Extended Neonatal Metabolic Screening by Tandem Mass Spectrometry: Models and Simulation of Alternative Management Solutions

Neonatal metabolic screening aims at identifying newborns with severe metabolic pathologies in order to promote appropriate interventions to avoid or to improve adverse outcomes. Tandem Mass Spectrometry permits, from a blood drop, collected on a blotting paper by a puncture on the heel, to measure a lot of metabolites according to their mass; this method can identify more than 30 metabolites, each of which is a potential marker of a hereditary metabolic disease. The large amount of available information and the difficulty in correctly interpreting them in a short time, compatible with the exigencies of newborns, imposes to find an optimal management of structures devoted to perform the related tests. In the paper four different solutions, based on different utilizations of a cluster of two or more test structures, are examined and evaluated. A simulation model, coded in language Arena, has been built to get numerical results; such a model may be usefully employed to compare the effects of different solutions for an actual situation and to give a correct dimensioning to the chosen solution.