Best practice guidance and evidence used
- UK National Screening Committee (UKNSCa) (2010) ‘Infectious
Diseases in Pregnancy Screening Programme, Programme Standards’
- UK National Screening Committee (UKNSCb) ‘Infectious
Diseases in Screening Programme Handbook for Laboratories’
- Department of Health (DoH) ‘Hepatitis B antenatal screening
and new-born immunisation programme - Best practice guidance’ makes
clear recommendations to improve the uptake rate of existing
Hepatitis B immunisation programmes for new-borns who are at risk
of Hepatitis B infection (DH, 2011).
What do we know?
Pregnant women are offered antenatal screening
for HIV in order to identify infection, to both allow the timely
offer of interventions to reduce the risk of mother-to-child
transmission and to safeguard the women’s own health. A combination
of antiretroviral therapy, appropriate management of labour, and
the avoidance of breastfeeding can reduce the risk of
mother-to-child transmission from 15-25% to 1% or less (UKNSC,
Hepatitis B infection is caused by the
Hepatitis B virus (HBV), which is transmitted through infected
blood and other bodily fluids. The risk of perinatal transmission
is dependent on the status of the maternal infection, with around
70-90% of mothers testing positive for HBV e-antigen passing the
infection on to the infant. The rate of transmission is lower, at
around 10%, in women with antibodies to HBV e-antigen.
The objectives of the screening programme
- To ensure that all Hepatitis B
positive mothers identified are referred for specialist care within
6 weeks of screening results and
- To ensure that all infants born to
Hepatitis B positive mothers receive vaccination within 24 hours of
delivery and at 1, 2 and 12 months. In babies born to mothers with
a higher risk of transmission, the additional Hepatitis B Specific
Immune Globulin (HBIG) can reduce the risk further. With this
strategy, transmission can be prevented in over 90% of infants
exposed to maternal infection (UKNSC, 2010a).
The antenatal screening programme
for infectious diseases should be delivered in line with ’The
Infectious Diseases in Pregnancy Screening Programme
Standards’ (UKNSC, 2010a). Specific best practice titled
‘Hepatitis B antenatal screening and new-born immunisation
programme’ (DH, 2011) is available in relation to the delivery
of neonatal Hepatitis B immunisation. Both Hepatitis B and
postnatal MMR vaccination should be delivered in line with the
Department of Health ‘Green Book’ recommendations for immunisation
(DH, 2009). Screening for each of the four conditions should be
undertaken using the nationally agreed screening protocols.
Analytical processes which govern the diagnostic sensitivity and
specificity of tests are outlined in the IDPS Handbook for
Laboratories (UKNSC, 2010b).
What are the unmet needs/
There are a number of gaps identified in
relation to the screening pathway for infectious disease in
pregnancy and newborn screening, as well as the subsequent
management of positive screens.
- The ability to disaggregate data in order to
analyse screening uptake for women living in Bedford Borough. This
subsequently prevents the development and implementation of
targeted strategies to promote screening uptake within specified
populations. The ability to analyse screening outcome data beyond
the level of acute Hospital Trust. This inhibi the compilation of
trend data relating to HIV, Syphilis, Hepatitis B and Rubella.
- The absence of a locally agreed, multiagency
protocol to govern the postnatal management of women identified as
- Sickle Cell Thalassaemia screen: Currently
early access is measured at 12 weeks and 6 days against expected 10
- Newborn Blood spot test: Delay in sample
taking, some of the samples are taken at day 17. Also there are
issues with avoidable repeat test that has risen nationally due to
new National Lab Quality Criteria implementation; and issue with NB
coverage for Movers- In where there are delays in maintaining time
frame of 21 days from GP notifications to results
- Newborn physical Examination: No
designated clinical lead at the provider hospital. and
communication gap within the service; no clarity on
responsibilities such as who owns the KPI and who is responsible
for data entering; exceptional report required, and not clear who
will do that.
- Develop and implement a local protocol for the management of
infants born to Hepatitis B positive mothers.
- Data quality improvements should be sought,
in order to improve local knowledge of screening uptake and trends
in relation to screening outcomes. Access to this level of data
will need to be negotiated with Acute Trusts.
- Improving early access to Antenatal and newborn screening so
that results are available by 10 weeks
Back to top
To download a PDF copy of this chapter, please click