Newborn screening is a comprehensive public health prevention system that seeks to identify newborns at increased risk for certain inherited congenital conditions. Institution-alizing and sustaining this system presents a formidable challenge within developing public health systems often competing with other healthcare priorities and political agendas. We re-view some of our experiences in overcoming newborn screening implementation challenges and discuss recent efforts to encourage increased newborn screening through support networking and information exchange activities in the Middle East/North Africa and in the Asia Pacific Regions.

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JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org.. The National Institute of Environmental Health Sciences (NIEHS) andBrogan & Partners are collaborating with JSTOR to digitize, preserve and extend access to Environmental Health Perspectives. This is the first large population-based study of demographic risk factors for elevated lead in Texas children. It summarizes data on 92,900 children covered by Medicaid screened for blood lead during the first 6 months of 1993 in Texas. The highest percentage of elevated lead levels (14.3%) was in children 25-36 months of age, with slightly lower percentages in those younger (13% of 19-24 months) and older (12% of 37-48 months) with blood lead levels greater than 10 pg/dl. The group with the highest percentage of elevated blood lead levels was 2-4-year-old African American males (17.3%), making this subgroup 3.5 times higher than the group with the lowest percentage-white girls over age 4 (4.8%). Males had higher blood lead levels for all ages and ethnic groups. Three principal risk factors were found for excessive blood lead in children: ethnicity, gender, and age; this is consistent with the second National Health and Nutrition Examination Survey (NHANES II) and Phase I of the NHANES III results demonstrating ethnicity and income association with lead in children in the United States.

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Since Nov 1, 1983, we have tested more than 1 million infants for sickling hemoglobinopathies. The laboratory procedures used for analysis of the filter paper blood spots include a combination of cellulose acetate and citrate agar electrophoresis. Isoelectric focusing offers an alternative screening procedure. Satisfactory interpretations of electrophoretic patterns are generally acceptable on specimens analyzed within five days of collection. Specimen age does not seem to be as critical a factor with isoelectric focusing. Consumable supply costs are slightly more with isoelectric focusing protocol (approximately $0.50 v $0.25), however, and the technical complexity and time involved are also somewhat higher. We have found the incidences to be as expected. Annual births in Texas number approximately 42,000 blacks, more than 90,000 Hispanics, and more than 175,000 whites. The newborn screening program is detecting approximately 100 cases of sickle cell anemia, 40 cases of SC disease, and 4,200 sickle hemoglobin carriers annually. Although the morbidity and mortality data demonstrating the effectiveness of this program will take some time to accumulate, support for its continuation from the physician community and the general public appears widespread. Follow-up of disease conditions is an integral part of the protocol, and the involvement and recommendations of an advisory committee, including qualified pediatric hematologists, have proven extremely beneficial. Both educational literature and treatment protocols have been addressed by the department and its advisers. Although the program still lacks a strong genetic counseling effort, and there are considerable communication and transportation problems associated with the state's geography, the Texas Department of Health remains dedicated to improving the public health of infants throughout the state with its quality newborn screening program.