January 3, 2000
ADMINISTRATIVE ORDER
No. 1–A series 2000
POLICIES ON THE NATIONWIDE IMPLEMENTATION OF NEWBORN SCREENING
I. RATIONALE
Newborn
screening enables early detection and management of certain inborn metabolic
disorders, which, if left untreated, may lead to mental retardation and even
death. This procedure was introduced almost four decades
ago in developed countries. In the Philippines, newborn screening was initiated
by the University of the Philippines – National Institutes of Health in 1996.
In a period of 3 years, statistical information was collected for some of the
disorders:
Metabolic Disorder Incidence
Congenital hypothyroidism 1:4,237
Congenital adrenal hyperplasia 1:6,844
Phenylketonuria 1:44,491
Galactosemia 1:44,491
While
the incidence is low from a public health point of view, DOH is putting high
priority for newborn screening in as much as the provision of quality life even
for a fraction of our 2 million born annually deserves as much attention as
survival.
II. POLICY
STATEMENT
1. The Philippine Newborn Screening Project is a
collaboration between the Department of Health (DOH) and the University of the
Philippines – National Institutes of Health (UP–NIH)
2. The project shall be lodged at the Family Health and
Nutrition Cluster of the DOH
3. All DOH retained and renationalized hospitals shall
participate in the project by year 2000. All other hospitals both private and
governmental shall participate in the project by year 2004.
4. At the initial phase of the project up to year 2004,
the screening process shall be primarily hospital based. It is envisioned that
by year 2004, newborn screening shall be part of standard newborn care and be a
national program.
5. Pilot tests involving selected health facilities shall
be started prior to wide scale community based newborn screening. It is
envisioned that by year 2010, all newborn babies will be screened.
6. The scope of the project shall include 6 disorders
namely: Congenital hypothyroidism, congenital adrenal hyperplasia,
phenylketonuria, glucose–6–phosphate dehydrogenase deficiency, homocytinuria
and galactosemia. The screening fee is currently priced at P450.00. The cost is
inclusive of all materials, supplies and freight which are incidental to the
screening process.
7. Expenses for the screening process shall be borne by
the parents unless the hospital or the local government or NGO has a scheme
providing full or partial subsidy depending on the financial capability of the
parents. The Philippine Health Insurance Corporation shall hopefully implement
a new package for newborn care in its insurance scheme.
8. DOH funds allocated for newborn screening shall at the
initial phase of the project until year 2004 be utilized for advocacy, training
of health workers and management of babies found to be positive for any of the
six disorders.
9. Newborn screening shall be done through a heel prick
to be performed by trained health workers. The procedure shall be done
preferably on the 48th hour of life. However, in cases of early
discharge, the sample collection must be done not earlier than the 24th
hour from birth. In case a baby is discharged earlier than the 24th
hour, the baby should be brought back to the health facility for screening
within the first week of life.
10. DOH shall draft and finalize the policies pertaining
to the project. It shall make the directional plan, secure funds for the
project and be active in advocacy.
11. UP–NIH shall provide technical advice. At the initial
phase, it will act as central laboratory taking charge of screening all
specimens. UP–NIH will assist DOH in training laboratory personnel and in
setting–up satellite laboratories by year 2001. In addition, it shall be
responsible for monitoring laboratories for quality assurance.
12. DOH and UP–NIH shall conduct trainings for health
workers to enable them to harness their skill at advocacy, organizing newborn
screening teams in hospitals, RHUs, private clinics (e.g. lying–in clinics) to
implement the project. Medical specialists shall be selected to undergo short
course on the diagnosis and management of common metabolic disorders. Medical Technologists of selected hospitals shall be
trained in setting up the satellite laboratories. Physicians, nurses and health promotion officers
shall be trained on genetic counseling.
13. UP–NIH is also tasked to come up with treatment
protocols for each of the disorders in question and assist DOH in the
preparation of IEC materials.
14. Currently, the UP–NIH is the repository of all
statistical information related to the project. By year 2001, the DOH registry
of diseases shall be revised to include congenital metabolic disorders.
15. A newborn screening surveillance system shall be
established in all regions to track down the number of infants with congenital
metabolic disorders and the percentage of infants for whom appropriate
management has been instituted.
16. The regional health office (RHO) shall designate
newborn screening coordinators to coordinate with DOH in the implementation of
the policies. The regional coordinators shall include newborn screening in the
regional plan, monitor and evaluate the project. In addition, they shall
advocate for newborn screening through enactment of local ordinance by LGU.
17. Newborn screening coordinators shall be designated at
all levels to oversee the implementation in the province, city and catchment
municipalities.
18. The RHO/PHO/CHO shall monitor the implementation of
the project. They shall collate and analyze performance reports provided by
UP–NIH, conduct field visits, hold conferences among implementers to discuss
issues and recommend solutions.
19. The LGU may assist in the recall of patients with
positive results through the PHO, CHO and district offices. They may also
devise a financing scheme to assist indigent patients.
20. At the initial phase of the project up to year 2004,
the hospitals, whether private or government shall be the implementing unit of
the project. Each hospital shall organize a hospital coordinating team composed
preferably by a pediatric consultant, an obstetrics–gynecology consultant and
the Chief Nurse.
21. The hospital coordinating team shall perform the
following tasks:
a. Increase awareness among the hospital medical–nursing
staff
b. Devise strategies whereby parents or mothers are
informed of newborn screening as early as the first prenatal visit
c. Ensure that babies are screened through a heel prick
after obtaining parental consent
d. Ensure that all filter papers are promptly sent to the
laboratory
e. Inform parents about the results
f. Recall patients with positive screen for confirmatory
test
g. Manage and monitor patients who are confirmed to have
any of the six disorders
22. In addition to the above tasks, the hospital coordinating
team shall see to it that administrative matters including correspondence,
information and statistical data are collected and financial concerns are
handled efficiently.
23. The NGO and other GOs shall be tapped for advocacy,
financial support and assistance in recall.
24. DOH, in collaboration with UP–NIH, shall undertake a
comprehensive evaluation of the project by year 2003. However, special studies
may be conducted to address issues and problems that surface in the reports.
25. Research and development concerning newborn screening
processes and the diseases with which it is concerned is strongly encouraged
and must be included in the regional/provincial/city plans.
III. EFFECTIVITY
This order shall take effect immediately.
ALBERTO G. ROMUALDEZ
JR, M.D.
Secretary of Health
No comments:
Post a Comment