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Keeping newborn screening up and running during an emergency is a daunting but critical task for states. For babies with metabolic conditions, a break from their medications and dietary treatment can be life-threatening.

State officials face problems ranging

States vary in how they organize emergency response programs. Some states--typically larger ones with experience preparing for and responding to disasters--have taken steps to protect the newborn screening infrastructure. Most states, however, have only one laboratory available to them, with little capacity to absorb additional volume, according to the Emergency Preparedness for Newborn Screening and Genetic Services National Workgroup.

To maintain critical services during a crisis, about two dozen states have funded new and better-equipped laboratories, according to the Association of Public Health Laboratories. Mutual aid agreements with other states can also help. They allow states to back up each other when an emergency threatens newborn screening programs.

States are also promoting electronic records, so that if patients must leave their homes, their new providers have instant access to their medical records. Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio and Wisconsin are working together on a web-based database of critical health information needed during an emergency, such as medications and formulas, immunization history and children's emergency medical treatment protocol.

According to Stephen Martin, director of Louisiana's Public Health Laboratory, dropping the ball on newborn screening during an emergency is not an option. "Babies were going to continue to be born. I couldn't stop that," he says of his experience during Hurricane Katrina. "And if they weren't tested within the first few days of life, some might be irreparably harmed."

RECOMMENDATIONS FOR STATES

A state's contingency plan for newborn screening should include:

* Stocking of testing chemicals and supplies by labs and manufacturers.

* Plans on how to collect and test specimens with electrical generators and alternative water sources.

* Plans on providing services for infants diagnosed with a disorder.

* Regional agreements with other states identifying alternative public or private labs.

* Adoption of uniform tests so results are comparable among states involved in an agreement.

* Appropriate data systems to ensure the timely transmission of test results to an infant's provider and state public health authority.

Source: Association of Public Health Laboratories, Newborn Screening and Genetics in Public Health Committee