A roadmap to navigating the NICU: Implementing CLSI NBS guidelines in Hawai‘i

In 2009, the Clinical Laboratory and Standards Institute (CLSI) released guidelines regarding newborn screening (NBS) in preterm, low birth, and sick newborns. These guidelines were created in response to the concern that the physiological states of these particular infants often lead to unreliable NBS results. The CLSI guidelines suggest a three part NBS: 1) at the time of admission into a newborn intensive care unit (NICU), 2) 48-72 hours following admission, and 3) day 28 of life or at the time of discharge (whichever comes first). This is in contrast to the “one specimen with repeat specimens as needed” system currently utilized in Hawai‘i.

The Hawai‘i Department of Health Genetics Program (HDOH) and the HDOH NBS program brought together leaders from the NICUs in Hawai‘i to plan how to best implement the CLSI guidelines. It was decided that Hawaii's primary children's hospital would take the lead and launch a pilot program implementing the three part screening guidelines. Educational materials were developed and provided to NICU staff prior to implementation of the project. The educational aims, implementation protocol, and preliminary results of the pilot project will be presented. Discussion will address challenges and successes and proposed statewide implementation strategies. The results of this study will provide requested feedback to the CLSI on practical implementation of the guidelines. Additionally, it can serve as guidance to other NBS programs looking to implement these guidelines within their state.