International cooperation in the expansion of a newborn screening programme in Lebanon: a possible model for other programmes
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Tandem mass spectrometry (MS/MS) is rapidly gaining support, even in less-developed nations, as the method of choice for the newborn screening of metabolic disorders, although difficulties in acquiring this technology may at times be major obstacles in several Middle East and North Africa (MENA) countries. In Lebanon, international cooperation allowed this acquisition at the Newborn Screening Laboratory (NSL) of the Saint Joseph University (USJ) in the capital city of Beirut. NSL is currently screening up to 20% of all newborns in Lebanon. The expansion was made possible through initial collaboration with the Metabolic Laboratory at the Hamburg University Medical Center (HUMC) and subsequently with other centres. During phase I of the expansion (2006–2007), blood spots were shipped to HUMC with rapid couriers twice a week and electronic reports were sent back generally within 4 days after shipment. Positive cases were recalled to NSL and new specimens were sent back for confirmation at HUMC. During that first phase, the Beirut staff received training at the HUMC and in other centres. Phase II was a transitory period of 4 months during which machines were installed in Beirut and working procedures were adopted and documented. The activity has now entered a consolidation phase (Phase III) in which all measurements are exclusively performed in Beirut while HUMC acts as a backup centre. International cooperation remains crucial for periodic quality assurance procedures, and for supporting the transformation of the USJ-NSL into a training centre able to transfer MS/MS technology to the MENA region.
KeywordsPositive Predictive Value International Cooperation Newborn Screening Congenital Hypothyroidism G6PD Deficiency
Biochemical Genetics Laboratory
Centers for Disease Control
Hamburg University Medical Center
International Society for Neonatal Screening
Middle East and North Africa
tandem mass spectrometry
multiple reaction monitoring
Newborn Screening Laboratory – University Saint Joseph
positive predictive value
total parenteral nutrition
We are greatly indebted to our partners at the Hamburg Metabolic Laboratory who started the process of cooperation with us. Special thanks go to Professor Harry Hannon, head of the Newborn Screening branch at CDC, and to Professor Piero Rinaldo, head of the Biochemical Genetics Laboratory at the Mayo Clinic, for training our staff and for supporting quality improvements in our laboratory and all over the world. We are also grateful for the technical support obtained from the Chromsystem staff in Munich. Meetings of the International Society for Neonatal Screening (ISNS) allowed networking and exchange of ideas that proved invaluable for this project. Finally we would like to thank Ms. Rola Salman and Ms. Maya Rizkallah, for their technical support at the USJ Newborn Screening Laboratory in Beirut. NSL scientific activities are partially funded by the Caisse Nationale de Recherche Scientifique (CNRS) in Lebanon, and by special funds from USJ.
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