Newborn Care: Newborn Screening

CLINICAL GUIDELINES

Newborn screening is mandated by each state. Screening tests are ordered by the infant’s primary healthcare provider.
A registered nurse (RN) or licensed practical nurse (LPN) may perform newborn screening.
All newborns complete newborn screening before discharge from the newborn nursery, preferably between 24 and 72 hours of age, and in no case later than 7 days of life. Some states require a second specimen is collected between 2 and 6 weeks of age. Check individual state requirements.
If the initial specimen for newborn screening is collected before 12 hours of age, a second specimen should be collected at 1 to 2 weeks of age.
Screening of premature or sick infants is completed as close as possible to the time of discharge from the nursery or at or near the seventh day of age, regardless of feeding status.
Complete screening before transfusion or dialysis, if the infant’s condition permits. If the infant requires a blood transfusion or dialysis before the specimen is collected, complete newborn screening 24 hours after completion of the blood transfusion/dialysis.
If the newborn is transferred to another facility for continuing care on or before the seventh day of age, the receiving hospital will obtain the specimen. A “Hospital Report of Newborn Specimen Not Obtained” form must be completed and sent immediately to the Department of Health Services, Genetic Disease Branch.
Newborn screening is repeated as soon as possible if the initial sample was inadequate.
Parents/legal guardians may refuse the test on the basis of religious beliefs or practices. A “Newborn Screening Test Refusal” form must be signed and copies sent as directed on the form. Notify the infant’s primary healthcare provider if parents decline newborn screening.
Newborn screening results are forwarded to the infant’s primary healthcare provider.
The parent/legal guardian is provided with results of newborn screening by the infant’s primary healthcare provider.
Abnormalities found through newborn screening are referred to the appropriate provider for follow-up and treatment by the infant’s primary healthcare provider.

CHILD AND FAMILY ASSESSMENT AND PREPARATION

Instruct parent/legal guardian about procedure and reason for screening.
Provide family printed information about the screening tests that will be completed.

Some states require informed consent from parents/legal guardians to perform newborn screening. Check with the state laws to verify regulations before performing this procedure. In almost all states, required testing can be overridden by invoking a religious exception.

To decrease procedural pain provide the infant a pacifier or sucrose-coated pacifier (see Chapter 7).

PROCEDURENewborn Screening

Steps	Rationale/Points of Emphasis
1 Identify infant and write infant and maternal biographic data on newborn screening blood collection form.	Ensures correct patient for procedure and correct results will be documented for the correct patient.
2 Write hospital data and infant’s primary healthcare provider information, including primary healthcare provider’s license number on newborn screening blood collection form.	Ensures that newborn screening results are forwarded to appropriate primary healthcare provider.
3 Perform hand hygiene and don gloves.	Reduces transmission of microorganisms.
4 Perform heel stick (see Chapter 17 , and Figure 17-1 for sites for capillary blood specimens).	Obtains blood sample for screening.
5 Wipe away first drop of blood from heel stick area with sterile gauze.	Ensures that sample will not be contaminated with alcohol used to clean heel stick site or serous drainage from heel stick.
6 Allow second large drop of blood to form at site of heel stick and gently apply filter paper to drop of blood, allowing blood to soak into paper, completely filling preprinted circle on newborn screening blood collection form (Figure 77-1). Drops must not overlap.	Collects adequate blood sample.
	caREminder
	Capillary tubes and blood gas tubes containing heparin or other anticoagulants may not be used to collect the blood sample for newborn screening analysis. The anticoagulants interfere with metabolic analysis and can give inaccurate results.

Figure 77-1 When collecting blood samples for newborn screening, completely cover the preprinted circles on the form with blood.
7 Repeat procedure, filling each circle completely with an individual drop of blood.	Collects adequate blood sample.
8 Dispose of heel lancet in needle receptacle. Remove gloves and dispose of gloves in appropriate receptacle. Perform hand hygiene.	Promotes needle safety. Reduces transmission of microorganisms.
9 Allow blood-soaked circles on the filter paper to air-dry thoroughly prior to submission of the sample.	Complete drying of blood samples preserves the sample to allow for proper processing.
10 Forward copies of newborn screening blood collection form to appropriate locations, per state protocol. One copy will go to the infant’s parents/legal guardians, one copy will go into the infant’s medical record, and the remaining copies will be retained with the blood sample.	Provides appropriate notification and documentation that sample has been obtained.
11 Place collected sample on completed newborn screening blood collection form in biohazard bag and forward to testing laboratory.	Prevents healthcare personnel exposure to blood and body fluids and routes sample to appropriate location for processing.