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.
Due to their immaturity, newborns weighing less than or equal to 1800 grams are more likely to have conditions that are missed by standard screening protocols. To address this, the Newborn Screening Program requests that additional specimens be collected at 14 days and 30 days of age. 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, providers should use their medical judgment to determine whether a subsequent specimen is warranted.
Reviewing the results of multiple screens will provide a more accurate risk assessment for the infant. This reflexive rescreening protocol is intended to reduce both false positive and false negative results.
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 less than or equal to 1800 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 impacted by transfusions, collecting a blood specimen prior to transfusion is critical in determining whether an infant is at risk for these disorders. The second specimen will be used to screen for the remaining disorders, which are affected by the timing of collection.
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 the Newborn Screening Program to accurately interpret those results which are impacted by transfusion.
Within Minnesota, birth hospitals are legally responsible for collecting a newborn screening specimen for every infant born at the facility and for sending the specimen to the Newborn Screening Program.
If transferring an infant to another hospital/unit, the birth hospital should collect the newborn screening specimen before the infant leaves with the transport team – even if the infant is less than 24 hours old. The transferring hospital/unit should also notify the receiving hospital/unit of the newborn’s screening status. The receiving hospital/unit should verify that every admitted infant has been screened. If the receiving hospital/unit cannot verify that a newborn has been screened, collect a specimen as soon as possible after 24 hours of life. It is preferable for an infant to be screened twice than to not be screened at all. The Newborn Screening Program encourages providers to reference the Newborn Screening: Pre-Transfer Checklist page before transferring an infant to another hospital/unit. This from can be found on the Education Materials and Forms page.
Each state has different newborn screening policies. If an infant born in another state is admitted to a Minnesota NICU, the receiving hospital should verify the infant’s screening status with the birth hospital. If the receiving hospital cannot verify that the infant has been screened, collect a Minnesota newborn screening specimen as soon as possible after 24 hours of life. Infants born in Minnesota who are transferred to another state should be screened before the transfer occurs – even if the infant is less than 24 hours old.