COVID-19 NBS Response: Second or Repeat Screens

Date: July 2020

COVID-19 Second or Repeat Screen Challenges, Practices and Resources: (refer to the COVID-19 web page) 

 

Practices  Challenges Resources/Strategies
Second/ Repeat Screens                                             
  • Families do not want to return to the hospital/ birthing facility to get specimens collected
  • Hospitals/ birthing facilities are practicing social distancing, and are turning away "non-essential patients" 
  • Families are being turned away by commercial laboratories when trying to get their newborn's second screen because it is not an essential service
  • Some state NBS programs implement two screens for all newborns. The second screen recommendation for all newborns is putting families at risk and has the potential to tax the medical system during this critical time.       
  • There are lower staffing levels in the laboratory     
  • Some outpatient laboratories are currently closed 
  • Some laboratories do not have age-related cutoffs for samples collected at less than 24 hours of age 
  • This is a time of uncertainty around the availability of healthcare services/ recollection options for families       
  • Some clinics have modified their hours, making it more challenging to get in touch with medical specialists and schedule follow-up appointments to collect repeats.                                                                          
  • Perform after-hour laboratory draws for newborns 
  • APHL Position Statement on Newborn Screening Contingency Planning
  • APHL Short-Term Follow-Up Position Statement
  • The Washington State Newborn Screening Program has provided a document that includes justification for relaxing the recommendation that all newborns have their second screens for the duration of the COVID-19 pandemic. The program will accept second screens, and only require them for newborns with first screens that are abnormal or unsuitable. This will allow families to better practice social distancing, and will reduce the specimen load for Washington NBS' split shift laboratory staff. The program has also developed a list of frequently asked questions to accompany the recommendations:   
  • The Colorado Newborn Screening Program (CONBSP) recommends the collection of the second screen at 8-14 days after delivery. If facilities are unable to collect the specimen in this time frame, then the program recommends that they collect the specimen within the first 20 days after delivery. CONBSP recommends that the first newborn screen be collected at 24-48 hours after delivery. If facilities have to collect a specimen earlier than recommendations, they will need to submit another specimen collected at 48-72 hours after delivery. They will also need to collect the traditional second screen at 8-14 days after delivery. 
  • Educate local health districts on collecting newborn screens, and provide them with resources in the event that a pediatrician or hospital is unable to conduct a repeat screen 
  • Automatically request a repeat sample (if possible) when testing samples less than 24 hours of age 
  • Closely monitor the return of repeat samples to ensure there are no delays
  • In Puerto Rico NBS, repetitions that are collected in the laboratory and/ or birthing facility are coordinated with an appointment to minimize exposure. The DBS card is filled out via phone. 
  • In North Carolina NBS, genetic coordinators follow-up with health care providers via telehpone regarding repeat requests. 
  • For Louisiana NBS, the urgency of repeat requests is dependent on whether the result is unsatisfactory, inconclusive or presumptive positive. 
  • Wisconsin NBS has been tracking time of collection of repeats on a weekly basis. So far, they have not witnessed a statistical change in the time of collection for repeats. 

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