Mission NEEV - Objectives and Workflow | DNB Solved questions

This post covers the the purpose, and workflow integrtation of mission NEEV. The question was recently asked in June 2022 DNB Pediatric theory exam.

Introduction

Newborn screening for IEM is regarded as one of the most important health initiatives of the decade. This forms the main basis of Mission NEEV.

Aim

Mission NEEV stands for Neonatal Early Evaluation Vision (NEEV). It aims at the early identification (screening) and treatment of visible, functional, and metabolic defects in neonates.

Who started mission NEEV?

The Delhi government has started ‘Mission NEEV’ for providing early treatment against fatal diseases. The scheme is being supported by the Delhi government and Delhi State Health Mission under the Rashtriya Baal Swasthya Karyakram (RBSK) and is aimed at covering 1.5 lakh Newborns.

The major objectives

1. Screening for Visible Birth Defects (VBD)
2. Screening of functional birth defects such as Retinopathy of prematurity & congenital Hearing defects, blindness, etc.
3. Screening for metabolic birth defects which include screening for congenital hypothyroidism, congenital adrenal hyperplasia, and G6PD deficiency.

NEEV Workflow

It consists of five distinctive steps during the birth period followed by repeat tests during re-visits up to 5 years.

These are described in the following subsections.

1. VBD Screening

VBD screening is the first screening to be conducted within 24 hours of birth.

A unique VBD number is created for the newly born time. It may be used later to identify this child.

All demographic details of the child and mother are entered in the portal along with this number, so that these may be accessed from other systems interlinked with it over the NEEV portal. (an app is developed for this which is available on the play store)

Barcodes needed for subsequent blood tests are generated and kept ready.

2. Subsequent screening and integration

Within 48 hours of birth, after all, newborns are provided with unique VBD Id, and other screenings such as OAE, pulse oximetry, and ROP are done along with screening for metabolic diseases (IEM).

More on how to approach an IEM? here

There is no particular sequence or order for these tests and can be done based on logistics considerations.

OAE Screening

OAE screening is done on the second or third day of birth.

It is done by the nurse using the OAE mobile app linked to the OAE instrument over Bluetooth or other interfaces.

The mobile app displays an audiometry chart on the mobile screen and gives an indication of pass or fail. The test is repeated for both ears.

Metabolic Screening

Blood collection for Metabolic screening is conducted along with other vaccinations to reduce pain. This has to be completed prior to discharge.

It is done by the nurse using the Metabolic mobile app.

The collected samples are tagged with the VBD number and sent to the lab.

Pulse Oximetry Screening

Pulse Oximetry screening is conducted on the second or third day of birth. It is done by the nurse using the PO mobile app that is linked to the pulse oximetry instrument. This will be integrated with the NEEV server.

The mobile app displays the SPO2 chart on the mobile screen and gives derived parameters like heart rate, etc. The test is repeated for both hands and legs

Retinopathy Screening

It is done by the nurse using the Retinopathy mobile app and appropriate connected hardware. The images are stored in the NEEV database for later examination by an ophthalmologist.

Screening at later stages

It is done when a child visits the hospital either for a follow-up or for a new visit.

In the case of the follow-up, the old VBD number is used to access the previous results. Otherwise, a new VBD number is generated and the child is admitted to the system as a fresh case.

The OAE, PO, and Retinopathy screening may be done at this stage as suggested by the clinician.

References

1. Mission NEEV - Procurement of equipment, IECC activity. [Ext Link]
2. Public-Health Relevance Project under High Research Priority Area Program [Ext Link]

Author

Gaythri G | DNB Pediatrics

Gayathri is DNB in Pediatrics. She has completed her residency from Meenakshi mission hospital and research centre, Madurai