University of British Columbia Nepal Sickle Cell Project Status Report 2015-2020

Purpose of Study In 2015 the University of British Columbia partnered with Creating Possibilities (CP), a charitable organization located in Dang, Nepal. Each year, a team of medical students is sent to assist CP in the long term management of sickle cell disease (SCD) in rural Western Nepal. Due to COVID-19 limitations, we were unable to travel to Nepal this year for the field component of our project. Instead, we took this opportunity to reflect on the project as a whole and create a project status report, outlining the past five years of work. The purpose of this report included: summarizing overall project progress, identifying future project directions, and improving communication amongst project stakeholders. Methods Used To create the project status report, our team reviewed all project documents since 2015. We also conducted virtual interviews with previous team leads to clarify questions and fill in gaps. Project progress was assessed by comparing activities completed to date to the project's initial three main objectives. Summary of Results The first objective of characterizing the prevalence of SCD among the Tharu population is currently ongoing. Since 2015, we have conducted large-scale screening of the Tharu population, with 4483 individuals having been screened by our team. Thus far, a hemoglobin S prevalence of 9.3% has been estimated. Our second objective of identifying barriers to SCD management is also ongoing. Since 2016, yearly focus groups and needs assessments have been conducted with community members and health workers. Common themes of barriers included accessibility, financial limitations, and education. Finally, our third objective of implementing sustainable solutions for long term detection and management of SCD still needs to be addressed. Conclusions Screening and needs assessments will continue as we progress toward addressing our first two objectives. Following consultation with experts and a literature review, we have identified a pilot newborn screening program for SCD as the first step in addressing our third objective.

Have newborn hearing screening programs been affected by the COVID-19 pandemic?

Introduction: Due to the vital importance of early diagnosis and intervention of congenital hearing loss, the aim of this study was to compare the rate of newborn hearing screening before and after the COVID-19 pandemic quarantine. Material(s) and Method(s): In this study, the data related to 6144 newborns during two 18-month time periods before and after the onset of the COVID-19 pandemic quarantine, was analyzed. Result(s): From all visited newborns, 3770 and 2374 referred to the centre before and after the COVID-19 pandemic quarantine, respectively. There were statistically significant differences in the results of screening and the referral rate of neonates before and after the pandemic (p = 0.00). The results showed that both the residents of urban and rural regions visited for newborn hearing screening less frequently after the onset of the pandemic, but no statistically significant difference was shown between the number of boys and girls before and after the pandemic (p = 0.72). Conclusion(s): Our results help gain new insights regarding the impacts of disruptive events such as pandemics on the implementation of health screening programs. Boosting public knowledge by providing families with proper education appears to be helpful in preventing the negative effects of delayed implementation of health screening programs.Copyright © 2022 International Association of Physicians in Audiology.

Newborn Screening Knowledge, Attitudes and Practices among Obstetrics-Gynecology Residents, Pediatric Residents, and Newborn Screening Nurses in a Tertiary Government Hospital in the Philippines during the COVID-19 Pandemic.

Newborn Screening (NBS) saves babies from mental retardation and death. In the Philippines, it was formally established by law in 2004. Program success requires physicians, nurses, and midwives to educate and motivate parents. The COVID-19 pandemic reduced NBS coverage from 91.6% to 80% between December 2019 and December 2020. This study aimed to (1) determine the knowledge, attitudes, and practices of residents and nurses relative to NBS during the COVID-19 pandemic; and (2) identify possible factors that may have affected NBS services at the Philippine General Hospital during the pandemic. Participants' demographics were also compared with NBS practices. The study enrolled 189 participants employed during 2020. The results of a self-administered online questionnaire were evaluated. Only 31% of participants scored above a mean passing level for NBS knowledge set by experts. Most participants expressed a favorable attitude towards NBS. Knowledge scores were a significant factor in favorable attitude. Obstetrics-gynecology residents had lower attitude scores than Pediatric residents and NBS Nurses. Prenatal parent education was only practiced by 1/3 of participants. Despite the obstacles of the COVID-19 pandemic, participants appreciated the value of the NBS and were willing to perform specimen collection using safety precautions. Participants identified the need for additional NBS training. The challenges identified provide an avenue for further research with the goal of strengthening NBS, especially during a public health emergency.

Newborn Screening in a Pandemic-Lessons Learned.

The COVID-19 pandemic affected many essential aspects of public health, including newborn screening programs (NBS). Centers reported missing cases of inherited metabolic disease as a consequence of decreased diagnostic process quality during the pandemic. A number of problems emerged at the start of the pandemic, but from the beginning, solutions began to be proposed and implemented. Contingency plans were arranged, and these are reviewed and described in this article. Staff shortage emerged as an important issue, and as a result, new work schedules had to be implemented. The importance of personal protective equipment and social distancing also helped avoid disruption. Staff became stressed, and this needed to be addressed. The timeframe for collecting bloodspot samples was adapted in some cases, requiring reference ranges to be modified. A shortage of essential supplies and protective equipment was evident, and laboratories described sharing resources in some situations. The courier system had to be adapted to make timely and safe transport possible. Telemedicine became an essential tool to enable communication with patients, parents, and medical staff. Despite these difficulties, with adaptations and modifications, some centers evaluated candidate conditions, continued developments, or began new NBS. The pandemic can be regarded as a stress test of the NBS under real-world conditions, highlighting critical aspects of this multidisciplinary system and the need for establishing local, national, and global strategies to improve its robustness and reliability in times of shortage and overloaded national healthcare systems.

Introducing the speech therapist in the Neonatology Unit: an innovative way to support breastfeeding in healthy newborns even during COVID-19 pandemic

Objective. The aim of the study was to intercept early problems and difficulties in onset and stabilization phases of breastfeeding, in a population of healthy full-term newborns - during the COVID-19 pandemic - through a Clinical Governance Project, supported by the Department of Neonatology and Pediatrics, which introduced a speech therapist, as part of the professional team acting synergistically with neonatologists, pediatricians, pediatric nurses, midwives and gynecologists. Materials and Methods. Over a period of two months (2020), n = 72 newborns, 38 males and 34 females, were recruited (mean age:1.3 days) in the Departments of Neonatology and Obstetrics and Gynecology of Castelli Hospital, ASLRM6. Lingual frenulum neonatal screening (Martinelli, 2015) was administered to all the newborns and the frenulum was classified as normal, doubtful or impaired. Breastfeeding difficulties were evaluated and speech therapist counseling was performed, to support early onset and stabilization of breastfeeding. Results. Lingual frenulum screening resulted normal in 36 (50%), doubtful in 20 (28%) and impaired in 16 (22%) of total newborns. An alteration of both lingual and upper labial frenulum was found in 16 (22%) of the newborns studied. n = 23 newborns (32%) showed alterations able to hinder breastfeeding: these cases were successfully managed by helping the mothers to change the breastfeeding position, adopting a rugby hold position. Conclusions. According to our preliminary results, speech therapist counselling, in the critical COVID-19 pandemic, allowed early detection of lingual frenulum alterations, and their impact on the onset of breastfeeding. We found that altered lingual frenulum was associated with breastfeeding difficulties: in these patients, speech therapist intervention resulted useful in managing early breastfeeding problems.

Community Health Nurses' Role in Genetic Sequencing: A Prospect for Health Team Preparedness Against Covid-19

Genetic sequencing is a scientific process of reading genetic material using advanced technology. Through genetic sequencing, we can better comprehend super-spreader events and outbreaks, and strengthen national public health responses. A better understanding of the transmission of viruses, the severity of patient illness, and mortality rates can be gained by combining this information with that from the IDSP and patient reports. Connecting the dots between the data and the host's genetics, immunology, clinical outcomes, and risk factors is also possible. Many roadblocks must be overcome before raw sequence data can be put to direct clinical application. Since DNA sequencing has so many potential applications in the field of nursing, it ought to be a required topic for students in the profession. Group wellness Preparing patients for procedures, identifying those most at risk, doing sentinel surveillance, and conducting in-depth studies are all areas in which nurses can be of assistance. The goals of this paper are twofold: (1) to present the notion of genetic sequencing and (2) to highlight the role of Community health nurses. To reduce the impact of pandemics and endemics and improve nursing care, Western countries are seeing an uptick in the participation of nurse scientists in genetic sequencing;the case of newborn screening provides a particularly apt example.Copyright © 2023, Institute of Medico-legal Publication. All rights reserved.

Embracing Use of Telemedicine in Metabolic Newborn Screening (Nbs) Follow-Up

Background: Our Metabolic Genetics clinic serves as contracted consultants for the follow-up of abnormal metabolic newborn screens for all infants born in Oregon. We are a large (100,000 sq mi2), rural state and to serve our population we previously depended on primary care providers to help coordinate initial disclosure and follow-up diagnostic test collection for infants with abnormal metabolic results prior to an available office visit. In March 2020 our institution moved into "modified operations" which altered our workflows in unprecedented ways including dramatically expanding our use of telemedicine (both virtual video visits and telephone visits). Method(s): In order to fulfill institution requirements as well as to provide uninterrupted expedient follow-up of potentially affected babies identified by screening we expanded our use of telemedicine in this population. In most cases, these visits were offered for parents either in their homes or coordinated with their pediatrician's office. Metabolic Genetics clinic office visits were reserved only for critical cases. By 2022, our institution had returned to "normal operations", however, we continued to offer parents the option of a telemedicine visit or office visit in most abnormal screen follow-up cases. Result(s): The majority of newborn screen visits to our Metabolic Genetics clinic in 2020 and 2021 were conducted virtually with 74% in 2021. Despite loosening of COVID-era restrictions, in the first 9 months of 2022 we maintained this majority with 64% of infants initially seen via telemedicine (61% via virtual visit and 3% via telephone visit). Conclusion(s): Using telemedicine for metabolic newborn screen follow-up has reduced some of the Metabolic Genetic clinic's previous barriers including space, provider availability and timeliness. It has also been well-received by families for reducing barriers and stress and early signs indicate they prefer this method of follow-up. We feel this is a sustainable model for metabolic newborn screening follow-up in our program.Copyright © 2023

Newborn Screening Long-Term Follow-Up Clinics (Continuity Clinics) in the Philippines during the COVID-19 Pandemic: Continuing Quality Patient Care.

The COVID-19 pandemic has challenged healthcare systems worldwide. In the Philippines, long-term care for patients with conditions identified through newborn screening (NBS) is coordinated through Newborn Screening Continuity Clinics (NBSCCs). These clinics are integral to achieving optimal outcomes by providing follow-up oversight and assistance for individuals identified through screening. Continuity of NBSCC care for NBS during the COVID-19 pandemic was both challenging and necessary and was accomplished through innovative strategies of dedicated personnel. Following the discontinuation of the community quarantine, a situation assessment survey was completed by each NBSCC to better understand the challenges encountered and their effect on patient care. Performance data from each NBSCC were reviewed both before and after an extended community quarantine (2018-2021) to evaluate the impact of NBSCC disaster contingency plans in overcoming the resultant challenges (transportation, supply chain, etc.). Thematic analysis of the survey showed three primary challenges: Operations, communications, and safety. In 2018 and 2019, successful patient contacts were 70.6% and 70.2%, respectively. During the pandemic, successful contacts were 74.9% in 2020 and 76.8% in 2021, demonstrating that the contact approaches taken by the NBSCCs were sufficient to maintain (and even improve) patient contacts. The number of unresponsive patients decreased during the pandemic likely due to decreased mobility and improved follow-up actions from the NBSCCs.

Case report: Cystic fibrosis with kwashiorkor: A rare presentation in the era of universal newborn screening.

Background: Universal newborn screening changed the way medical providers think about the presentation of cystic fibrosis (CF). Before implementation of universal screening, it was common for children with CF to present with failure to thrive, nutritional deficiencies, and recurrent infections. Now, nearly all cases of CF are diagnosed by newborn screening shortly after birth before significant symptoms develop. Therefore, providers often do not consider this illness in the setting of a normal newborn screen. Newborn screening significantly decreases the risk of complications in early childhood, yet definitive testing should be pursued if a patient with negative newborn screening presents with symptoms consistent with CF, including severe failure to thrive, metabolic alkalosis due to significant salt losses, or recurrent respiratory infections. Case presentation: We present a case of a 6-month-old infant male with kwashiorkor, severe edema, multiple vitamin deficiencies, hematemesis secondary to coagulopathy, and diffuse erythematous rash, all secondary to severe pancreatic insufficiency. His first newborn screen had an immunoreactive trypsinogen (IRT) value below the state cut-off value, so additional testing was not performed, and his growth trajectory appeared reassuring. He was ultimately diagnosed with CF by genetic testing and confirmatory sweat chloride testing, in the setting of his parents being known CF carriers and his severe presentation being clinically consistent with CF. Acutely, management with supplemental albumin, furosemide, potassium, and vitamin K was initiated to correct the presenting hypoalbuminemia, edema, and coagulopathy. Later, pancreatic enzyme supplementation and additional vitamins and minerals were added to manage ongoing deficiencies from pancreatic insufficiency. With appropriate treatment, his vitamin deficiencies and edema resolved, and his growth improved. Conclusion: Due to universal newborn screening, symptomatic presentation of CF is rare and presentation with kwashiorkor is extremely rare in resource-rich communities. The diagnosis of CF was delayed in our patient because of a normal newborn screen and falsely reassuring growth, which after diagnosis was determined to be secondary to severe edematous malnutrition. This case highlights that newborn screening is a useful but imperfect tool. Clinicians should continue to have suspicion for CF in the right clinical context, even in the setting of normal newborn screen results.

A clinical case of combined immunodeficiency diagnosed by TREC assay

Early diagnosis and timely treatment of combined immunodeficiency (CID) is extremely important for the child's future life. At birth, children often have no specific signs of the disease, Put from the first months of life CID manifests Py severe infections that can impact on the results of further treatment. Detection of T-cell lymphopenia by determining the number of T-cell receptor excision circles (TRECs) in a dry spot after the birth of a child formed the basis for newborn screening for severe CID. KREC (kappa-deleting recombination excision circle) assay is used for detection of B-cell lymphopenia. Clinical case. We report the first case of CID (T-B+NK+) suspected by detection of TREC in Ukraine in a 2.5-month-old child. Immunodeficiency was manifested by severe complicated pneumonia at the age of 2 months, which had an atypical course and was resistant to treatment. A screening study to detect T- and B-lymphopenia using the TREC/KREC assay twice showed a zero TREC value and a KREC number of 3.12×105per 106cells, indicating severe CID. Subsequent immunological studies confirmed the deficiency of T-cell immunity. Venous thrombosis and increasing multiorgan failure led to the death of the child. Thus, newborn screening using TREC assay will allow the timely detection of severe combined immunodeficiencies with further adequate therapy and measures to prevent life-threatening infections, including SARS-CoV-2. The research carried out in accordance with the principle of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. © 2022 by the Author(s).

Using Facebook, Instagram, and Pinterest advertising campaigns to increase enrollment in newborn screening research

IntroductionSocial media ad campaigns can be an efficient, cost-effective way to recruit for studies online, especially as the onset of the COVID-19 pandemic limited in-person recruitment. Early Check, a large ongoing study offering testing for a panel of conditions for all newborns in North Carolina, uses social media ad campaigns, along with direct mail, email, print materials in health care settings, and messages through patient portals to contact pregnant women and mothers with eligible newborns. All materials refer women to the online Early Check portal for consent and enrollment in the study. MethodsTo evaluate social media options for outreach and recruitment, we ran two paid ad campaigns on Pinterest in May and July 2021 and compared performance to simultaneous Facebook and Instagram campaigns. ResultsFacebook and Instagram cost $136.53 per sign-up in May and July. Our first Pinterest campaign in May resulted in 206,416 impressions, 529 link clicks, and a cost per sign-up of $536.56. After adjusting the campaign to incorporate lessons learned about the platform, the second Pinterest campaign in July resulted in 225,286 impressions, 621 link clicks, and a cost per sign-up of $216.55. DiscussionOthers looking to implement social media ad campaigns for public health recruitment should note that ad costs have increased since 2020. However, social media ad campaigns on Facebook, Instagram, and Pinterest remain a cost-effective and convenient way to recruit participants for studies, especially when in-person efforts are not feasible. Ad campaign strategy should also be tailored to the specific platform. Facebook and Instagram ads should be run together in the same campaign to optimize the budget across both platforms and should run using an on-off schedule. Pinterest campaigns should run for a longer period to optimize continually for sign-ups over time.

Advances and Challenges of the Decade: The Ever-Changing Clinical and Genetic Landscape of Immunodeficiency.

In the past 10 years, we have witnessed major advances in clinical immunology. Newborn screening for severe combined immunodeficiency has become universal in the United States and screening programs are being extended to severe combined immunodeficiency and other inborn errors of immunity globally. Early genetic testing is becoming the norm for many of our patients and allows for informed selection of targeted therapies including biologics repurposed from other specialties. During the COVID-19 pandemic, our understanding of essential immune responses expanded and the discovery of immune gene defects continued. Immunoglobulin products, the backbone of protection for antibody deficiency syndromes, came into use to minimize side effects. New polyclonal and monoclonal antibody products emerged with increasing options to manage respiratory viral agents such as SARS-CoV-2 and respiratory syncytial virus. Against these advances, we still face major challenges. Atypical is becoming typical as phenotypes of distinct genetic disease overlap whereas the clinical spectrum of the same genetic defect widens. Therefore, clinical judgment needs to be paired with repeated deep immune phenotyping and upfront genetic testing, as technologies rapidly evolve, and clinical disease often progresses with age. Managing patients with organ damage resulting from immune dysregulation poses a special major clinical challenge and management often lacks standardization, from autoimmune cytopenias, granulomatous interstitial lung disease, enteropathy, and liver disease to endocrine, rheumatologic, and neurologic complications. Clinical, translational, and basic science networks will continue to advance the field; however, cross-talk and education with practicing allergists/immunologists are essential to keep up with the ever-changing clinical and genetic landscape of inborn errors of immunity.

Impact of COVID-19 on Pediatric Laboratory Medicine: An IFCC C-ETPLM, SSIEM, ISNS Global Survey.

Objective: Pediatric laboratory medicine is a unique practice serving a vulnerable group of patients including highly specialized testing aiming to detect and treat inherited conditions early to avoid adverse outcomes. Data on the actual impact of COVID-19 pandemic on this speciality is lacking. Methods: A survey was conducted by the IFCC Committee on Emerging Technologies in Pediatric Laboratory Medicine in partnership with the Society for the Study of Inborn Errors of Metabolism and International Society for Neonatal Screening, to assess the impact on the clinical service provision during the initial wave (January to July 2020) of the COVID-19 pandemic and to gather experiences learned in order to improve laboratory preparedness for future outbreaks. Results: 217 survey responses were received from 69 regions. Sixty-three laboratories (29%) reported a restriction or suspension of service for a median period of four months. The common tests/ services suspended were new-born screening program, body fluids and sweat testing. The reasons for the suspension were related to bio-safety risks of COVID-19 transmission, manpower constraints and supplies disruption. A minority (9-10%) of laboratories did observe delayed/missed diagnoses or a more severe presentation of a clinical disorder. The critical operational decisions that helped manage the initial wave of COVID-19 included modifying work shift patterns, split-teams arrangement, use of personal protection equipment and social distancing. Conclusion: The provision and delivery of pediatric laboratories services were affected during the initial wave of the COVID-19 pandemic. Manpower preparedness for future potential disruptions to pediatric laboratory services is a key finding and recommendation from this survey.

A Qualitative Study: Mothers' Experiences of Their Child's Late-Onset Pompe Disease Diagnosis Following Newborn Screening.

Pompe disease was added to the United States recommended uniform screening panel in 2015 to avoid diagnostic delay and implement prompt treatment, specifically for those with infantile-onset Pompe disease (IOPD). However, most newborns with abnormal newborn screening (NBS) for Pompe disease have late-onset Pompe disease (LOPD). An early diagnosis of LOPD raises the question of when symptoms will arise which is challenging for parents, patients, and providers managing an LOPD diagnosis. This study aimed to characterize mothers' experiences of their child's LOPD diagnosis and medical monitoring. A qualitative descriptive approach was chosen to gain an in-depth understanding of parental experiences. Eight mothers were interviewed about their experiences with positive NBS and diagnosis, experiences with living with the diagnosis, and experiences with medical monitoring. Interview transcripts were analyzed through conventional content analysis. Negative emotions like fear were more frequent with communication of NBS results. Participants expressed uncertainty surrounding age of symptom onset and the future. The medical monitoring experience increased worry but participants expressed that being vigilant with management reassured them. Parental emotions shifted to thankfulness and reassurance with time and education. These findings can provide guidance to providers about the psychosocial implications of receiving positive NBS results and an LOPD diagnosis.

Prenatal COVID-19 Infection Does Not Increase the Risk of Congenital Hearing Loss

Introduction: The global pandemic caused by the novel coronavirus (SARS-CoV-2), commonly known as COVID-19, has had profound effects at every level of society. Other known viral illnesses during pregnancy, such as cytomegalovirus, can affect the developing fetus and cause congenital hearing loss. The long-term effects of COVID-19, including the risk of congenital hearing loss, are not currently established. Method(s): A retrospective cohort study was performed at a quaternary care facility. Sixty-four consecutive patients with a COVID-19 infection during pregnancy were identified. Charts were reviewed for trimester of positive COVID-19 test, maternal and neonatal comorbidities, symptomatology, vaccination status, and results of newborn screening and follow-up hearing testing, if performed. Result(s): Sixty-four women with positive COVID-19 test during pregnancy (6 in second trimester, 59 in third trimester) were identified. Most (n=54, 84.4%) patients were asymptomatic at time of positive test and 29.7% (n=19) had received at least 1 dose of a COVID-19 vaccine. Newborn hearing screening was performed in 58 patients (90.6%). Failed initial screening occurred in 3 (5.2%) right ears and 4 (7.0%) left ears. Two patients passed on repeat screening, and the remaining 1 patient was found to have a mild conductive hearing loss in the right and middle ear dysfunction on the left. Conclusion(s): This study demonstrates no significant increased risk of congenital hearing loss in prenatal COVID-19 infection. Additional investigation into timing of infection and effect of vaccination status will be performed to provide guidance to women navigating pregnancy during the pandemic.

Maternal SARS-CoV-2 sero-surveillance using newborn dried blood spot (DBS) screening specimens highlights extent of low vaccine uptake in pregnant women.

SARS-CoV-2 vaccine uptake in pregnant women is believed to be low and lags behind the general population contributing to increased hospital admissions, and poor maternal and fetal outcomes. However, there is a paucity of information on the SARS-CoV-2 serostatus of pregnant women to help inform policy planning and assess impact of interventions to improve vaccine uptake in this at-risk group. We analyzed 8,683 residual, anonymized newborn screening dried bloodspot (DBS) specimens during a 15-month period (October 2020 to December 2021) in Wales (UK) for SARS-CoV-2 IgG-antibodies. We compared newborn DBS antibody-positive rates to the percentage number of pregnant women vaccinated and the percentage number of antibody-positive adults. In December 2021, 47.8% of women in Wales had received two doses of the vaccine by their delivery date; however, only 41.1% of DBS specimens had high antibody concentrations. Results indicate that a proportion of pregnant women remain at higher-risk of COVID complications, particularly given the reduction in antibody neutralization of Omicron versus the Delta variant. Our study demonstrates the utility of newborn screening DBS specimens to monitor SARS-CoV-2 serostatus in pregnant women representing maternal vaccination and natural infection in almost real-time, defining the immunity gap and impact of any interventions.

Use of Online Newborn Screening Educational Resources for the Education of Expectant Parents: An Improvement in Equity.

Educating parents about the newborn screening (NBS) process is critical in ensuring that families are aware of their child's NBS, which could contribute to better outcomes for the baby and experiences for the family. Successful education efforts result in expecting parents understanding the importance of NBS, feeling comfortable with the NBS process, and being aware of their choices after NBS is complete. Educating parents prenatally is challenging for many NBS programs for a variety of reasons. The COVID-19 pandemic added additional barriers to NBS programs' ability to educate parents prenatally about NBS. By initiating a department-wide partnership among other programs with a similar target audience, Michigan's NBS Program was able to host a virtual baby fair. Since the inaugural event, Michigan's NBS Program has hosted seven virtual fairs with 15 participating programs. A total of 692 participants registered for the baby fair and received a resource packet, over 157 participants joined one of the live presentations, and 211 have viewed the YouTube videos of recorded fairs. Virtual baby fairs are a cost-effective and convenient approach to education that could be implemented in any NBS program to educate parents prenatally about NBS.

Trends in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Seroprevalence in Massachusetts Estimated from Newborn Screening Specimens.

BACKGROUND: Estimating the cumulative incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is essential for setting public health policies. We leveraged deidentified Massachusetts newborn screening specimens as an accessible, retrospective source of maternal antibodies for estimating statewide seroprevalence in a nontest-seeking population. METHODS: We analyzed 72 117 newborn specimens collected from November 2019 through December 2020, representing 337 towns and cities across Massachusetts. Seroprevalence was estimated for the Massachusetts population after correcting for imperfect test specificity and nonrepresentative sampling using Bayesian multilevel regression and poststratification. RESULTS: Statewide seroprevalence was estimated to be 0.03% (90% credible interval [CI], 0.00-0.11) in November 2019 and rose to 1.47% (90% CI: 1.00-2.13) by May 2020, following sustained SARS-CoV-2 transmission in the spring. Seroprevalence plateaued from May onward, reaching 2.15% (90% CI: 1.56-2.98) in December 2020. Seroprevalence varied substantially by community and was particularly associated with community percent non-Hispanic Black (ß = .024; 90% CI: 0.004-0.044); i.e., a 10% increase in community percent non-Hispanic Black was associated with 27% higher odds of seropositivity. Seroprevalence estimates had good concordance with reported case counts and wastewater surveillance for most of 2020, prior to the resurgence of transmission in winter. CONCLUSIONS: Cumulative incidence of SARS-CoV-2 protective antibody in Massachusetts was low as of December 2020, indicating that a substantial fraction of the population was still susceptible. Maternal seroprevalence data from newborn screening can inform longitudinal trends and identify cities and towns at highest risk, particularly in settings where widespread diagnostic testing is unavailable.

Improving Recruitment for a Newborn Screening Pilot Study with Adaptations in Response to the COVID-19 Pandemic.

Seven months after the launch of a pilot study to screen newborns for Duchenne Muscular Dystrophy (DMD) in New York State, New York City became an epicenter of the coronavirus disease 2019 (COVID-19) pandemic. All in-person research activities were suspended at the study enrollment institutions of Northwell Health and NewYork-Presbyterian Hospitals, and study recruitment was transitioned to 100% remote. Pre-pandemic, all recruitment was in-person with research staff visiting the postpartum patients 1-2 days after delivery to obtain consent. With the onset of pandemic, the multilingual research staff shifted to calling new mothers while they were in the hospital or shortly after discharge, and consent was collected via emailed e-consent links. With return of study staff to the hospitals, a hybrid approach was implemented with in-person recruitment for babies delivered during the weekdays and remote recruitment for babies delivered on weekends and holidays, a cohort not recruited pre-pandemic. There was a drop in the proportion of eligible babies enrolled with the transition to fully remote recruitment from 64% to 38%. In addition, the proportion of babies enrolled after being approached dropped from 91% to 55%. With hybrid recruitment, the proportion of eligible babies enrolled (70%) and approached babies enrolled (84%) returned to pre-pandemic levels. Our experience adapting our study during the COVID-19 pandemic led us to develop new recruitment strategies that we continue to utilize. The lessons learned from this pilot study can serve to help other research studies adapt novel and effective recruitment methods.