Kerala to introduce Comprehensive Newborn Screening program to detect birth defects

The program aims to detect and prevent conditions which lead to disability at a later age and treating them if possible.

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A new initiative by the Kerala state government will ensure that all newborns born in public health facilities will be screened for various developmental diseases and birth defects within 48 hours of delivery. The universal Comprehensive Newborn Screening (CNS) programme will be the first of its kind to be launched in India.

Dr M. Sreehari, State Nodal Officer (Child Health), National Health Mission, told TNM, “Since Kerala has low infant mortality rates now, we are focusing on the quality of survival of the newborns. The low infant mortality rates do not reflect the quality of life of the surviving children. Our target is to reduce Infant Mortality Rate (IMR) to 8 by the year 2020 from the current rate of 10. This initiative will help to improve the quality of life of surviving children."

This will be the first time in the country that a newborn will be screened for four major parameters: visible birth defects, functional birth defects, metabolic defects, and neurodevelopmental defects.

Additional Chief Secretary Rajeev Sadanandan told TNM, "This is all the part of our strategy to achieve our sustainable development goal of reducing the IMR to 8 by 2020 as well as to prevent and reduce disabilities among children."

Visible birth defects are those that can be seen in infants, such as clubfoot, cleft lip and cleft palate, to name a commonly seen few.

Under functional birth defect screening, babies will be tested for auditory problems and heart defects as well.

Newborns will be screened for hearing problems using Oto-Acoustic Emissions test (OAE) and those presenting with defects will be followed up within the months which follow. The aim is to take corrective measures before 6 months.

Babies will also be screened for Congenital Heart Diseases (CHD) as well.

An extensive programme called Hridayam was launched last year by the state government with the goal of decreasing the infant mortality rates due to congenital heart diseases. Now under the umbrella of the CNS programme, screening for CHD too will be present.

Retinopathy of prematurity (ROP), which can lead to blindness, is another functional birth defect which will be screened for.

According to Dr Sreehari, the prevalence of low birth weight in newborns has seen an increase in the state, as has the number of premature births. Often times, premature babies in the intensive care units are given a high flow of oxygen supply. This uncontrolled oxygen flow will cause increased blood flow in the in the retina which can lead to retinopathy and possibly result in blindness.

The remedy is to screen the babies, identify the defect and start the treatment at the earliest stage. Thus ROP screening can prevent blindness.

Though screening for metabolic disorders such as congenital hypothyroidism was in place for last 4 years, it had not been made universal. Now under CNS programme, every child born in a public health facility will be screened.

Neurodevelopmental defects cannot be identified at birth. However, screening help detect whether any babies will require a follow-up in the future.

Dr Sreehari said, “We want to identify all these cases at the earliest and act on them so that the disabilities due to them can be minimized.”

An Android application for documentation has been developed which will be used at the delivery point wherein data on 21 parameters will be collected. The information will come to a central server where the database is maintained. All the screening results against a unique number generated by the Android application will be available for every child.

Once the screening and documentation have been done and if the baby is found to have an anomaly, the information will go to the concerned area field staff under the health department. The alerts thus generated will help the medical team in the follow up and treatment of the defects.

The state government will also offer treatment support using Rashtriya Bal Swasthya Karyakram (RBSK), an initiative of National Health Mission, and Arogyakiranam funds.