working standard for phenylalanine determination in dried blood spots. J Med Screen 5: 63–67.

    PubMed  CAS  Google Scholar 

  • Dionisi-Vici C, Deodato F, Roschinger W, Rhead W, Wilcken B (2006) ‘Classical’ organic acidurias, propionic aciduria, methylmalonic aciduria and isovaleric aciduria: Long-term outcome and effects of expanded newborn screening using tandem mass spectrometry. [Report]. J Inherit Metab Dis 29: 383–389.

    Article  PubMed  CAS  Google Scholar 

  • Elvers LH, Loeber JG (1996) The need for standardized bloodspot TSH-calibrators in congenital hypothyroidism screening. Early Hum Dev 45: 179–190.

    Article  PubMed  CAS  Google Scholar 

  • Elvers LH, Loeber G, Dhondt JL, et al (2006) First ISNS reference preparation for neonatal screening for thyrotropin, phenylalanine and 17-alpha-hydroxyprogesterone in dried blood spots. 16th ISNS International Meeting, Awaji/Tokoshima, Japan, Abstract P111.

  • Elvers LH, Loeber JG, Dhondt JL, et al (2005) First ISNS reference preparation for neonatal screening for thyrotropin, phenylalanine and 17α-hydroxyprogesterone in blood spots RIVM rapport 230011004. Rijksinstituut voor Volksgezondheid en Milieu, RIVM.

  • ESPE (1999) Revised guidelines for neonatal screening programmes for primary congenital hypothyroidism. Working Group on Neonatal Screening of the European Society for Paediatric Endocrinology. Horm Res 52: 49–52.

    Article  Google Scholar 

  • Fitness J, Dixit N, Webster D, et al (1999) Genotyping of CYP21, linked chromosome 6p markers, and a sex-specific gene in neonatal screening for congenital adrenal hyperplasia. J Clin Endocrinol Metab 84: 960–966.

    Article  PubMed  CAS  Google Scholar 

  • Forsberg SA (1997) Infant metabolic screening: a total quality management approach. J Obst Gynecol Neonatal Nurs 26: 257–261.

    Article  CAS  Google Scholar 

  • Fukushi M, Honma K, Yoshinaga M, et al (2006) An international training and support programme for neonatal screening in developing countries. 6th ISNS International Meeting, Awaji/Tokoshima, Japan, Abstract SY12.

  • Green J, Hewison J, Bekker M, Bryant L, Cuckle H (2004) Psychosocial aspects of genetic screening of pregnant women and newborns: a systematic review. Health Technol Assess 8: 57–68.

    Google Scholar 

  • Gruters A, Delange F, Giovannelli G, et al (1994) Guidelines for neonatal screening programs for congenital hypothyroidism. European Society for Pediatric Endocrinology Working Group on Congenital Hypothyroidism. Horm Res 41, 1–2.

    PubMed  CAS  Google Scholar 

  • Heeley ME, Travert G, Ferre C, Lemonnier F (1991) The international quality assurance program (IRTIQAS) for the assay of immunoreactive trypsin in dried blood spots. Pediatr Pulmonol Supplement 7: 72–75.

    Article  Google Scholar 

  • HGSA (2000) HGSA Policy on the Retention Storage and Use of Sample cards from Newborn Screening Programs. Alexandria, VIC: Human Genetics Society of Australasia. www.hgsa.com.au.

  • HGSA (2004) Policy Statement: Newborn Screening. Alexandria, VIC: Human Genetics Society of Australasia. www.hgsa.com.au.

  • Hoff T, Hoyt A (2006) Practices and perceptions of long-term follow-up among state newborn screening programs. Pediatrics 117, 1922–1929.

    Article  PubMed  Google Scholar 

  • Hoff T, Hoyt A, Therrell B, Ayoob M (2006) Exploring barriers to long-term follow-up in newborn screening programs. Genet Med 8: 563–570.

    PubMed  Google Scholar 

  • Holzman C, Slazyk W, Codero J, Hannon H (1986) Descriptive epidemiology of missed cases of PKU and congenital hypothyroidism. Pediatrics 78(4): 553–558.

    Google Scholar 

  • Honma K, Yoshinaga M, Ota N, et al (2006) Improving the positive predictive value in newborn screening for congenital adrenal hyperplasia. 6th ISNS International Meeting, Awaji/Tokoshima, Japan, Abstract P30.

  • IAEA (2006) Screening of Newborns for Congenital Hypothyroidism. Guidance for Developing Programmes. Vienna: International Atomic Energy Agency.

    Google Scholar 

  • ISNS (2005) Lexicon of Terms to be Used in Newborn Screening. Wentworthville, NSW International Society for Neonatal Screening. www.isns-neoscreening.org/pdf/Lexicon8.pdf.

  • ISNS (2007) Website. www.isns-neoscreening.org.

  • Jones JH, Mackenzie J, Croft GA, Beaton S, Young D, Donaldson MD (2006) Improvement in screening performance and diagnosis of congenital hypothyroidism in Scotland 1979–2003. Arch Dis Child 91, 680–685.

    Article  PubMed  CAS  Google Scholar 

  • Kaye CI, Accurso F, La Franchi S, et al (2006) Introduction to the newborn screening fact sheets. Pediatrics 118: 1304–1312.

    Article  PubMed  Google Scholar 

  • Kempers M, van der Sluijs Veer E, Nijhuis-van der Sanden R, et al (2007) Neonatal screening for congenital hypothyroidism in the netherlands: cognitive and motor outcome at 10 years of age. J Clin Endocrinol Metab 92: 919–924.

    Article  PubMed  CAS  Google Scholar 

  • Li L, Zhou Y, Bell CJ, Earley MC, Hannon WH, Mei JV (2006) Development and characterization of dried blood spot materials for the measurement of immunoreactive trypsinogen. J Med Screen 13, 79–84.

    Article  PubMed  CAS  Google Scholar 

  • Lindner M, Ho S, Fang-Hoffman J, Hoffmann G, Kolker S (2006) Neonatal screening for glutaric aciduria type I: strategies to proceed. J Inherit Metab Dis 29, 378–382.

    Article  PubMed  CAS  Google Scholar 

  • Loeber G, Webster D, Aznarez A (1999) Quality evaluation of newborn screening programs. Acta Paediatr Suppl 88: 3–6.

    Article  PubMed  CAS  Google Scholar 

  • MacKenzie F (2007) United Kingdom External Quality Assessment Service. Neonatal Screening. http://www.ukneqas.org.uk/Directory/CC/neonatal.htm.

  • Minutti CZ, Lacey JM, Magera MJ, et al (2004) Steroid profiling by tandem mass spectrometry improves the positive predictive value of newborn screening for congenital adrenal hyperplasia.[see comment]. J Clin Endocrinol Metab 89: 3687–3693.

    Article  PubMed  CAS  Google Scholar 

  • Naruse H, Tsuji A, Suzuki E, et al (2003) Quality control system for mass screening in Japan. Southeast Asian J Trop Med Public Health 34: 30–35.

    PubMed  Google Scholar 

  • NCCLS (2003) Blood collection on filter paper for Newborn Screening Programs; Approved Standard. Clinical and Laboratory Standards Institute. www.nccls.org.

  • Oglesbee D, Lacey J, Spolar C, et al (2006) Newborn screening for MSUD: increased specificity by addition of 2nd-tier assay for allo-isoleucine by LC-MS/MS 16th ISNS International Meeting, Awaji/Tokoshima, Japan, Abstract P88.

  • Oglesbee D, He M, Majumder N, et al (2007) Development of a newborn screening followup algorithm for the diagnosis of isobutyryl-CoA dehydrogenase deficiency. Genet Med 9: 108–116.

    Article  PubMed  CAS  Google Scholar 

  • Olgemoller B, Roscher A, Adelbert A, Liebl B, Fingerhut R (2003) Screening for congenital adrenal hyperplasia: adjustment of 17-hydroxyprogesterone cut-off values to both age and birth weight markedly improves the predictive value. J Clin Endocrinol Metab 88: 5790–5794.

    Article  PubMed  CAS  Google Scholar 

  • Oltarzewski M, Jablonska E, Nowacka M, Radomyska B (2006) Comparison of tandem mass spectrometry (MS/MS) with colorimetric test in newborn screening for phenylketonuria discrimination power and cut-off values. 6th ISNS International Meeting, Awaji/Tokoshima, Japan, Abstract P33.

  • Pass K, Levy H, eds (1995) Early Hospital Discharge: Impact on Newborn Screening. Atlanta GA: Council of Regional Networks for Genetic Services.

    Google Scholar 

  • Patch C (2006) Newborn screening policy in the United Kingdom, the United States: two different communities of practice. [Review] [22 refs]. MCN, Am J Maternal Child Nurs 31: 164–168.

    Article  Google Scholar 

  • Paterson R (1999) Auckland Healthcare Services Limited Health and Disability Commisioner’s Report on Opinion Case 99hdc09011.

  • Pollitt R (2006a) Sensitivity, specificity and the ‘ethnic question’: controversies surrounding CF screening in the UK 6th ISNS International Meeting, Awaji/Tokoshima, Japan, Abstract WS16.

  • Pollitt RJ (2006b) Newborn screening policies in the UK: progress and problems. 6th ISNS International Meeting, Awaji/Tokoshima, Japan, Abstract SY19.

  • Pollitt R (2006c) International perspectives on newborn screening. J Inherit Metabc Dis 29: 390–396.

    Article  CAS  Google Scholar 

  • Pollitt R, Matthews A (2006) Population centile-centile plots for monitoring assay performance. 6th ISNS International Meeting, Awaji/Tokoshima, Japan, Abstract P110.

  • Pollitt RJ, Dalton A, Evans S, Hughes HN, Curtis D (1997) Neonatal screening for cystic fibrosis in the Trent region (UK): two-stage immunoreactive trypsin screening compared with a three-stage protocol with DNA analysis as an intermediate step. J Med Screen 4: 23–28.

    PubMed  CAS  Google Scholar 

  • Raimann E, Valiente A, Soto V, Cabello F, Cornejo V (2006) Succinylacetone assay in dried blood on filter paper. 6th ISNS International Meeting, Awaji/Tokoshima, Japan, Abstract P60.

  • Rinaldo P, Safari S, Tortorelli S, Matern D (2006a) Newborn screening of metabolic disorders by tandem mass spectrometry: the impact of performance on the cost–benefit equation. 6th ISNS International Meeting, Awaji/Tokoshima, Japan, Abstract PL5.

  • Rinaldo P, Tortorelli S, Matern D (2006b) Improved specificity of newborn screening for congenital adrenal hyperplasia by steroid profiling using tandem mass spectrometry. 6th ISNS International Meeting, Awaji/Tokoshima, Japan, Abstract WS17.

  • Roussey M, Le Bihannic A, Audrezet M, et al (2006) Neonatal Screening (NNS) of CF: Diagnostic problems with CFTR mild mutations. 6th ISNS International Meeting, Awaji/Tokoshima, Japan, Abstract P74.

  • Rovet J, Daneman D (2003) Congenital hypothyroidism: a review of current diagnostic and treatment practices in relation to neuropsychologic outcome. [Review] [96 refs]. Paediatr Drugs 5: 141–149.

    PubMed  Google Scholar 

  • Schymik I, Liebig M, Mueller M, et al (2006) Pitfalls of neonatal screening for very-long-chain acyl-CoA dehydrogenase deficiency using tandem mass spectrometry. J Pediatr 149: 128–130.

    Article  PubMed  CAS  Google Scholar 

  • Shepherd AJ, Glenesk A, Niven CA, Mackenzie J (2006) A Scottish study of heel-prick blood sampling in newborn babies. Midwifery 22: 158–168.

    Article  PubMed  Google Scholar 

  • Sherwin J, She J, Bhandal A (2006) California newborn screening for congenital adrenal hyperplasia using two tier test system with birthweight adjusted cutoffs for improved precision. 6th ISNS International Meeting, Awaji/Tokoshima, Japan, Abstract SY3.

  • Simon E, Flaschker N, Schadewaldt P, Langenbeck U, Wendel U (2006) Variant maple syrup urine disease (MSUD)—The entire spectrum. J Inherit Metab Dis 29: 716–724.

    Article  PubMed  CAS  Google Scholar 

  • Suolinna EM, Torresani TE, Westgard JO (2003) Designing quality control for neonatal screening assays. Southeast Asian J Trop Med Public Health 34: 103–106.

    PubMed  Google Scholar 

  • Sweetman L, Forni S, Alvarado L, Roe D, Fu X, Roe C (2006) Second tier testing for the differential diagnosis of short-chain acyl-CoA dehydrogenase deficiency, isobutyryl-CoA dehydrogenase deficiency, isovaleric acidemia and 2-methylbutyryl-CoA dehydrogenase deficiency. 6th ISNS International Meeting, Awaji/Tokoshima, Japan, Abstract P7.

  • Therrell B (2007) Program Evaluation and Assessment Scheme (PEAS).http://genes-r-us.uthscsa.edu/PEAS.doc.

  • Therrell B, Hannon H (2006) National Evaluation of newborn screening system components. Ment Retard Dev Disabil Res Rev 12: 236–245.

    Article  PubMed  Google Scholar 

  • Therrell B, Panny S, Davidson A, et al (1992) US Newborn Screening System Guidelines: Statement of the Council of Regional Networks for Genetic Services. Screening 1: 135–149.

    Article  Google Scholar 

  • Therrell B, Hannon H, Pass K, et al (1996) Guidelines for the Retention Storage and Use of Residual Dried Blood Spot Samples after Newborn Screening Analysis: Statement of the Council of Regional Networks for Genetic Services. Biochemistry Mol Med 57, 116–124.

    Article  CAS  Google Scholar 

  • Tillotson SL, Fuggle PW, Smith I, Ades AE, Grant DB (1994) Relation between biochemical severity and intelligence in early treated congenital hypothyroidism: a threshold effect. Br Med J 309: 440–445.

    CAS  Google Scholar 

  • Torresani T (2003) Quality control requirements in neonatal screening. Eur J Pediatr 162: S54–56.

    Article  PubMed  Google Scholar 

  • Tuuminen T, Kapyaho K, Rakkolainen A, Weber T (1994) Analytical quality control in neonatal screening. Clin Biochem 27: 429–434.

    Article  PubMed  CAS  Google Scholar 

  • UK (2005) Newborn blood spot screening in the UK Policies and Standards. UK Newborn Screening Programme Centre. London: Department of Health. www.newbornscreening-bloodspot.org.uk.

  • Wald N, Leck I (2000) Antenatal and newborn screening. Oxford: Oxford University Press.

    Google Scholar 

  • Wang S, Pizzolato S, Demshar H (1997) Receiver operatoing characteristic plots to evaluate Guthrie Wallac and Isolab phenylalanine kit performance for newborn phenylketonuria screening. Clin Chem 43: 1838–1842.

    PubMed  CAS  Google Scholar 

  • Wang W, Chen X, Zang J, He Y, Zhang P, Shen F (2003) Development of a newborn screening laboratory quality assurance system in Shandong China. Southeast Asian J Trop Med Public Health 34: 36–38.

    PubMed  CAS  Google Scholar 

  • Watanabe N, Suzuki E, Ikegami M, et al (2006) Quality control of the materials and reagents for neonatal screening in Japan. 6th ISNS International Meeting, Awaji/Tokoshima, Japan, Abstract P114.

  • Webster D, Dhondt JL, Hannon WH, Loeber G, Torresani T (1999) Quality assurance and standardization: summary of the satellite meeting Turku Finland, 11–12 June 1999. Acta Paediatr Suppl 88: 7–12.

    PubMed  CAS  Google Scholar 

  • Wilcken B (2006a) Mini-Symposium: Newborn screening for inborn errors of metabolism—Clinical effectiveness. J Inherit Metab Dis 29, 366–369.

    Article  Google Scholar 

  • Wilcken B (2006b) Newborn screening by tandem mass spectrometry assessing the benefits. 6th ISNS International Meeting, Awaji/Tokoshima, Japan, Abstract SY22.

  • Wilcken B, Wiley V, Sherry G, Bayliss U (1995) Neonatal screening for cystic fibrosis: a comparison of two strategies for case detection in 1.2 million babies. J Pediatr 127: 965–970.

    Article  PubMed  CAS  Google Scholar 

  • Wiley V, Carpenter K, Wilcken B (2006a) Detection of inborn errors of metabolism in newborns using tandem mass spectrometry—Lessons learned. 6th ISNS International Meeting, Awaji/Tokoshima, Japan, Abstract P141.

  • Wiley V, Tan E, Wilcken B (2006b) Non-ketotic hyperglycinaemia is usually not detectable by tandem mass spectrometry newborn screening. 16th ISNS International Meeting, Awaji/Tokoshima, Japan, Abstract P90.

  • Wilson J, Junger G (1968) Principles and Practice of Screening for Disease. Geneva: World Health Organization.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to D. Webster.

Additional information

Communicating editor: Toni Torresani

Competing interests: None declared

Rights and permissions

Reprints and permissions

About this article

Cite this article

Webster, D. Quality performance of newborn screening systems: Strategies for improvement. J Inherit Metab Dis 30, 576–584 (2007). https://doi.org/10.1007/s10545-007-0639-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10545-007-0639-2

Keywords

Navigation