Report: Make Newborn Screening Uniform

If you have a baby in California, the doctor must test the infant for galactosemia, a genetic condition that requires a milk-free diet. But if you reside in Louisiana, the test is not mandated.

Concerned by such inconsistencies, a new federal report calls for national standards in the screening for diseases of the 4 million babies born each year in the United States. But one prominent children’s organization is criticizing the report for not going far enough.

The report, published in this month’s Pediatrics, is being released today by the federal Health Resources and Services Administration and the American Academy of Pediatrics, a year after a national task force met in Washington to examine current practices.

The report found that state newborn screening systems need to be both modernized and standardized.

Screening Denied

“Newborns are being denied services just by the states in which they are born,” says Dr. Edward McCabe, co-chairman of the task force and physician-in-chief at the Mattel Children’s Hospital in Los Angeles. “There should be a consideration at the national level of what the core battery of tests are.”

Health Resources and other agencies will use the report in working with states to “try to produce some national agreement on what tests should be developed or be part of a core set of tests that at a minimum states should test for,” says Dr. Peter van Dyck, director of HRSA’s Maternal and Child Health Bureau.

Currently, every baby born in the United States is tested for anywhere from two to as many as 35 genetic or metabolic diseases that are treatable with special diets or medication.

But screening is done on a state-by-state basis through the local health department, with requirements varying widely from state to state.

State Disparities Every state requires newborns be tested for phenylketonuria (PKU) and hypothyroidism, two metabolic disorders that can lead to mental retardation without a special diet or medications. But only around half of all states require babies be given universal hearing tests.

States such as Massachusetts, Wisconsin, Michigan, Virginia and Arizona require testing of at least seven conditions, while others, like Utah and South Dakota, only require three.

If your baby has sickle cell anemia — a condition caused by abnormally shaped red blood cells that is common in the black community — but you happen to live in Idaho, Utah, North or South Dakota, chances are the infant won’t be tested. If your baby has galactosemia, but you live in a state that doesn’t currently require testing for it — Louisiana, Pennsylvania or Washington — it may not be detected.

Without treatment, the child may have developmental disabilities. This spotty screening means that many children with these rare diseases develop severe illnesses or even die, which could have been prevented with proper treatment.

“It’s clear that if you’re born in one state, that state may be giving you more or less tests than the others,” says Brad Ferrell, a task force member and chairman of the National Newborn Screening and Genetic Resource Center in Austin, Texas. “People might legitimately ask their state legislators, why does our state gets fewer tests than the state next door?”

Self-Testing Some parents have resorted to paying independent labs for tests not done in their own states. Baylor University Medical Center in Dallas offers a $25 test kit parents can order by mail.

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