minnesota newborn screening program
Homebirths - Specimen Collection
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 you are using.
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.
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.
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:
- 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.
- 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
- a swollen or previously punctured site
Diagram for proper heel-stick technique (PDF 320KB/2 pages)
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