Croydon Health Services ANTENATAL AND NEW BORN SCREENING (ANNB)

SCREENING It is a process of identifying apparently healthy people who may be at increased risk of a disease/ condition. They can be offered information, further tests and appropriate treatment to reduce the risk and/or any complication arising from the disease or condition Public Health England (PHE) leads the national screening programmes The screening programmes are implemented on the advice of the UK National Screening Committee (UKNSC)

ANNB SCREENING PROGRAMMES Six components: Sickle Cell and Thalassemia (SCAT) Infectious Diseases (ID) Downs Syndrome Screening and Fetal Anomaly Newborn Infant Physical Examination (NIPE) Newborn Blood Spot (NBBS) Newborn Hearing Screening

Sickle Cell and Thalassemia (SCAT) Croydon is a high prevalence area Booking bloods by 8-10 week If screen positive: Referred to SCAT centre for Genetic counselling and Haematology clinic Prenatal Diagnosis (PND) – Done at Kings College Hospital. Early referral/ Early booking/ Early intervention

INFECTIOUS DISEASES Minimum 95% uptake of screening in pregnancy is required. HIV Hepatitis B Syphilis

HIV Number of HIV positive women looked after in pregnancy in 2015/16 were 17, 4 were newly diagnosed Caseload Care by Infectious Disease team (ID) - Lavender Team –Midwifery Team - Heath Clinic – Sexual health Screening/ Viral Load monitoring -Lead Obstetrician (for ID) – Mr Kamel Early referral/ Early booking/ Early intervention

HEPATITIS B TEAM -Lavender team -Hepatologist – Dr Philipose -Obstetric Consultant – Mr Kamel 2015/2016 - 37 Hepatitis B positive (CUH) Patients are reviewed at 20/40 and 36/40 by the Obstetrician Plan of care for delivery is made for birth and the baby in the postnatal period. Baby’s care plan - which could include vaccine and/or immunoglobulin

SYPHILIS Syphilis can result in congenital syphilis (CS) Untreated syphilis can result in a range of adverse outcomes, including: -premature birth -stillbirth -congenital abnormalities Screening is done at booking, results are followed by the ID team Remember new infections can occur late in pregnancy Antibiotics Neonatal assessment at birth to look for signs of congenital syphilis

DOWNS SYNDROME SCREENING AND FETAL ANOMALY Combined –First trimester (Local uptake-61%) Quad- 2nd trimester (Local uptake -14%) Declined screening =10.5% Screen Positive Non- Invasive Pre natal Test (NIPT) CVS 34 Amniocentesis 21

Multidisciplinary team for anueploidy screening Midwives – Mary O’Mahoney Sonographers – Becky Paine Obstetricians – Heather Allen-Coward, Rosol Hamid Maternity support workers

Non- Invasive Pre natal Test (NIPT) Placentally derived, cell free DNA extracted from maternal circulation Screening for T13,T18 and T21 Offered to screen positive singleton pregnancies from 10-22 weeks 99% sensitive Results obtained in 5-7 days Private

Fetal anomaly 18+0- 20+6 weeks Fetal anomaly screening Program (FASP) FETAL ANOMALY SCAN Fetal anomaly 18+0- 20+6 weeks Fetal anomaly screening Program (FASP) Anencephaly Open spina bifida Exomphalos Serious cardiac abnormalities Cleft lip Diaphragmatic hernia Gastroschisis Bilateral renal agenesis Lethal skeletal dysplasia No of fetal anomaly scans 3126 (81%) Pathway Weekly perinatal meeting 9/26/20179/26/2017

Newborn Blood Spot (NBBS) Conditions Screen : - Sickle cell disease (SCD) - Cystic Fibrosis (CF) - Congenital Hypothyroidism (CHT) - Phenylketonuria(PKU) - Medium chain acyl-CoA dehydrogenase deficiency (MCADD) -Maple Syrup disease (MSUD) -Isovaleric acidemia (IVA) -Glutaric aciduria type 1 (GA1) -Hystocystinuria (HCU) 9/26/20179/26/2017

Newborn Infant Physical Examination (NIPE) Screening lead – Dr Kumar, Mary O’Mahoney Identifies congenital abnormalities of: Heart Hips Eyes Testes NIPE clinic runs 7 days per week. Undertaken by 72 hours of age and at 6-8 weeks by the GPs 9/26/20179/26/2017

NEWBORN HEARING SCREENING All babies are offered hearing screen with 4 weeks of life Performed in house prior to discharge Outpatient within 1 month of birth 2015/2016 Unlateral hearing loss 8 Bilateral hearing loss 8 9/26/20179/26/2017

CONTACT DETAILS ANNB team/ Lavender Team 0208 401 3000 ex 4131/ 4004 Ch-tr.antenatalscreening@nhs.net Ch-tr.Idscreening@nhs.net SCAT Centre 0208 251 7229 Mhn-tr.sicklethal@nhs.net