TSH newborn screening dried blood spot rejection rates: A two-year experience from low-middle income country
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Fauqa Arinil Aulia 1 2 3 , Ferdy Royland Marpaung 2 3 *
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1 Clinical Pathology Subspecialist Program, Faculty of Medicine, Universitas Airlangga, Surabaya, INDONESIA2 Department of Clinical Pathology, Faculty of Medicine, Universitas Airlangga, Surabaya, INDONESIA3 Department of Clinical Pathology, Dr. Soetomo General Academic Hospital, Surabaya, INDONESIA* Corresponding Author

Abstract

Background: Preanalytical errors in dried blood spot (DBS) sampling delay critical congenital hypothyroidism diagnosis, particularly in resource-limited settings. This study evaluates temporal shifts in DBS rejection rates across East Java, Indonesia (2024 vs. 2025), and identifies evolving clinical patterns of sampling errors to guide targeted quality improvement strategies.
Methods: This retrospective study combined aggregated district-level data (38 districts; N = 770,854 screenings) with individual-level data from a subset of rejected samples (N = 931). Wilcoxon signed-rank tests compared paired programmatic outcomes; Mann-Whitney U and Chi-square tests analyzed individual-level data using IBM SPSS statistics version 29.0 for Windows.
Results: Total screenings increased 7.0% from 2024 (N = 372,454) to 2025 (N = 398,400). Median rejected samples per district decreased significantly from 373.0 to 359.5 (p = 0.004), but rejection rates did not change significantly (4.07% to 3.61%; p = 0.243). Extreme inter-district disparity persisted (0.44%-25.20%). Monthly analysis revealed significant improvements in January (p = 0.003), February (p < 0.001), and June (p = 0.023). A total of 931 DBS samples were rejected, with the distribution of rejection causes shifting significantly (p < 0.001). The rejection type of “small sample” decreased from 16.8% to 7.9%, while samples with “hemolysis” increased from 20.0% to 29.2%.
Conclusion: While overall rejection rates remained stable, the newborn screening (NBS) program drove a significant structural transition in preanalytical error patterns—successfully reducing basic collection errors while encountering an emerging vulnerability in specimen handling (hemolysis). These novel insights demonstrate that scaling up NBS in low- and middle-income countries requires a strategic evolution from universal training to data-driven, precision quality interventions.

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Article Type: Original Article

ELECTRON J GEN MED, Volume 23, Issue 5, October 2026, Article No: em757

https://doi.org/10.29333/ejgm/19567

Publication date: 11 Oct 2026

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Article Downloads: 6

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