Newborn bloodspot screening for inherited metabolic disease and follow-up — branching viva

Station opening

Examiner: "The baby looks perfect. Why are you delaying discharge for a blood test card?" [17]

Strong candidate (must-hit)

• Bloodspot is a closed-loop programme, not optional paperwork. [17]
• Distinguishes clear, positive, unsatisfactory and incomplete states. [17]
• Names an owner for incomplete items. [17]

Weak candidate

• "Feeding well so the GP can do it sometime." [17]
• Collapses screening into diagnosis language. [17]

Branch A — Critical TSH

Examiner: "Day 7, thriving infant, critical TSH on bloodspot." [3]

Strong

• Same-day contact; confirmatory free T4/TSH; protocolised levothyroxine pathway; endocrine follow-up. [3]
• Explains brain risk despite well appearance. [3]

Weak

• "Review at 6 weeks if still well." [3]

Branch B — Possible classic galactosaemia

Examiner: "Screen suggests classic galactosaemia. Baby is on milk and looks fine." [10]

Strong

• Stop galactose-containing feeds now; suitable alternative formula; confirm diagnosis; watch for sepsis/liver failure. [10]

Weak

• Continues milk until "the enzyme comes back next week." [10]

Branch C — MCADD education

Examiner: "MCADD is confirmed. Teach the parents in one minute." [7]

Strong

• Avoid prolonged fasting; illness emergency regimen; early presentation if intake fails. [7]

Weak

• "No special care after the newborn period." [7]

Branch D — Refusal

Examiner: "Parents decline the heel prick after online reading." [17]

Strong

• Explores reasons, corrects specific myths, documents residual risk, offers lawful process, ensures not lost to follow-up. [17]

Weak

• Coercive confrontation or complete disengagement with no safety-net. [17]

Close

Examiner: "One-sentence handover." [17]

Strong

• Card status, result state, open actions, owner, family contacts, safety-net. [17]