minnesota newborn screening program

Homebirths - Specimen Collection

On this page:
Completing the Specimen Card
Specimen Collection
Billing for newborn screening

This section has been written based on 2008 specimen cards. Older specimen cards have several different fields. Please follow the instructions below for only those fields found on the newborn screening cards you are using.

Completing the Specimen Card Demographic Information

When you 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. Below are instructions as to how to fill out each component of the card.

Medical Record Number:
You can write home here or leave it blank.

Infant’s Name:
Record the newborn’s last name followed by first name. Providing the correct last name for an infant can save valuable time if the baby has an abnormal result. While parents may not have decided on the baby’s first name at the time of newborn screening, they have usually determined the baby’s last name. Be sure to write down the correct last name, bearing in mind that it may not be the same as the mother’s.

Infant’s Date of Birth:
Use a six-digit number (mm/dd/yy) for date of newborn’s birth. For example, a baby born on January 2, 2008 would be recorded as 01 02 08.

Time of Birth:
It is very important to correctly enter the infant’s time of birth because some of the newborn screening test cut-offs are based on how old the infant is at the time of specimen collection. Please use military time with 0000 for midnight, 0100 for 1: 00AM, 1200 for noon, etc.

Sex:
Write an M to designate newborn’s gender as male or F to designate newborn’s gender as female.

Birth Weight (in grams):
It is important to accurately enter the infant’s birth weight as some tests have cut-offs based on the infant’s weight at the time of specimen collection. Please always write the birth weight in grams. If your scale is only in pounds and ounces, please indicate that clearly on the form.

Multiple Births:
Completely shade in the box indicating whether the baby is a multiple. If yes, indicate birth order by filling in the squares labeled 1, 2, or 3.

Gestational Weeks:
Record newborn’s week of gestation at time of birth. It is important that this information is accurate, as gestational age does correlate with some analyte levels and can be used to better interpret some results.

Date of Collection:
Use a six-digit number (mm/dd/yy) representing the date on which the specimen was obtained.

Time of Collection:
Accurately record time of specimen collection. Time of collection is used to ensure that baby was at an appropriate age at the time of specimen collection. Please use the same time method as Time of Birth. Again, military time should be used.

Clinical Information:
Completely shade in box to indicate if there are special circumstances that the lab should be aware of when analyzing the specimen. Completely shade in “Jaundice” if the baby has significant jaundice requiring treatment.

Collected By:
This space is optional. Record initials of person collecting the specimen.

Date of First Feeding:
Use a six-digit number (mm/dd/yy) representing the date that the baby first nursed.

Time of First Feeding:
Use military time to indicate the time the baby’s first nursed.

Type of Feeding:
Completely fill in box to indicate the type of feeding an infant is receiving. If the infant required supplementary formula, indicate whether the formula is milk or soy-based.

Mother’s Name:
Record last name followed by first name. It is important that this information is accurate so that we can easily identify the infant in the event there is a positive newborn screen.

Mother’s Date of Birth:
Use a six-digit number (mm/dd/yy) for mother’s date of birth.

Mother’s Address:
Record mother’s current street address, followed by city, state, and zip code. Information about the mother is needed for follow-up of positive results and to aid in locating infants in need of retesting.

Mother’s Phone:
Record the phone number mom can be most easily reached the first few weeks after the specimen is collected. Record mother’s area code and telephone number.

Alternative Contact for Family:
Record a name and contact number for an alternative contact person for the family. This person can be a friend or relative. In the event that the baby is being adopted, it should be the name and number of the adoptive parents. If the family does not have a phone, it can be the number of a neighbor. The purpose of this information is to provide another way to find the infant with a positive result who needs further testing.

Submitter’s Name:
Record the name of the midwife.

Submitter’s Phone Number:
Write in midwife’s area code and phone number.

Submitter’s Number:
The Public Health Laboratory assigns a code number to each midwife, to enable accurate tracking of samples in our system. If you do not have a “submitter number” or have forgotten yours, please contact the Newborn Screening Program at 1-800-664-7772. Please write your submitter number in the box provided on every specimen card.

Physician Responsible for Infant Follow-Up:
If the parents will be working with a physician or other healthcare provider for well-child care, please indicate the name and clinic. If no name is provided, the midwife will be called with abnormal results and will be expected to help contact the family and arrange for needed testing.

Physician’s Phone Number:
Provide physician’s area code followed by telephone number. This information is used to contact the physician or other health care provider with positive test results and follow-up information.

Risk Factors:

NICU Patient: Simply check no
Birth Defect: Check this box if the baby was born with birth defects such as cleft lip/palate, Down syndrome, or heart defects.
Maternal Pregnancy Complications: Indicate whether pregnancy complications were present. Examples include AFLP, HELLP, preeclampsia, etc. which can be caused by metabolic disorders in the infant.
Deceased Sibling: Check this box if the baby has a sibling who died. Please indicate cause of death on line below.
Family History of disorder on MN screening panel: If the infant has a family history of any of the disorders, including hearing loss, on the newborn screening panel, check the "Yes" box. Write the name of the condition on the "Other" line.

Mandatory Hearing Screening

Homebirth attendant should complete any information on the hearing page that they are able to complete. Please write if you gave the family information on hearing screening. If they have chosen to go for the screening and you know where it will be done please write that in the blank area provided.

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Specimen Collection

As a practitioner, you need to determine if you have the skills and experience to safely collect newborn screening specimens. If you don’t feel that you were trained to collect the specimens or that you would do the heel-stick often enough to keep your skills sharp, you need to help families make alternate arrangements for newborn screening.

It may be that the families you care for plan to take their children to pediatricians or nurse practitioners for well-child care. If so, you need to encourage them to make an early enough visit to allow for collection of the screening specimen in a timely manner at the clinic.

As another option, you may be able to work cooperatively with area professionals including hospitals, clinics, local public health departments, and other homebirth providers to find a simple way for screening specimens to be collected.

If you do delegate the collection of the specimen to another person, the law still obligates you to make sure that either the baby is screened or that you document that the parents refused testing.

If you want to be able to offer newborn screening to families, but have not been trained in the technique, please supplement MDH written material with time spent with experienced providers who can show you how they collect specimens and observe you as you perform the procedure and can offer you feedback on your technique.

Expectant parents and birth attendants can 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 designed 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 family and 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 you.

Blood is easiest to collect from an infant who is: nursing well, adequately hydrated, and warm. Attention to warmth is especially important in Minnesota’s winter and in the house without central heating. Some midwives suggest seating the mother comfortably, putting the swaddled baby on her shoulder, and wrapping both of them in a warm quilt. In this warm cocoon, gravity will be your ally and blood will naturally flow to the baby’s heel. Some suggest that the baby nurse during the procedure. Other practitioners find that if the baby “reddens,” the specimen is easier to collect. Your experience and that of your colleagues will help you find the best approaches to specimen collection at home. Mothers are likely to want to comfort their babies by nursing them after the heel-stick.

Proper specimen collection techniques as outlined by the Clinical and Laboratory Standards Institute are below:

  1. 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, antiseptic solutions, glove powder, hand lotion, or other materials to come into contact with the specimen card before or after use.

  2. 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

    Diagram for proper heel-stick technique (PDF 320KB/2 pages)

  3. 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.

  4. Use a heel incision device to make an incision 1 mm deep and 2.5 mm long. The spring-loaded gadgets automatically make the appropriate sized prick and prevent you from accidentally making your puncture too deep.

  5. 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.

  6. 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.

  7. 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.

  8. 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. Avoid the temptation to dry them on the family’s wood stove or on the dashboard of your car. 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. Put the specimen in an envelope large enough to hold it without folding. Mail it to:
    Newborn Screening Program
    Minnesota Department of Health
    P.O. Box 64899
    St. Paul, MN 55164-0899

  9. Delivery can be made in person by providers or parents if you are in the metro area and want to shorten the time until results are available. Specimens can be brought to the Public Health Laboratory at the Minnesota Department of Health between 7:30 AM and 4:30 PM Monday through Friday except on legal holidays. The laboratory is located at 601 Robert Street North in St. Paul at the foot of the State Capitol. Deliveries are accepted at the loading dock, which is on the west side of the building next to the Armory. Please write on the envelope that the specimen is for the Newborn Screening Program.

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Billing for newborn screening

Practitioners and institutions can bill patients to recoup the costs of newborn screening and follow-up. Hospitals are likely to use CPT coding when submitting their charges. From the attached list you can see that the CPT codes allow for a billing rate that is above the cost of purchasing the screening card from MDH.

The cost of the screening card does not include hearing screening. Hospitals charge for this service separately or include it in their maternity charges.

CPT Codes for Newborn Screening (PDF: 16KB/1 page)

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Updated Monday, 30-Jul-2012 13:40:26 CDT