Written by Stephanie Limb

Approximately 240 hospitals in Texas deliver babies. In that capacity, they not only provide labor and delivery services, they also provide critical screening of newborns to identify serious and potentially fatal disorders or medical conditions.

These conditions may not be evident immediately at birth, but early identification and intervention is vital to prevent serious complications, such as growth problems, developmental delays, deafness, blindness, intellectual disabilities and seizures, and even sudden or early death.

“The newborn screening role is one Texas hospitals take very seriously,” said Carrie Kroll, vice president, advocacy, quality and public health at the Texas Hospital Association. “Identifying potentially life-threatening conditions in newborns born in their facilities is a privilege and an important responsibility.”

The number of conditions for which hospitals screen has grown exponentially in recent years as technology advances and medical interventions also have grown. Today, Texas hospitals screen babies for more than 50 conditions with just a simple heel-stick blood sample as well as conduct a screen for hearing loss and critical congenital heart disease.

Texas has required newborn hearing screening since 1999. As many as six in every 1,000 babies are born with permanent hearing loss. Early detection means infants identified and receiving intervention before six months of age can develop language similar to that of hearing children. Nationally, more than 12,000 newborns yearly are affected by disorders identified through blood spot screening. Screening for critical congenital heart disease has been a state requirement since 2013. Congenital heart disease is the most common and deadly of all birth defects and affects about 40,000 newborns each year. With CCHD screening, states are seeing an increase in previously unrecognized heart disease and corresponding reduction in infant death.

Texas law requires newborn screening unless the parent refuses for religious reasons. Hospital staff collect the first blood sample between 24 and 48 hours after the child is born. The second sample is collected at seven to 14 days of age, usually by the child’s community-based pediatrician. 

Results from the heel stick are sent to the Texas Newborn Screening Laboratory in Austin that operates under the auspices of the Texas Department of State Health Services. The lab tests nearly 800,000 specimens annually.

Given the importance of identifying these conditions as early as possible to avoid serious adverse outcomes, national recommendations encourage first screen specimens to arrive at the lab within 24 hours after collection. To help hospitals monitor and improve screening and timeliness of delivery to the lab, TDSHS provides hospitals with a monthly report card that includes information on:

- Total number of specimens submitted by the facility.

- Total number of specimens with quality problems and the most frequent quality problems.

- Timing of collections by the facility.

- Specimen transit time from collection to the state laboratory.

- Total number of specimens missing key demographic information.

- The report card includes statewide averages for benchmarking purposes.

“There’s logistical complexity in newborn screening because of the timing imperative,” said THA’s Kroll. “Texas hospitals and TDSHS work together to make workflow and collection and submission processes as seamless and efficient as possible.” This month, for example, THA hosted an educational webinar for members on best practices for improving newborn screening and released a best-practice whitepaper. The whitepaper can be found at www.tha.org/newbornscreening.

Providers and facilities purchase the specimen collection kits, which includes the cost of the testing, for patients covered by private health insurance or who self pay. TDSHS provides specimen collection kits at no cost for patients covered by Medicaid or the Children’s Health Insurance Program and is reimbursed by those programs for the cost of testing. For hospitals, payment for screening typically is bundled into the reimbursement rate for labor and delivery. As more conditions are added to the screening protocols, it is important that payers adjust labor and delivery rates to accommodate the additional requirements.

More information on newborn screening requirements and practices can be found at www.tha.org/newbornscreening and dshs.texas.gov/newborn