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Background: Hospitals in New York City (NYC) are required to record maternal HBsAg status on the Newborn Metabolic Screening Form (NMSF) that accompanies blood specimens sent to the New York State Metabolic Screening Program for every newborn. This universal reporting method is the single reporting source for 5%-10% of infants born to HBsAg-positive women identified by the Perinatal Hepatitis B Prevention Program (PHBPP).
Objectives: Evaluate the completeness and accuracy of NMSF data.
Methods: The number of NMSFs received was compared to the number of births in NYC. Accuracy of NMSF data was assessed by matching all NMSFs against PHBPP data on HBsAg-positive pregnancies. A sample of NMSFs without maternal HBsAg status was assessed via medical record reviews. We conducted interviews with staff at a sample of hospitals to assess errors and best practices for capturing maternal HBsAg status on the NMSF.
Results: For the 128,960 NYC births in 2007, 128,521 (99.7%) NMSFs were submitted of which 98.7% included maternal HBsAg status. Compared to PHBPP records, NMSFs had a sensitivity of 91.09 (95% CI: 89.66-92.34) and specificity of 99.85 (95% CI: 99.83, 99.87) for identifying HBsAg-positive pregnancies. Medical records were reviewed on a sample of NMSFs lacking maternal HBsAg status. Among those sampled, all had HBsAg results and nine HBsAg-positive cases were identified that had not previously been reported to the PHBPP. Practices yielding more accurate NMSFs included repeating maternal HBsAg testing when prior reports were unavailable and including a copy of maternal lab report in maternal chart.
Conclusions: The NMSF is a useful surveillance tool for identifying most births to HBsAg-positive mothers but is not 100% complete or accurate. NMSF data could be improved through implementation of best practices for collecting and recording maternal status on the NMSF. Thorough follow-up on NMSFs without maternal HBsAg status is recommended.
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