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 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 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. Below are instructions as to how to fill out each component of the card.
Specimen Card Instructions (PDF: 87KB/4 pages) Newborn Specimen Card Tips |
Medical Record Number:
Record the birth hospital’s identification or medical record number for the infant.
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.
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. Additionally, if the infant is <1800g, a separate newborn screening protocol is used. Please always write the birth weight in grams.
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. If the baby received antibiotics, filling the box marked "Antibiotics." Check the box labeled "Transfused" if the baby was transfused with red blood cells prior to specimen collection. If baby was transfused, give date Date of Transfusion: (mm/dd/yy)
Collected By:
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 was first fed.
Time of First Feeding:
Use military time to indicate the time of baby’s first feeding.
Type of Feeding:
Completely fill in box to indicate the type of feeding an infant is receiving. If the infant is on 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 at after discharged to home. 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. In the event that the baby will be in protective services, it should be the name of the baby’s case worker. 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 birth hospital or midwife.
Submitter’s Phone Number:
Record hospital and midwives' area code and phone number.
Submitter’s Number:
All hospitals and midwives have been assigned a hospital code number that should be recorded in the box provided.
Physician Responsible for Infant Follow-Up:
Correctly filling out this field is critical. MDH needs the name of the primary provider in order to make sure follow-up of abnormal results is done. If the specific doctor is not known at the time of birth, be sure to write down the name of the clinic where the parents plan to take the baby for his or her first well baby check-up. Do not write the name of the doctor who is rounding on the baby in the hospital.
Physician’s Phone Number:
Provide physician’s area code followed by telephone number. This information is used to contact the physician or health care provider with positive test results and follow-up information.
Risk Factors:
NICU Patient: Indicate whether the baby is in the NICU or Special Care Nursery.
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.
Deceased Sibling: Check this box if the baby has a sibling who is deceased. 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
Date Screen Performed:
Indicate the date (mm/dd/yy) that the last hearing screen was performed.
Right Ear/Left Ear:
Completely fill in the box to indicate whether the infant passed the hearing screen or received a refer result. Complete for both the right and left ear.
Screening Method:
Check the box to indicate the technology used: Automated Brainstem Response (ABR) or Otoacoustic Emissions (OAE). If the infant had more than one hearing screen, please indicate what technology was used for each screen.
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 Sunday, 29-Jul-2012 16:39:33 CDTQuick Links
50th Anniversary of Newborn Screening
Fact Sheets
Disorders screened in MN
Specimen Collection Information
Newborn Screening Card Expiration Date
If you have questions or comments about this page, please contact Newborn Screening at: health.newbornscreening
@state.mn.us
