Integrating newborn screening for spinal muscular atrophy into health care systems: an Australian pilot programme

Arlene M D'Silva; Didu S T Kariyawasam; Stephanie Best; Veronica Wiley; Michelle A Farrar; NSW SMA NBS Study Group

doi:10.1111/dmcn.15117

Integrating newborn screening for spinal muscular atrophy into health care systems: an Australian pilot programme

Dev Med Child Neurol. 2022 May;64(5):625-632. doi: 10.1111/dmcn.15117. Epub 2021 Nov 28.

Authors

Arlene M D'Silva^{1

2}, Didu S T Kariyawasam^{1

2}, Stephanie Best^{3

4}, Veronica Wiley^{5

6}, Michelle A Farrar^{1

2}; NSW SMA NBS Study Group

Collaborators

NSW SMA NBS Study Group:
Anja Ravine, David Mowat, Hugo Sampaio, Ian E Alexander, Jacqui Russell, Kristi Jones, Zena Junek

Affiliations

¹ Department of Neurology, Sydney Children's Hospital Network, Sydney, New South Wales, Australia.
² School of Women's and Children's Health, University of New South Wales Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
³ Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
⁴ Australian Genomics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
⁵ NSW Newborn Screening Programme, Children's Hospital Westmead, Westmead, New South Wales, Australia.
⁶ Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.

Abstract

Aim: This study dynamically designed, evaluated, and implemented the components of an Australian newborn bloodspot screening (NBS) pilot programme for spinal muscular atrophy (SMA).

Method: We used an implementation-effectiveness study design and continuous interdisciplinary review to measure SMA NBS test protocol performance, identify and overcome laboratory and clinical barriers to implementation, and describe progress during the 2-year pilot study.

Results: The NBS programme screened 252 081 newborn infants from 1st August 2018 to 31st January 2021. Using an NBS pilot test protocol, 21 infants were diagnostically confirmed with SMA. The NBS pilot test protocol had a sensitivity of 100%, specificity greater than 99.9%, false-positive rate less than 0.001%, a false-negative rate of 0%, and positive predictive value of 95.5%. A severe phenotype was predicted on the basis of two copies of SMN2 in 57.2% of newborn infants screening positive for SMA. Clinical signs consistent with SMA were evident in 6 out of 21 screen-positive newborn infants within the first 4 weeks of life. A multidisciplinary team establishing strong partnerships across clinical and laboratory staff was key to implementation.

Interpretation: This pilot programme suggests that NBS is essential for early identification of newborn infants at risk of SMA and can be effectively translated into clinical practice.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia
Delivery of Health Care
Humans
Infant, Newborn
Muscular Atrophy, Spinal* / diagnosis
Neonatal Screening*
Pilot Projects