Newborn Screening Information for Providers:
Blood Spot Screening in the Neonatal Intensive Care Unit (NICU)
Most infants in the NICU are hospitalized for reasons not associated with one of the disorders on the newborn screening panel. However, all infants in the NICU are more likely to have false positive results due to confounding factors such as immaturity, birth defects, drug side-effects, or non-standard feeding needs. Depending on their health status, infants in the NICU also require special attention when it comes to screening. For these reasons, it is critical that all medical staff members that play a role in newborn screening – including neonatologists, neonatal nurse practitioners, nurses, laboratory professionals, and support staff members – understand these nuances and are prepared to follow alternative screening protocols.
Newborns Weighing Under 2000 Grams
Standard screening protocols can miss affected infants born prematurely, Because of this, we request additional screens at 14 and 30 days on infants born weighing under 2000 grams. If the infant is ready for discharge before either of these subsequent screens, a specimen should be collected on the day of discharge. If the infant is scheduled to be discharged shortly after the 14-day specimen was collected, please use medical judgment to determine whether a subsequent specimen is warranted.
Reviewing the results of multiple screens helps us provide a more accurate risk assessment for the infant. This reflexive rescreening protocol is intended to reduce both false positive and false negative results.
Newborns Requiring Transfusion
If an infant requires any type of blood transfusion, collect the blood spots before blood products are administered, even if the infant is less than 24 hours of age. If the pre-transfusion specimen was collected prior to 24 hours of life, a subsequent specimen should be collected after 24 hours. In all instances where a specimen was collected prior to 24 hours of life from an infant weighing under 2000 grams, the subsequent specimen can be collected at 14 days of age instead of at the usual 24 to 48 hours of life.
The first specimen will allow for accurate interpretation for biotinidase deficiency, cystic fibrosis, galactosemia, hemoglobinopathy, and severe combined immune deficiency results. Because these screening results are not impacted by timing but are impacted by transfusions, collecting a blood specimen prior to transfusion is critical in determining whether an infant is at risk for these disorders. We will use the second specimen to screen for the remaining disorders, which are affected by the timing of collection, but not by transfusion. If screening is done following these guidelines, an infant would have a complete screen between the two specimens.
If an infant is transfused and a prior specimen was not collected, a specimen should be collected between the optimal time of 24 to 48 hours of life or as soon as possible, and a second specimen should be collected at 90 days after the last transfusion. The 90-day specimen allows our staff to accurately interpret those results which are impacted by transfusion.
Newborns Requiring Transfer
Within Minnesota, birth hospitals are legally responsible for arranging to have newborn screening administered to every infant in its care. This can be accomplished by screening the newborn in the birth facility or by having a protocol in place with a receiving hospital to screen the infant.
The birth hospital should screen an infant before transport in the following situations:
- The infant is over 24 hours of age at the time of transport.
- The infant will be transfused before transport.
- There is a strong likelihood that the infant will not survive the transport.
When receiving an infant from another hospital, the receiving hospital should:
- Collect a specimen at 24-48 hours of age if the newborn was admitted when (s)he was less than 24 hours of age.
- Collect a specimen prior to transfusion or other treatments that may impact screening, even if the newborn is less than 24 hours of age.