Reduction in Newborn Screening False Positive Results Following a New Collection Protocol: a Quality Improvement Project.

Abstract

Premature infants are known to have a higher rate of false positive newborn screening (NBS) results, with TPN as a contributing factor. The purpose of this quality improvement (QI) project is to reduce false positive NBS results via a TPN interruption protocol. A multidisciplinary team reviewed the literature and developed a new NBS collection protocol, which was implemented in 2 periods. In period 1, TPN was interrupted for 4 hours before NBS sample collection and initiation of carnitine supplements was avoided. In period 2, TPN was interrupted for 6 hours for infants birth weight (BW) < 1000 g, carnitine supplementation continued to be avoided. The rates of false positives NBS results were compared pre- and post-interventions in periods 1 and 2. Four hundred twelve neonates were evaluated prior to implementation of this QI project (July 2013-June 2014) and 414 during period 1 intervention (July 2014-June 2016). False positive results decreased from 20.6% to 11.4% (p < 0.001) among all BW categories following the 4-hour TPN interruption. The rate of false positives was further reduced among infants < 1000 g (p = 0.035) in period 2 (n = 112), including a significant reduction in false positive results with elevated amino acid profiles (p = 0.005). The implementation of a strict NBS collection protocol reduced false positive NBS results, which potentially can improve patient care by reducing unnecessary laboratory draws, pain, and parental anxiety. Interruption of TPN for 6 hours was significant in reducing NBS false positive results in neonates < 1000 g.