CHHS15/145

Canberra Hospital and Health ServicesClinical ProcedureNewborn Screening TestContents

Contents....................................................................................................................................1

Purpose.....................................................................................................................................2

Alerts.........................................................................................................................................2

Scope........................................................................................................................................ 2

Section 1 – Newborn Screening Test.........................................................................................2

Implementation........................................................................................................................ 4

References................................................................................................................................ 5

Search Terms............................................................................................................................ 5

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Purpose

Newborn screening tests are performed to diagnose genetic metabolic disorders in all newborns. The newborn screening blood sample is to be collected when the infant is 48-72 hours of age.

Scope

Alerts

A neonatal screen must be taken prior to transfusion of any blood products and a repeat test is to be taken 48 hours following the last transfusion. A third sample is to be taken 3 weeks post transfusion.

Scope

This document pertains to the following: Medical Officers Nurses and Midwives who are working within their scope of practice (Refer to Scope of

Practice for Nurses and Midwives Policy) Student Nurses under direct supervision.

Section 1 – Newborn Screening Test

Equipment Alcohol Based Hand Rub (ABHR) Equipment for collecting blood as per the umbilical artery catheter or heel lance

standards, depending on the infants clinical status Newborn Screening Card Pathology form

Procedure Method1. Newborn Screens are to be taken at the following times:

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Sample Patient group Timeframe1st sample All infants (including palliative or

deceased infants)48-72 hours

2nd sample Infants who have received blood transfusions/exchange transfusions/platelets/FFP, albumin, from birth to 72 hours of life

Obtain sample pre-transfusion (even <48 hours of age), then > 48 hours post transfusion-NB: need to obtain 3rd sample

2nd sample Infants on Total parenteral Nutrition (TPN)

48 hours post cessation of TPN

2nd sample Premature infants birth weight <1500gms

3 weeks

3rd sample Infants who have had transfusions of blood within the 1st 48-72 hours of life

3 weeks post transfusion

2. A twin or triplet of a neonate who weighs <1500gms requires a second screen at 3 weeks of age

3. Explain to parents why the neonate requires the test and provide written information pamphlet “tests to protect your baby”

4. Obtain verbal consent and document in medical records 5. Attend hand hygiene before touching patient by either washing hands or using ABHR6. Pain relief: recommend the woman breastfeeds her baby prior to or preferably during

procedure to minimise pain. If baby is not breastfeeding or is tube fed, give baby own mothers’s breast milk (up to 0.25mls) prior to procedure or if not available, or not breastfeeding give oral Sucrose (20%) solution( 0.25mls) 2 minutes prior to procedure

7. Collect equipment8. Check neonate’s identification tags9. Complete identification details on Newborn Screen Card IN PEN. ENSURE ALL FIELDS ARE

COMPLETED ON CARD10. Place pathology identification label on back of card well clear of the blood spots and sign

by nurse/midwife completing test11. Pathology request form which can be signed by nursing/midwifery staff12. Check neonate’s identification tags13. Complete identification details on Newborn Screen Card IN PEN. ENSURE ALL FIELDS ARE

COMPLETED ON CARD14. Place pathology identification label on back of card well clear of the blood spots and sign

by nurse/midwife completing test15. Pathology request form which can be signed by nursing/midwifery staff

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AlertWhen completing card for multiple births write Twin/Triplet 1, Twin/Triplet 2 or Triplet 3 and their name even if a death of one or more sibling has occurred

16. Obtain blood from arterial line or heel lance17. Fill the three circles from one side only AlertDo not layer blood or contaminate the card with an substance e.g. alcohol, heparin, water or milk

18. Comfort and settle the infant19. Dispose of used equipment according to OH&S guidelines20. Place completed NNS card in drying rack and allow to dry for 4 hours then send to first

floor pathology in an envelope not plastic21. Must not go via pathology shute as it will only go to the second floor

AlertDocument in: Progress notes with stamp (NICU/SCN) Baby feed chart (Maternity) Discharge planning and transfer information sheet(NICU/SCN) Sign and date in ward register(NICU/SCN) Personal Health Record BOS (Maternity)

22. If repeat newborn screening is required then the date of repeat is to be written on the “Discharge planning and transfer information sheet” (NICU/SCN only)

23. When the repeat is taken then the documentation is the same as above (NICU/SCN only)

Neonatal AlertWhere parents do not give consent for test write REFUSED and INFANTS DETAILSOn the newborn screening card send to pathology. The parents are requested to complete refusal questionnaire (found at CMC’s desk) as per SOP Newborn Screen Refusal, document in medical record sign and send a copy to pathology

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Implementation

This procedure will be outlined during orientation of new staff.

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References

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1. Matthews, A and Robin, N. (2006) “Genetic disorders, malformations, and inborn errors of metabolism.” In Merenstein G and Gardner, S Ed Handbook of Neonatal Intensive Care 6th Ed. Mosby Inc St Louis.

2. Newborn Screening Guideline, NSW Policy Directive 24 march 20053. Spiel JK. (1997) Capillary blood collection for neonatal screening tests should require a

certificate of competence. Journal - Australian College of Midwives. 10(2) 8-13.

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Search Terms

TestNewborn ScreenGuthrie testSpecial Care NurseryGeneticCystic fibrosisGalactoscaemiaPhenylketonNeonatal Intensive Care

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Disclaimer: This document has been developed by ACT Health, <Name of Division/ Branch/Unit> specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

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Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register