Importance of newborn screening for early detection and treatment emphasized by patients and families

Three panelists share their stories during the APHL 2022 Newborn Screening Symposium.

By Melanie Padgett Powers, writer

At six weeks old in the early 1970s, Kendra Hogenson was adopted. But her new parents quickly realized that instead of cooing and wiggling around, all their baby did was cry and beat her head against the wall. They had no idea what was wrong with their daughter and took her from doctor to doctor seeking help.

As Hogenson, now age 51, told her story as part of the Parent/Patient Panel during the APHL 2022 Newborn Screening Symposium in October, she began to cry. “One doctor even said, ‘put her away in an institution; she’ll never amount to anything,’” she recalled. But Hogenson’s mom said, “I know she’s in there.”

Finally, a pediatrician suspected sickle cell anemia and had the baby tested. The results were positive. Sickle cell anemia is part of a group of inherited disorders known as sickle cell disease (SCD). People with SCD have abnormal hemoglobin in their red blood cells that causes the cells to become hard and sticky and die early, according to the Centers for Disease Control and Prevention. The red blood cells can also get stuck in small blood vessels, causing severe pain and other serious health problems.

Routine newborn screening in the US will celebrate its 60th anniversary next year, and as of 2011 all 50 US states were screening for at least 26 disorders. Through a simple heel prick in the hospital when a baby is one to two days old, newborn screening tests an infant for rare but serious disorders that can be treatable.

If Hogenson, born in Washington, had received newborn screening when she was born, SCD would not have been included in the panel. New York was the first state to screen for the disease beginning in 1975. It wasn’t until 2006 that universal newborn screening for SCD was in place in all 50 states, Puerto Rico and the US Virgin Islands.

As a child, Hogenson was in and out of Seattle Children’s Hospital, which she referred to as her “second home.” She’s had meningitis three times which caused brain damage; strokes that led to learning disabilities; more than 20 surgeries; and 32 years of routine exchange blood transfusions, which she credits with saving her life.

Despite her challenges, Hogenson said she “exceeded all their expectations.” She graduated high school even though it was difficult: “Me and math still don’t get along.” She drives and has held a full-time job. “I wasn’t supposed to live this long; here’s to proving them wrong,” she said.

She thanked Symposium attendees for now screening every infant for SCD, “so their families don’t have to go what mine went through to find out what was wrong.”

Hogenson and fellow panelist Denise Bazemore, a 63-year-old woman who also has SCD, will soon be living in a new “sickle cell house” in Seattle called the “HUB,” which was developed by the Metro Seattle Sickle Cell Task Force, a grassroots organization.

HUB, which stands for healing, use and belonging, will offer people with SCD massage, yoga, acupuncture, reflexology and other therapies. It will offer educational and occupational workshops and offer a safe place for those with SCD to connect and support each other.

Improving newborn screening education

Susan Mays and daughter, Indie, share their story at the APHL 2022 Newborn Screening Symposium.
Susan Mays and daughter, Indie, share their story at the APHL 2022 Newborn Screening Symposium.

Also speaking on the panel were Susan Mays and her daughter, Indie, age 9. Thanks to the newborn screening program, Indie was diagnosed with maple syrup urine disease (MSUD) a few weeks after she was born. MSUD is a condition in which the body cannot process certain amino acids, requiring a strict low-protein diet.

Susan Mays said she didn’t really know what newborn screening was until her baby’s second-week follow-up appointment with her pediatrician, when she was told her daughter needed a second screening test.

“It makes me cringe to think about it now, but at the time I questioned why a second test was necessary, simply being clueless as to its importance,” she said. Indie wasn’t showing symptoms of MSUD, making the second test all that more important because that’s what led to her diagnosis. She had a confirmatory test a few days later.

Now Indie is a happy little girl who loves soccer, French fries and reading. She’s limited to 12-15 grams of protein a day and drinks four to five servings a day of medical formula.

While Mays said the process of getting tested and notified was “textbook,” she pointed out that she doesn’t remember being told about newborn screening during her pregnancy. She didn’t understand what it was for, causing her to push back a bit on that second test.

Mays said there’s an opportunity to explain what newborn screening is “far earlier than when the mom is pregnant,” perhaps even teaching about it as part of high school sex education classes. And it should certainly be emphasized in birthing classes and by pregnant women’s health care providers, she said.

It’s also important for families like hers to continue to share their stories about how newborn screening saved their babies’ lives and led to earlier treatment, she said. “I think all of us who have been impacted have a responsibility and an opportunity to help educate, starting with your friends, your family, using social media. I don’t think it relies on any one person or any part of the puzzle. Certainly, there’s a big opportunity for an understanding of why it’s done and why it’s important.”

The presentation concluded with a powerful video of other families sharing how newborn screening saved their babies’ lives. Afterward, attendees and panelists, and other families affected by newborn screening, gathered for a mixer in the exhibit hall.

Melanie Padgett Powers is a freelance writer and editor specializing in health care and public health.

APHL 2022 Newborn Screening Symposium was held in Tacoma, Washington, and online October 16-20, 2022. 

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How to improve inequalities in newborn screening

Photo of a newborn baby

By Melanie Padgett Powers, writer

Every year in the US, nearly 4 million babies receive newborn screening for a variety of health conditions within the first 24–48 hours of birth. Newborn screening was developed almost 60 years ago on the basis of equality—screening all babies for the same conditions.

However, public health professionals recognize that disparities exist across the newborn screening system. A panel of experts outlined these disparities and recommended actions that public health laboratories can take to improve the system, during the 2022 APHL Annual Conference May 18 session, “Exploring Equity Across the Newborn Screening System: From Discourse to Action.”

Newborn screening is “an interesting use case because newborn screening has historically been heralded as this universal program, a great equalizer among diagnoses for rare congenital diseases in newborns,” said Amy Gaviglio, MS, CGC, a genetic consultant based in Minneapolis.

The most obvious disparity, Gaviglio said, is the differences in conditions screened for from state to state, despite what is recommended by the US Recommended Uniform Screening Panel (RUSP). She said the RUSP did a great job at level-setting the panels in 2009—with all programs screening for at least 20 of the core conditions. However, as the complexity of diseases has grown, so have the disparities.

Gaviglio outlined three problem areas within newborn screening programs at public health laboratories:

  1. Lack of tiered testing. Using tiered testing can reduce referral rates, which can improve follow-up screening and diagnosis.
  • Programs vary in their incorporation of molecular technologies. Use of such technology can reduce the lack of access to genetic testing that some groups face, including Hispanic people, uninsured people, non-citizens and people with lower education levels.
  • All babies may not be screened in the best possible way. This is often discussed in relation to cystic fibrosis, which often uses a CFTR variant panel, which was created using white individuals.

The APHL NewSTEPs data showed that time to diagnosis and to intervention for cystic fibrosis was longer for Black and African American babies than for Asian and white babies, according to Gaviglio. The program also studied hemoglobinopathies such as sickle cell disease, which largely affect Black and African American people.

“Despite this condition being considered more of an African American condition, there was no real statistical difference in time to diagnosis or time to intervention,” Gaviglio said. “What was important with this work … was to indicate that the universality of newborn screening really does fall short when we call results out. These babies and these families succumb to the disparities in our health care system, and this is an area we’re going to have to focus on to make sure all of our babies are receiving similar care post-newborn screening.”

Involving families at every step

It’s important to recognize that different groups have varying access to resources, skill sets and opportunities to get their condition and causes “on the radar,” said Natasha Bonhomme, founder of Expecting Health and director of Baby’s First Test, the nation’s newborn screening resource center.

When it comes to educating communities about newborn screening and various conditions in recent years, the public health community has done better in providing materials in multiple languages, listening to feedback to inform new projects, using images that reflect the community and considering rural versus urban issues, Bonhomme said.

However, she said, the areas in which public health must improve include taking into account different learning styles; creating a consistency in language, terminology and descriptions; acknowledging people’s health care experiences; and considering an individual’s hierarchy of needs.

A person’s hierarchy of needs, Bonhomme said is “where there’s all these ‘nice to haves’ and things we wish people would understand are important, but we also need to listen to families who say: ‘I know that’s important, but I need this to get through today, to get through this week.’”

That’s a different starting-off point and must be incorporated as we educate people about the importance of public health issues, Bonhomme said.

In the advocacy arena, the newborn screening community has improved in addressing learning opportunities, sharing stories and perspectives, and informing policy and sharing across groups. However, the newborn screening system needs to build an infrastructure for policy and developing long-term data, while also expanding partnerships and providing more leadership opportunities, she said. It’s critical that the newborn screening system keeps families central and continually asks for their input.

Bonhomme said she often hears from families who say: “I went to a conference and I told my story and people cried or said ‘you’re so strong,’ and ‘that’s amazing,’ and then I never heard from them again. I want to help.”

She ended her presentation with a quote: “Equality is giving everyone a shoe. Equity is giving everyone a shoe that fits.”

“There are a lot of barriers,” Bonhomme said. “We work in a lot of systems that are not flexible, but what can we do, bit by bit, day by day, to get to that shoe that actually fits?”

Melanie Padgett Powers is a freelance writer and editor specializing in health care and public health.

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