New born Screening

  • Nearly 2100 babies are born every hour in India. More than 3400 infants a day – suffer from a congenital abnormality
  • If left undetected and untreated, these disorders will likely claim most of these young lives by age five
  • If detected in the first few days after birth, those infants may be given a healthy start to life

NEWBORN SCREENING: Restoring the right to a healthy childhood

  • Suburban Diagnostics in association with PerkinElmer ( a global leader in newborn screening with over 30 years of experience) offers complete Newborn screening range
  • Detects over 50 metabolic disorders
  • Uses VICTOR 2D (time resolved Fluorometry) and MS/MS (Tandem Mass Spectroscopy) delivering high sensitivity and reproducibility of results
  • Complete solution provider – from sample to result with expert interpretation of results
  • Complete solution provider – from sample to result with expert interpretation of results
  • Over 500 million babies screened using PerkinElmer solutions worldwide
Newborn Screening Basic Panel
  • Can detect metabolic conditions after 48 hours of age and within 15 days
  • Sample collection is safe and simple – a heel prick on specially designed DBS card
  • Congenital Hypothyroidism (CH)
  • Congenital Adrenal hyperplasia (CAH)
  • G6PD Galactosemia
  • Cystic Fibrosis (CF)
  • Biotinidase
  • Phenylketonuria (PKU)
Disorder Screened Effected if not screened Effect if screened and managed Management
Congenital Hypothyroidism Severe mental retardation, intellectual disability and abnormal growth Normal – if treatment begins in the first month after birth Daily oral dose thyroid hormone (thyroxine)
Congenital Adernal Hypothyroidism Death, muscle wasting and dehyderation, Hisutism and abnormal enlargement of genitals Normal with medication Hydrocortisone / Liquid prednisolone in infancy and childhood prednisone or Dexamethasone in adults
Glucose -6-phospate Dehydrogenase Deficiency Severe Anaemia, Prolonged neonatal Jaundice, Kernicterus Normal with dietary and medical restrictions Immediate exclusive of dietary galactose
Cystic Fibrosis Chronic obstructive lung disease, airway infections, gastrointestinal abnoramalities Dramatic improvement in the qualities of life with early diagnosis, treatment and diet management Phenylalanine – restricted food with proper dietary control under close supervision of the dietician / physician, lifelong
Biotinidase Deficiency Hypotonia, ataxia, seizures, development delays, vision/hearing loss, alopecia, dermatitis Normal with supplements Oral Biotin adminstration. This treatment is lifelong and highly effective

1 in 1500 to 3000 newborns suffer from inborn Errors of Metabolism

Newborn Screening: Expanded Panel – Inborn Errors of Metabolism

  • A comprehensive screening program for clinically significant disorders performed using MS/MS (Tandem Mass Spectrometer), the most widely used technique for IEM testing
  • Detects more than 50 disorders which includes
    • 11 Amino Acid disorders
    • 13 Acylcarnitines (Fatty Acid disorders)
    • Organic Acid disorders
    • Hemoglobinopathies
    • Newborn Screening: Basic Panel
Heel Prick Sample Collection Technique


Why is a Dual Marker not done when one foetus is aborted in case of twin pregnancies?

If one foetus is aborted, we need to look for the foetal pole. If the foetal pole is present in the demised twin, the dual test is not possible as there will be production of substances (PAPP-A & Free βhCG) from the demised twin and the resulting interpretation will be erroneous. Foetal pole needs 8-9 weeks to close in cases where one foetus in aborted. If there is no foetal pole we can take the pregnancy as a singleton and the dual test can be processed.

Why do we report single risk in monochorionic twins although the CRL (Crown-rump Length) and NT (Nuchal Translucency) values are different?

Monochorionic twins originate from the same embryo, so they are assumed to be genetically identical although there is the difference in biometry.

What is the benefit of NT value measured using FMF (Fetal Medicine Foundation) guideline?

FMF guidelines provide a standardized methodology for NT measurement. This is paramount in maintaining the sensitivity of the combined screening as it contributes significantly (about 70% to the 91%) detection rate in the dual test.

What is Corrected MoMs?

Corrected MoMs are MoMs with weight corrections.

  • Weight correction should be applied to all analytes in Down’s syndrome screening
  • Evidence shows that weight correction improves the detection rate
  • Multiple median values can be significantly affected by weight correction
What is the importance of the sample collected on the DBS card over serum?

Free βhCG is more stable and intact on the DBS card. Also dissociation from free βhCG occurs slow on the DBS card.

Why is maternal screening not done between 14 and 15 week of gestation?

One of the most discriminating markers for NTD is AFP which is best accessed from the 15th week for the quadruple test. Hence, the window of the 14 to 15 week is not ideal for dual or quadruple test.

Why do we not report Patau syndrome (T13) in 2nd trimester screening?

Sensitivity of patau syndrome is very low in the 2nd trimester as pregnancies diagnosed with T13th end in miscarriages between 12 to 15 week of gestation.

What is the difference between LifeCycle software, ssdw, Austria and Prisca?

LifeCycle risk calculation engine is a comprehensive informatics package for maternal health monitoring and risk assessment. An accessible patient data management system is coupled with a flexible risk calculation engine, which can be configured to meet local variations. Because the system has been fully validated and all calculation methods, algorithms and values are supported by the current published literature, LifeCycle gives full confidence in a maternal risk assessment program.

Are there any insights on Pre-eclampsia (PIGF- PLACENTAL GROWTH FACTOR)?

Pre-eclampsia is a sudden increase in blood pressure and protein in the urine after the 20th week of pregnancy. Pre-eclampsia can lead to eclampsia, or convulsions, posing serious health implications for the mother and the baby. Symptoms of pre-eclampsia may include:

  • High blood pressure (≥140/90 mmHg)
  • Swelling in the face and hands (and feet, although swollen feet are common during pregnancy)
  • Weight gain of more than 2 kgs in a week
  • Other problems such as headache, blurred vision, abdominal pain and nausea
What is MAP & uAD and what is their relevance in PlGF test?
  • Mean Arterial Pressure (MAP) – Accurate measurement of blood pressure in pregnant women is particularly important when attempting to identify early signs of pre-eclampsia. As a means of prediction, it has been suggested that the MAP, whether measured in the first or second trimester, is better than systolic blood pressure, diastolic blood pressure, or an increase of blood pressure. In clinical practice MAP measurement in the first trimester may not make a clinical impact in isolation but could be suitable for use with other markers, including maternal serum markers, to improve the accuracy for estimating the risk of pre-eclampsia.
  • Uterine Artery Doppler (uAD) – The uterine artery Doppler can be evaluated by direct visualization, i.e. examining the characteristics of the waveform to determine if nothing is present or absent, or by quantifying the waveform by measuring the blood flow velocity at peak systole (maximal contraction of the heart) and peak diastole (maximal relaxation of the heart). These values are then computed to derive a ratio. The most common approach is to measure the Resistance Index (RI) in which the peak of systole is divided by the sum of systole and diastole.
  • RI= systole/ (systole + diastole)
  • In early pregnancy, the peak flow at diastole is less than later in pregnancy. Therefore, as the duration of pregnancy increases, the amount of blood flowing in the umbilical artery increases during diastole.
Test Code Test Name Sample Comment/ Description
SGO61 Dual Marker Test: (11 – 13.6 weeks) PAPP-A, Free ßhCG 2 ml serum / DBS Card NT by USG report (NT & CRL values) and brief clinical history required
SGO62 Triple Marker Test: (15 – 21.6 weeks) AFP, ßhCG, uE3 2 ml serum USG report and brief clinical history required
SGO63 Quadruple Marker Test: (15 – 21.6 weeks) AFP, ßhCG, uE3, Inhibin – A 2 ml serum USG report and brief clinical history required
PRF2400 Integrated Test: Dual Marker (First Trimester Screening) & Quadruple Marker (Second Trimester Screening) 2 ml serum NT by USG report in 1 trimester & USG report in nd 2 trimester and brief clinical history required

Sequential Test: (Combined risk evaluation even if Dual Marker is done seperately)

Test Code Test Name Sample Comment/ Description
SDO61 Dual Marker Test: (11 – 13.6 weeks) PAPP-A, Free ßhCG 2 ml serum NT by USG report and brief clinical history required
SDO63 Quadruple Marker Test: (15 – 21.6 weeks) AFP, ßhCG, uE3, Inhibin A 2 ml serum USG report and brief clinical history required, (Patient needs to carry Dual Marker report)
SDO63 Prenatal BoBs (Aneuploidies + Microdeletion) 3 ml Amniotic Fluid / Chorionic Villi Brief clinical history required
SDO65 KaryoLite BoBs Placental biopsy without blood clot in normal special container provided by Lab Brief clinical history required

What is Zika Virus?

What is Zika Virus?

The Zika Virus (ZIKV) is an arbovirus that carries the name of a forest near Kampala, Uganda. The virus was first identified in rhesus monkeys in 1947and further isolated in humans in Uganda and Tanzania in 1952. The transmission is mostly vectorial by mosquito species, namely Aedes Egypti (also known as spread dengue virus and chikungunya virus). In addition, direct interhuman transmission has been documented through intrauterine transmission resulting in congenital infection, intrapartum transmission from a viremic mother to her newborn, sexual transmission and blood transfusion. During outbreaks, humans are primarily amplifying host for Zika Virus. An estimated 80% of persons who are infected with Zika virus are asymptomatic. The symptomatic disease generally is mild and characterised by acute onset of fever, maculopapular rash, arthralgia, or nonpurulent conjunctivitis. Symptoms usually last for several days to one week.

Clinical Symptoms and Diagnostic Algorithm

Approximately 20% of ZIKV infected individuals become symptomatic lasting for several days to a week. Charasteric clinical findings are acute onset of fever with maculopapular rash, arthralgia, or conjunctive myalgia and headache.

The Diagnosis of Zika virus infection can be made through both molecular and serological testing. Molecular testing is the preferred test (which is useful to detect the virus only in the initial days of an acute infection). This includes reverse transcription –polymerase chain reaction (RT – PCR) for viral RNA and should be performed on serum specimens. To detect congenital infections, serum samples should be collected from the umbilical cord or directly from the infant within 2 days of birth.

IgM ELISA for Zika virus and Dengue virus should be performed on infant serum, infant CSF, and maternal serum; however, results of these assays can be falsely positive of cross-reacting antibodies.

Tiered Algorithm for arbovirus for suspended cases of Chikungunya, Dengue, or Zika (testing only performed if travel history indicates travel to the affected area.)

  • PRNT’: Plaque reduction neutralization tests
  • Due to extensive cross-reactivity in flavivirus serological assays, for samples collected < 7 days post illness onset, molecular detection should be performed first.
  • Perform if sample > 4 days after symptoms after symptoms onset
  • Extensive cross-reactivity would be expected in samples from DENV/ZIKV circulation areas. A positive IgM assay with either antigen should be confirmed by using PRNT both ZIKV anf
  • DENV as well as any other flavivirus (eg: SLEV, ZIKV, WNV, etc.) that might be found in the geographic area (including travel areas)
  • PRNT should include any flavivirus (eg: SLEV, ZIKV, WNV, etc.) that might be found in the geographic area (including travel areas)
  • Management of ZIKV infections

    No specific antiviral treatment is available for Zika virus infections and no vaccine against Zika virus available. In the case of infants with congenital ZIKV infections, treatment is supportive and should address specific neurodevelopmental issues.


With its robust quality control process, Suburban Diagnostics assures accurate and precision test results.

Make Suburban your trusted partner in diagnostics

  • To ensure results that are accurate and precise
  • To translate into correct diagnosis and optimum patient care

Proficiency Testing (PT) = Essential Component of Laboratory External Quality Assurance

Proficiency testing is an inter-laboratory comparison, conducted by societies like CAP, Biorad and Randox. It compares results obtained by different by different laboratories for tests performed on unknown samples – to check for the closeness of results to the actual known mean.

Accuracy = Closeness of a measured value to a standard or known mean

Let’s consider the case of glucose for eg: if a patient’s glucose value is 85 mg/dL

Lab Reported Value Outcome
85.4 mg/dL Accurate
100 mg/dL Inaccurate

Precision = Measure of reproducibility of results with the closeness of two or more measurements to each other

Let’s consider the case of a patient with glucose value 93.9mg/dL

Days Glucose (mg/dL)
Day 1 93.9
Day 2 90.4
Day 3 87

Note: Total allowable error for glucose as per Clinical Laboratory Amendments (CLIA) guideline is 10%.

Suburban diagnostics is a NABL accredited and CAP accredited laboratory.

The laboratory uses stringent IQC and EQC for ensuring accurate and precise results and also successfully participates in Biorad, EQAS and CAP assessments, for increased clinical and patient confidence.

At each of our labs, the test performance has exceeded the acceptable cut off for > 95% for our samples. A summary for the same, for the period of Jan to Jun 2017 has been presented below.


Be wise. Swine Flu cases on a rise.

Every fifth person who underwent a test for influenza H1N1 since April 2007 in the city has tested positive for the Virus*.

*Times of India report 11th July 2017

Meta-Analysis of 29233 patients, spanning 78 clinical trials among hospitalized patients over a 5 year period confirms: (Lancet):
Swine Flu related mortality can worsen with each day’s delay in treatment. Oseltamivir treatment works best when given within first 2 days of symptom onset. Hence, prompt and early diagnosis of swine flu and early treatment can save many lives

Health authorities have categorized H1N1 patients as follows:

Category A (ideal for influenza screening) Category B Category C
Not Required Required Certainly Required


Mild fever, cough and sore throat, body ache, headache, nausea and diarrhoea

High grade fever, cough and sore throat, body ache, headache, nausea and diarrhoea in the high-risk category (children with mild illness, pregnant women, persons over 65, patients with lung, liver, heart, kidney, blood or neurological diseases or have been on long-term cortisone therapy)

Symptoms of category A and B.

Breathlessness, chest pain, drowsiness, fall in blood pressure, sputum mixed with blood, bluish discolouration of nail.

Children with influenza-like illness, high and persistent fever, inability to feed, convulsions & difficulty in breathing

Lab Tests Influenza screening by RT-PCR H1N1 testing by RT- PCR H1N1 testing by RT- PCR

Suburban Diagnostics, Your Trusted Partner in Diagnostic Solutions, offers CDC recommended H1N1 testing. Also available Influenza screening by RT-PCR

H1N1 testing at Suburban Diagnostics
Test Code Sample Type Method Cut-off Turn Around Time (TAT)
PATH007179 Throat swabs and/ or nasal swabs Real Time RT PCR Sample by 9 am* Same Day, 6 pm
Influenza screening at Suburban Diagnostics
Test Code Sample Type Method Cut-off Turn Around Time (TAT)
PATH007148 Throat swabs and/ or nasal swabs Real Time RT PCR Sample by 9 am* Same Day, 6 pm

Urine Cultures in Female

Study at Suburban Diagnostics of more than 7500 urine isolates in female patients indicated

  • Ecoli
  • Klebsiella
  • Pseudomonas

as most common organism.

Why is treating a UTI a challenge?

Studies indicated different Drug Sensitivity patterns for the same organism

% of cases in women found sensitive to the antibiotics Sensitivity Pattern (in %)
Amoxi-Clav Cefixime Nitrofurantoin Fluoroquinolone
E.Coli 48 36 74 35
Klebsilla 44 44 19 61
Pseudomonas 0 0 0 64
Proteus 65 69 0 51

ESBL: Extended Spectrum b Lactamase

The difference in sensitivity pattern is due to variable ESBL production in gram –ve organism with the age group

  • Higher Age – Higher ESBL
  • Higher ESBL – Lower Sensitivity
  • Higher Age – Lower Sensitivity


Urine culture test is essential in each case of UTI

Agewise antibiotic sensitivity pattern in women

Choose the right Antibiotics by getting a Urine Culture tested at Suburban Diagnostics!


  • Irregular painful cycles
  • ACNE
  • A lot of weight gain which cannot come off easily

It is known that women with PCOS are significantly more likely to have type II diabetes, thyroid, and heart disease and it also appears to have a link to endometrial cancer.

1 in every 5 women in India is estimated to have PCOS. As it is a cluster of disorders, no single test can diagnose the condition. PCOS diagnosis requires a battery of laboratory and radiological tests, the results of which need to be clinically correlated.

Lab tests for PCOS
  • Testosterone
    • Androgen excess can be tested by measuring total & free testosterone levels
    • An elevated free testosterone level is a sensitive indicator of androgen excess
  • DHEA – S
    • Most normal or slightly high in PCOS
    • If > 800 mcg/dl, consider adrenal tumor
  • LH/FSH ratio
    • Levels vary over menstrual cycle, released in pulsatile fashion, affected by OCPs
    • LH/FSH ratio > 2 has little diagnostics sensitivity and need not be documented
  • TSH – To detect Hypothyroidism
  • Prolactin – To detect Hyperprolactinemia
  • Hypdroxyprogresterone (r/o if > 200 ng/dl) – Late onset congenital adrenal hyperplasia
  • Cortisol – Crushing’s Syndrome
Diagnosis of PCOS is incomplete without USG Examination
  • Ultrasound Criteria for Polycystic Ovaries
    • PCO morphology: presence of 12 follicles of 2 – 9mm diameters and/or ovarian volume > 10mL without a cyst or dominant follicle > 10mm
    • Polycystic ovaries not specific for PCOS, & > 20% of normal women have incidental polycystic ovaries
Risk stratification of PCOS Patients

The AE – PCOS SOCIETY recommends all women with PCOS to be assessed for CVD risk, to test for BMI, waist conference and blood pressure at each clinical visit. In women diagnosed with PCOS, a Lipid Profile as well as FBS, PPBS (if BMI > 30kg/m2, age > 40 yrs, personal history of GDM of family history of T2DM) is recommended.

Suburban Diagnostics offers a comprehensive evaluation of PCOS
PCOS – Profile 1 PCOS – Profile 2 PCOS – Profile 3
Irregular cycles with suspended hyperandrogenism Classic PCOS/Ovulatory PCOS (with USG) Classic PCOS/Ovulatory PCOS (with USG)
FBS, PPBS, HOMA, Free testosterone, FSH, LH, Prolactine, 17OHP FBS, PPBS, HOMA, Free testosterone, FSH, LH, Prolactine, 17OHP, Androstenedione, DHEAS, DHT, Lipid Profile, FT3, FT4, TSH, SHBG, Cortisol, AMH FBS, PPBS, HOMA, Free testosterone, FSH, LH, Prolactine, 17OHP, Androstenedione, DHEAS, DHT, Lipid Profile, FT3, FT4, TSH, SHBG, Cortisol, AMH, USG Pelvis

Symptoms Speak Volumes!

Ankylosing Spondylitis has vague clinical manifestations and is often misdiagnosed or diagnosed late!

HLA B27 Detection by PCR is useful:
  • For confirmatory diagnosis of a suspended case of Ankylosing spondylitis
  • For evaluating the risk of developing ankylosing spondylitis
  • In the diagnostics workup of Reiter’s Syndrome and Anterior Uveitis

Why PCR is a better method than flow Cytometry for HLA B 27 testing

Flow Cytometry – Indentifies HLA – B27 alleles based on cell morphology PCR – identifies the Gene encoding the HLA – B27 allele
It provides False – Positive results.
1) It cannot distinguish between HLA – B27 subtypes. Hence, gives a positive result even for HLA – B27:06 and HLA – B27:09 which are not associated with AS
Provides True-negative results & True positive results.
1) Can distinguish between HLA – B27 subtypes
2) Provides Negative results of HLA – B27:06 and HLA – B27:09 which are not associated with AS
Provides intermediate / borderline results in 2 -3% cases Intermediate / Borderline samples can be classified as positive or negative
Test name: HLA B27 PCR
Sample Type: EDTA whole blood
Schedule: Daily 6 am
TAT: Same day 6 pm

Test it before you treat it!

A comprehensive test range to diagnose common fevers
  • Dengue
    • IgM
    • IgG
    • NS 1
    • Real Time PCR
    • IgM
    • IgG
    • Real Time PCR
    • Malaria Smear
    • Malaria Antigen
    • Real Time PCR
    • IgG
    • IgM
    • Real Time PCR
    • IgM
    • Blood Culture
    • Real Time PCR

Syndromic Double Multiplex PCR for Common Fevers

Suburban Diagnostics has successfully adopted a Syndromic Approach for diagnosis of common fevers through its “Syndromic Double Multiplex PCR” test, that diagnoses 5 common fevers at one go.

5 fevers

Our wide range of fever profiles for you and your patients’ convenience.

  • Fever Profile 1 – CBC, ESR, MP, Widal, SGPT, Urine Routine (7- 10 days*)
  • Fever Profile 2 – CBC, ESR, MP, Widal, SGPT, Urine Routine, Blood Culture (1 – 6 days*)
  • Fever Profile 3 – CBC, ESR, MP Antigen, Urine Routine, Rapid Typhoid, SGPT, Urine Culture (4 – 7 days*)
  • Fever Profile 4 – CBC, ESR, MP Antigen, Dengue NS1 Antigen ( 1- 9 days*)
  • Fever Profile 5 – CBC, ESR, MP Antigen, Rapid Typhoid, Dengue NS1 Antigen, Dengue IgM ( 4 – 5 days*)

*Tests to be done if fever persists for the number of days indicated.

A clue to recommend tests on the basis of seroconversion
Test Timing of Tests (after onset of illness)
Dengue NS1 Antigen 1 – 9 Days
Dengue IgM 4 – 5 Days, can persist for 30 – 90 Days
Dengue IgG 6 – 15 Days
Leptospira IgM 3rd Day
Chikungunya IgM 3 – 5 Days
Blood Culture Day 1 – Day 7
Rapid Typhoid 4 – 5 days
Widal Day 7
CBC, ESR, Urine Culture Day 1
MP Antigen Day 1
MP smear Day 1
CRP (Quantitative) Day 1
HAV IgM 4 – 5 days
X-Ray (Chest) Day 1
Sonography (Whole Abdomen) Day 1
Paired Blood Culture
  • 2.5 times yield over single blood culture
  • Centralized Pathology Lab Services along with the state-of-the-art Cardiology and Radiology services to provide a unique hub for all protocol-specific requirements under one roof
  • Fully automated blood culture system BacT/ALERT for detecting & fungus
  • Performed on blood & sterile body fluids
  • Helps differentiate contaminants from true pathogens
    • Contaminants will grow in 1 of the 2 blood culture bottles
    • True pathogens will grow in both blood culture bottles
Vitek Susceptibility
  • Identification based on 64 biochemical values and hence, gives better precision & accuracy
  • MIC values are useful in:
    • Most accurate method for prediction of clinical outcome of Antibiotic therapy
    • Better management of critically ill patients
  • Antibiotics reported according to the class of drugs

Do’s and Don’ts of TB Diagnosis

  • TB tests cannot be done from blood
  • TB tests should be done from site specific samples like endometrium, pleural fluid, ascitic fluid etc.
  • For every case of suspected TB, tests to be performed are TB culture and GeneXpert
  • Sputum sample should not be salivary in nature
  • In case a patient is unable to produce sputum, nebulization with hypertonic saline is done. If this fails, a bronchoscopic sample is desired
  • Three consecutive sputum samples are needed for TB culture for better yield
  • Five consecutive urine samples are needed for TB culture for better yield
  • TB gold is not a diagnostic test in cases of suspected TB
  • Tissue samples for GeneXpert and TB culture should be received in saline and not in formalin

As per the WHO’s latest data, India has an average burden of 2.79 million TB cases.



  • Rapid test for detection of M. tuberculosis genome and Rifampicin resistance (detects rpoB gene mutation)

TB Culture

  • TB Culture using MGIT BACTEC (Liquid Based System) is the Gold Standard in diagnosis of tuberculosis

AFB Smear

  • 3 consecutive early morning sputum sample is advisable for AFB smear tests as there could be intermittent shedding of bacteria in sputum.

TB Drug Sensitivity

  • Susceptibility to 13 drugs
1st Line 2nd Line 3rd Line
Streptomycin Kanamycin Ciprofloxacin
Isoniazid Ethionamide Levofloxacin
Rifampicin PAS Amikacin
Ethambutol Moxifloxacin Capreomycin

MTB Detection Test/ TB PCR

  • Targets IS6110 gene which is present in multiple (4-15) copies in TB genome, hence, sensitivity increases in comparison to other gene targets

Cytology/ Biopsy

  • Gross examination procedure by dedicated histopathologist

Adenosine Deaminase (ADA)

  • Rapid test useful in accurate and early diagnosis in patients with extra pulmonary tuberculosis

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