minnesota newborn screening programSpecimen Collection |
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Completing the Specimen Card
Specimen Collection
Alternative Collection Methods
This section has been written based on 2013 specimen cards. Older specimen cards have several different fields. Please follow the instructions below for only those fields found on the newborn screening cards used by your facility.
Completing the Specimen Card Demographic Information |
When health professionals accurately complete the demographic section of the newborn screening cards, MDH can locate a baby with an abnormal result as soon as possible. If affected babies are untreated, many of the disorders can lead to permanent mental or physical problems or even death. When a baby has an abnormal result, MDH calls the baby’s health care provider. Accurate information on the newborn screening cards is essential for quickly finding babies with abnormal results. The submitter is legally responsible for the accuracy and completeness of the information on the newborn screening card. Please take special care to fill out all fields.
Instructions for Properly Completing Newborn Screening Cards (PDF: 132KB/4 pages) Particular areas on the newborn screening card have repeatedly been a source of questions and/or concerns. The Newborn Screening Program has created a handout with tips for how to fill out these areas. |
Specimen Collection |
Hospitals and birth attendants purchase newborn screening cards from the Minnesota Department of Health.
Visit the Newborn Screening Specimen Card/Ordering page for information on obtaining cards.
The MDH Newborn Screening Program uses standards developed by the Clinical and Laboratory Standards Institute for blood collection on filter paper specifically for newborn screening programs.
The primary goal of this standard is to ensure the quality of blood spots collected from newborns. Poor quality specimens place an unnecessary burden on the hospital, potentially delay the detection and treatment of the affected infant, and may contribute to a missed or late diagnosed case. When the MDH Newborn Screening Program receives an unacceptable specimen, program staff request a repeat sample from the hospital.
Proper specimen collection techniques as outlined by the Clinical and Laboratory Standards Institute are below:
- Ensure that the expiration date of the specimen collection card has not passed. Complete the required patient information included on the card. Avoid touching the area within the circles on the filter paper section before, during, and after collection of the specimen, since oils and other materials from the hands might affect or contaminate the card or specimen. Do not allow water, feeding formulas, antiseptic solutions, glove powder, hand lotion, or other materials to come into contact with the specimen card before or after use.
- Blood collection from the heel is the standard for newborn screening. The medial and lateral parts of the underfoot are preferred. Blood should never be collected from:
- the arch of the foot
- the fingers
- earlobes
- a swollen or previously punctured site
- IV lines containing other substances (TPN, blood, drugs, etc.).
- Warm the heel with a damp cloth or commercially available heel warmer and position the leg lower than the heart to increase venous pressure before collecting the sample. Powder-free gloves are best worn while collecting. Lotion, Vaseline, and other substances, which can interfere with analysis, should be kept off the infant’s skin. Wipe the skin clean with an alcohol wipe and allow to thoroughly air dry.
- Use a sterile lancet or a heel incision devise to make an incision 1 mm deep and 2.5 mm long. When collecting from small, premature infants, it is safer to make a more shallow incision.
- Wipe away the first drop of blood with a sterile gauze. Allow a large drop of blood to form. Using the thumb to intermittently apply gentle pressure to the heel may be helpful in encouraging the drop to coalesce.
- Touch the first circle on the newborn screening card gently against the large blood drop, and in one step, allow the blood to soak through the filter paper and fill the circle in one step. Don’t press the paper against the baby’s heel. Each of the five circles needs to be filled and saturated through. Apply the blood from only one side of the filter paper.
- Do not apply multiple layers of blood drops to the same circle. The circles are measured and should contain a set volume of blood (think of them as small, flat test tubes). Layering can interfere with the accuracy of the test by providing a non-standard amount of blood or non-uniform analyte concentration. Excessive milking or squeezing of the puncture site can result in an unsatisfactory specimen because of hemolysis breaking down the blood cells to be analyzed or mixing tissue fluids in the specimen which can dilute it.
- Allow the specimens to dry flat at room temperature for at least 3 hours. This is essential to maintaining the integrity of the blood spots. Keep them out of direct sunlight and away from other heat sources. Do not allow them to touch other surfaces or specimens. Avoid stacking the cards. Do NOT close the biohazard flap over the spots until they are completely dry.
- Send dried samples to the Minnesota Newborn Screening Program within 24 hours after specimen collection. Samples can be sent either by hospital courier or through UPS with MDH incurring the cost of shipping.
Diagram for proper heel-stick technique (PDF 320KB/2 pages)
Diagram of Unsatisfactory Specimens (PDF: 130KB/1 page)
Alternative Collection Methods |
Umbilical Catheter Collection
Although direct collection from a heel-stick is preferred for optimal laboratory results, it is acknowledged that alternate collection methods may be used at times. For example, in sick newborns, blood has been collected from umbilical catheters. In order to avoid contamination from substances previously infused through the line, draw off 2-2.5 cc’s before collecting the newborn screening specimen. Collect the blood in a syringe and apply it to the circles immediately to avoid blood clots that would make the specimen unsatisfactory. Each circle holds 0.1 cc of blood.
Continue with steps 7-9 above.
Capillary Tube Collection
Blood collection using capillary tubes is discouraged because it increases the risk of a layered specimen or a torn or chafed card. If capillary tube collection becomes necessary due to clinical circumstances, use a fresh heparinized tube (EDTA is a coagulant and may interfere with analysis) for each circle to be filled. Touch the tip of the capillary tube to the blood drop from the heel and allow the blood to flow into the tube. The tube may fill better by holding it in a near horizontal position as it touches the drop of blood. Immediately after filling the capillary tube, apply the contents to the center of the first circle on the newborn screening card, allowing the blood to flow out and fill the circle. Waiting too long may allow the blood and plasma to separate and interfere with test analysis. Do not touch the tube to the filter paper. Do not dab the blood on or “color in” the circle. These actions can result in an unsatisfactory specimen because of scratching or compressing the paper or layering of over-filling the circle. Use blood from only one tube per circle.
Continue with steps 7-9 above.
Venous Blood Collection
If circumstances warrant specimen collection from the dorsal hand vein, avoid drawing from an extremity where an IV is in place. Using appropriate pediatric blood drawing techniques, obtain the sample through a butterfly (winged) whole blood collection set. Remove or shorten catheter length so the blood can flow freely onto all the filter paper circles. Syringe collection of the blood is discouraged because the lack of anticoagulant and time delays can cause clot formation and separation of the specimen.
Continue with steps 7-9 above.
Updated Monday, 17-Jun-2013 09:33:21 CDT