[Laboratory medicine in the neonatal age: quality, excellence and reduction of costs] [Article in Italian] • La medicina di laboratorio in età neonatale tra qualità, eccellenza e riduzione dei costi

Abstract

Our times are characterized by the dichotomy between the increasing need for health care and the global decrease in economic resources. Neonatology is at the centre of this scenario for several reasons. Firstly, the availability of molecular and genetic tests has made possible the accurate prenatal diagnosis of a series of diseases caused by transmissible and non-transmissible genetic defects, thus leading to the development of large-scale screening programmes and the consequent proper medical and surgical treatments. Secondly, thanks to improvements in assistance in intensive therapy in the last fifteen years, there has been a substantial increase in low, very low and extremely low weight premature births (LBW, VLBW and ELBW respectively). The survival rate of these premature neonates is good and their quality of life following the neonatal period has also improved. How can we combine the need to count on excellent laboratory diagnoses with the need to reduce the cost of healthcare and, more in particular, the costs of purchasing advanced systems of diagnosis? Three considerations can be formulated: 1) it is essential to eliminate waste, but it is just as essential to ensure the quality of the products (instrumentation and diagnostic kits); 2) we should change the objective of issuing tenders for the supplying of health equipment and services from the present scenario, which provides for supply contracts, often in-service, of diagnostic systems, we should change to contracts that call for a policy of savings through the providing of products of excellence. Although at first sight this may appear paradoxical, in reality it masks a vaster matter that involves different stakeholders: health professionals, suppliers and the public administration; 3) the use of sophisticated techniques and the study of molecular profiles are capable of generating far-reaching prospects for healthcare, investments and savings. An example of this is represented by metabolomics, one of the emerging “omics” disciplines, applicable in numerous fields such as that of infections of neonates and children. If, by means of experimental studies properly validated in clinical trials, metabolomics were found to be capable of recognizing eight to ten metabolites, thus making early identification of a clinical picture of systemic infection possible, an industrial investment could lead to the production of a dipstick containing these freeze-dried metabolites, like the dipstick commonly used in the chemical and physical analysis of urine. Such a disposable item would be extremely easy to use, economical and available to all mothers for testing the risk of sepsis of their babies simply by immersing the stick in the urine at a cost estimated at less than half a US dollar.