New JSNA: This is the test site for the new Joint Strategic Needs Assessment

Antenatal & Newborn Screening

Introduction

Access to antenatal and newborn screening for Reading residents is safe and performance against key indicators is in line or better than the national average. In some areas, performance exceeds the national average and reaches the most effective levels of performance. 

Antenatal tests are designed to make pregnancy safer and check and assess the development of the baby. Women should be provided with full information about the conditions being tested for and encouraged to make an informed decision about screening (NICE, 2014; NHS Choices). Those who are not offered screening, or do not feel adequately informed to confidently take up screening, may be at risk of complications in pregnancy and early infancy. 

Currently, we have little information about local patterns and trends in screening uptake, especially whether any particular groups of residents appear to be less likely to receive screening, whether this is by choice or the result of lack of access, and what interventions could be put in place to improve performance even further. 

What do we know?

Antenatal screening programmes are offered to pregnant women to test for certain health issues in unborn children. Standard checks include: 

  • Blood tests to detect infectious diseases that could cause harm during pregnancy - Hepatitis B, HIV, syphilis and immunity to rubella
  • Blood tests and ultrasound scan to assess the chance that the baby could have Down's syndrome (also called 'Trisomy 21 or T21), Patau's syndrome (or Trisomy 13 or T13) and Edward's syndrome (Trisomy 18 or T18). 
  • Blood test to detect sickle cell disease and thalassaemia.
  • Detailed ultrasound scan to check for any physical abnormalities.

Screening for newborn babies are also offered to detect physical abnormalities and health issues that can be detected via a blood test. The tests offered help to detect:

  • Physical examinations, including checks of the eyes, heart, hips and testes
  • A hearing test
  • A blood spot test to check if the baby has any of nine rare conditions

The NHS Antenatal and newborn screening timeline provides more information about screening, including the weeks that screening checks should be carried out, with an e-learning module including further information to understand the checks offered. 

Facts, Figures, Trends

Antenatal and newborn screening is provided by maternity units and all activity and performance are reported accordingly. The maternity unit at the Royal Berkshire Hospital has patients from a wide area and the majority of Reading residents are likely to use the unit for their maternity care. Key performance indicators for the NHS screening programmes are published on a quarterly basis. These include the antenatal and newborn screening programmes mentioned above. Recent information about national and local performance against these indicators is provided below. 

Antenatal infections disease screening

As described above, all pregnant women are offered screening for four infections: Hepatitis B, HIV, syphilis and susceptibility to rubella. If infected, women are offered care and treatment to reduce the risk of passing the infection to their baby, and to protect their own health and wellbeing. Women who are rubella susceptible are offered the Measles, Mumps and Rubella (MMR) vaccination to protect future pregnancies.

  • Nationally, 99.1% of pregnant women eligible for infectious disease screening were tested for HIV in 2015/16. This is an increase from 98.7% in 2014/15 exceeded the level that is considered to be acceptable and safe.
  • 73.6% of pregnant women in the UK who were Hepatitis B positive were referred and seen by an appropriate specialist within an effective timeframe (6 weeks from identification) in 2015/16. This met the national target level of 70% and represents an increase from 65.1% in 2014/15. Healthcare trusts providing services in the South of England reached 85.3%, an increase from 71.6% in the previous year. All 21 Hepatitis B positive women who were seen at the Royal Berkshire Hospital were referred within 6 weeks. 
  • 99.6% of eligible pregnant women were screened for HIV at the Royal Berkshire Hospital in 2015/16. Performance against this indicator is consistently high and above the targets for safe performance (90%) and effective performance (95%) (Figure 1) (PHE, 2016).

Figure 1: Antenatal screening coverage for HIV infection at Royal Berkshire Hospital (2011/12 - 2015/16)

image1

Source: UK National Screening Committee (published August 2016)

Screening for Down's Syndrome

  • 96.9% of Down's syndrome screening laboratory request forms nationally were submitted to the laboratory within the recommended timeframes of 10 and 20 weeks of gestation in 2015/16. This was below the acceptable level of 97% and had not improved from 2014/15 (96.5%). 
  • In 2015/16 Down's syndrome screening at the Royal Berkshire Hospital, as measured by completed laboratory request forms, was similar to the national average at 96.6%.

Antenatal sickle Cell & Thalassaemia Screening

  • 98.7% of pregnant women eligible for antenatal sickle cell and thalassaemia screening in the UK had a conclusive screening result available at the day of report in 2015/16. This is above the acceptable safe level of 95% and just below the achievable level of 99%, which is seen as the level at which the programme is running effectively. This is similar to 2014/15 (98.5%) 
  • 99.5% of eligible pregnant women at Royal Berkshire had conclusive screening results available at the day of report in 2015/16. Screening coverage is now consistently high and above the targets for safe performance (95%) and effective performance (99%) (Figure 2). 
  • 50.7% of women in the UK having antenatal sickle cell and thalassaemia screening had a conclusive screening result available by 10 weeks gestation in 2015/16. This is considered above the safe level of performance (50%) but falls well below level of performance that would be considered effective (75%). National performance against this target has fallen slightly from 51.6% in 2014/15. 
  • 58.5% of women at the Royal Berkshire Hospital had a conclusive screening result available by 10 weeks gestation in 2015/16. Although this exceeds the national average and indicates that performance is considered safe, it continues to be well below the target for effective performance (75%). 
  • 96.5% of antenatal sickle cell and thalassaemia samples submitted to the laboratory were supported by a completed Family Origin Questionnaire (FOQ) in 2015/16. This exceeds the level of effective performance of 95%. Performance at the Royal Berkshire Hospital fell slightly below this level, but exceeded the level of performance considered safe (90%). 

Figure 2: Antenatal screening coverage for sickle cell and thalesseamia at Royal Berkshire Hospital (2011/12 - 2015/16)

image2

Source: UK National Screening Committee (published August 2016)

Newborn Hearing Screening

  • In 2015/16 98.4% of babies in the UK eligible for newborn hearing screening in the UK had the screening completed by 4 weeks (hospital programmes-well babies, NICU (neonatal intensive care babies) babies) or by 5 weeks (community programmes-well babies). This represents a slight increase from 98% in 2014/15.
  • 88.3% of referred babies in the UK received audiological assessment within 4 weeks of the decision that referral for assessment is required or by 44 weeks gestational age. This represents a slight increase from 87.7% in 2014/15.
  • In 2015/16 97.2% of babies eligible for newborn hearing screening by the Royal Berkshire Hospital had the screening completed in the appropriate timescale. This exceeds the level considered safe (95%) but falls short of the target for effective performance (99.5%). 90.3% were referred for an audiological assessment within 4 weeks.

Newborn and infant physical examinations

  • 94.4% of babies in the UK eligible for newborn physical examination had the full test within 72 hours of birth in 2015/16. This was below the target for safe performance of 95%.
  • 48.6% of UK babies who were referred for further investigation of a possible clinical abnormality of the hips, underwent a further assessment by specialist hip ultrasound within two weeks of birth.
  • In 2015/16 97.7% of babies eligible for newborn physical examination by the Royal Berkshire Hospital had the full test within 72 hours of birth. This is better than the national average and exceeds the target for safe performance of 95%.

Newborn Bloodspot Screening

  • In 2015/16 96.2% of babies in the UK eligible for blood spot screening had a conclusive result recorded within an effective timeframe (17 days of age). This was above the target for safe practice of 95%. However, 3.6% of these tests had to be repeated, due to avoidable failure in the sampling. This was over the acceptable level of 2%.
  • In the same period performance against this indicator by GP practices under both North and West and South Reading CCGs (98.5% and 98.1% respectively) exceeded both the national average and the target for safe performance of 95%. Reporting was previously by Berkshire West PCT but is now split by the two Reading CCG areas.

Figure 3: Newborn blood spot screening with 17 days at by CCGs covering Reading area (2013/14 - 2015/16)

image3

Source: UK National Screening Committee (published August 2016)

National & Local Strategies (Current best practices)

National Institute for Health and Clinical Excellence's (NICE) guidance report on Antenatal Care (NICE CG62, 2008 - last updated in December 2014).

These guidelines cover advice and information to be given to women during pregnancy, including antenatal and newborn screening programmes, screening for clinical conditions such as gestational diabetes and pre-eclampsia, screening for infections, lifestyle advice, provision of care and management of pregnancy symptoms and breastfeeding.

NICE's guidance report on Antenatal Care and postnatal mental health (NICE CG192, 2014).

These guidelines provide recommendations for predicting, diagnosing and treating women with mental health problems in the antenatal and postnatal periods.

Overall, antenatal and newborn screening programmes continue to perform well except in a few areas related to Down's syndrome screening. Improving access to good antenatal healthcare, including the range of antenatal screening programmes, is essential in order to identify needs and risks to mothers and babies at an early stage.

What is this telling us?

On the whole, access to antenatal and newborn screening for Reading residents is safe and performance against key indicators is in line or better than the national average. In some areas, performance exceeds the national average and reaches the most effective levels of performance.

What are the key inequalities?

Antenatal tests are designed to make pregnancy safer and check and assess the development of the baby. Women should be provided with full information about the conditions being tested for and encouraged to make an informed decision about screening (NICE, 2014; NHS Choices). Those who are not offered screening, or do not feel adequately informed to confidently take up screening, may be at risk of complications in pregnancy and early infancy.

What are the unmet needs/ service gaps?

More information is needed in order to understand any local patterns and trends in screening uptake, especially whether any particular groups of residents appear to be less likely to receive screening, whether this is by choice or the result of lack of access, and what interventions could be put in place to improve performance.

This section links to the following sections in the JSNA:

Maternity

Breastfeeding

Infant Mortality

References

Public Health England (PHE) (2016). NHS screening programmes: KPI reports and briefings 2015 to 2016. Available at: https://www.gov.uk/government/publications/nhs-screening-programmes-kpi-reports-2015-to-2016 (Accessed 29th November 2016).

National Institute for Health and Clinical Excellence [NICE] (2008; 2014). Antenatal Care for uncomplicated pregnancies (NICE guidelines CG62). Available at: https://www.nice.org.uk/guidance/cg62.

NICE (2014). Antenatal and postnatal mental health: clinical management and service guidance (NICE guidelines CG192). Available at: https://www.nice.org.uk/guidance/cg192.

NHS Choices. Antenatal Checks and Tests. Available at: http://www.nhs.uk/conditions/pregnancy-and-baby/pages/antenatal-care-checks-tests.aspx (Accessed 29th November 2016). 

Switch To High Contrast Mode