Missed Screens

Since January 26, 2012, newborn screening results have been transmitted to the Better Outcomes Registry & Network (BORN). BORN notifies NSO of infants with a birth encounter who are 7 days of age or older and where there is no record of a sample at NSO. NSO then follows up with the birth hospital or midwifery practice to determine why an infant has not yet had a newborn screen. This is to reduce the number of missed newborn screens and improve care for newborns in Ontario.

If you receive a call and/or fax from NSO regarding a potential missed screen, please:

• Investigate why this infant had not yet had a newborn screen,
• Complete the faxback form right away,
• For true missed newborn screens, have the family return to have the newborn screen completed as soon as possible.

It is the responsibility of the birth hospital or midwifery practice caring for the mother and infant to investigate why the newborn screen has not been taken and obtain a specimen if the screen has been missed. The submitter should attempt to communicate the need for a specimen directly to the infant’s family or health care provider.

Common reasons for missed newborn screens

NSO has identified several common reasons for missed newborn screens. These include:

• Delayed: sample taken but not sent, OR sample collection delayed, OR batched sample sending
• Newborn screen declined by family.
• Infant born in hospital and discharged to midwifery care (both providers failed to collect the newborn screen)
• Not taken in error
• Inter-hospital transfer (both hospitals failed to collect the newborn screen)

NSO procedure for tracking potential missed newborn screens

NSO informs the responsible hospital/midwifery practice of the potential missed newborn screen and a need for a specimen by phone and fax by sending a Potential Missed Newborn Screen Alert. Communication attempts to the family and/ or health care provider, should be documented on the Potential Missed Newborn Screen Alert, which should then be faxed back to NSO.

The Potential Missed Newborn Screen Alert permits NSO to clearly identify the reason for the potential missed screen. If a specimen is not received 2 weeks following notification of a missed screen and NSO has not received documentation that the family has declined newborn screening, NSO sends a letter to the family. A copy of this letter is cc’d to the submitting institution/midwifery practice and the infant’s primary health care provider (if known).