Texas Texas Department of State Department of State

Health ServicesHealth Services

Newborn Screening Newborn Screening BranchBranch

Newborn Screening Program

Specimen Collection

Presentation

January 2007

Texas Newborn Texas Newborn ScreeningScreening

Table of Contents:

• The Specimen Collection Form

• Blood Sample Collection

• The Voice Response System

The The NNewborn ewborn SScreeningcreening

SSpecimen pecimen CCollection ollection FFormorm

What is a screening test kit?

The newborn screening test kit includes a specimen collection device, a form for demographic

information and a special envelope.

How do I order lab supplies?

CALL: 512 – 458 - 7661

N B S C o l l e c t i o n F o r mP a r e n t C o p y

A l l o w s f o r ‘ l in k in g ’ o f m u l t i p l e s p e c im e n sN e w f o r m a v a i la b l e in D e c e m b e r

N B S C o l l e c t i o n F o r mD e m o g r a p h i c s F o r m

T im e o f B ir thT im e o f C o lle c tio n

P C P in fo rm a tio n 1 s t S c re e n S e r ia l N o .

NBS Collection FormFilter Paper for Blood Collection

NBS Collection FormCollection Instructions

Is the form we have current?

The expiration date on all newborn screening kits is shown on the cover, demographic sheets and the

filter paper.

Expiration Date

Expiration Date

Can I use the mother’s Medicaid number for the newborn?

Yes. The mother’s Medicaid number may be used on the form to indicate that the newborn is Medicaid-eligible. DSHS recognizes that it may take months to issue a Medicaid number

for the newborn.

Medicaid Eligible

(1=Yes, 2=No)Medicaid No.

How does DSHS define charity care?

The charity care newborn is a patient who is not insured and is not covered or eligible to be

covered for newborn screening services by Medicaid or any other government program.

Specimen Collection Check List

Wear gloves when handling form.

Use black ink and print in block capital letters.

Use the same “baby’s last name” on the first and second filter collection form.

Specimen Collection Kit Cover Sheet

Provider/Submitter Instructions:

Complete Infant’s Last Name, First

Name and Date of Birth

Specimen Collection Kit Cover Sheet (con’t.)

Provider/Submitter Instructions:

For 1st screen:

Remove the PARENT COPY and give to the parent. Inform the parent that they MUST take this form to their infant’s doctor at the baby’s 1-2 week check-up.

Specimen Collection Kit Cover Sheet (con’t.)

Provider/Submitter Instructions:

For 2nd screen:

Write the serial number from the 1st screen PARENT COPY (brought to you by the parent) in the box labeled “Serial Number” in the Newborn Information area of the demographic form for the specimen being submitted.

Retain the PARENT COPY from the 2nd screen in the patient chart. If an additional screen is requested, use this serial number on the additional screen form.

Baby’s Last Name

When filling out the filter collection form for the second screen, ask mom what name was used on the form for the first screen in the “Baby’s last name” box and use the same name.

The NBS case management staff uses the baby’s last name, mother’s last name, and date of birth to link the

second screen to the first.

This information is vital for identification and location of infants for follow-up of abnormal tests results.

Gloves

To prevent specimen contamination, do not touch any part of the filter paper circles before, during or after collection. Disposable gloves can contaminate the specimen and powdered residue from the gloves can contaminate the hands.

Why do I have to fill out all the information when I know the

baby?

It may be necessary to reach the family in a hurry when you are not available. Also, the State Laboratory receives so may specimens that often there are several babies with the

same last name and the same birth date.

Why is it necessary to retest some babies several times?

Premature babies may have immature enzyme systems or thyroid functioning. It may be necessary to monitor their progress to be

certain they reach normal levels.

AND

A normal screen in an infant who has insufficient enteral intake does not rule out metabolic disease.

Total parenteral nutrition may cause a false positive result.

Check List Fill in both first and last name in the

“Physician’s Name” box.

Use grams in the “Birthweight” box.(This information is crucial for newborn

screening disorders because many interpretations of results are based on the birth weight of the infant).

Fill in the physician’s telephone number in the box directly below the medical record number box.

A free weight conversion chart is available from the Newborn

Screening Program.

1-800-252-8023

extension 2129

Birth Weight

Check List

Fill in the boxes for: Status Test Date of birth Date of specimen (specimen will be rejected

without a date of collection) Infant’s age at specimen collection Mother’s social security number

Repeat Screen

The NBS follow-up staff may contact submitters by fax, phone, and/or letter

to request a repeat screen.

Check List

Make sure all boxes are:

legible, accurate, and complete.

What if the screening test kit is no good?

Each screening test kit qualifies as a medical device. If a kit does not perform as it should, please notify

the Quality Assurance Officer at 512-458-7318. DSHS will replace defective kits free of charge.

Will DSHS pay postage?

DSHS has never paid postage for the newborn screening test kits and does not contemplate doing

so in the future.

NBS Specimen Rejection Possible

due to

NEW POSTAL REGULATIONS

Effective May 14, 2007 the USPS raised postage rates, and initiated new postage

pricing rules based on mail size and shape.  The changes will require you to carefully

evaluate your newborn screening specimen shipping practices to ensure that correct

postage is used.  Envelopes with insufficient postage may be returned, leading to critical

newborn screening delays or rejection of specimens.

General Information

• 1 specimen card in an envelope (Letter) used to cost $0.39 but will now cost $0.41 to ship. • The price increases as you add cards.

• 6 cards or more will require the more expensive flat rate pricing.

• Envelopes with metal clasps will be charged an additional $0.17 surcharge if the clasps are used to close the envelope. Leave the clasp flat and close with tape only.

The following are examples only. Please verify exact postage from

your facility.

• 1 specimen card in an envelope (Letter) will now cost $0.41 to ship.

• 2 specimen cards in an envelope (Letter) will cost $0.58 to ship.

• 10 specimen cards in an envelope (now considered Flats) used to cost $1.35 but will now cost $1.48 to ship.

Obtain a copy of the new pricing schedule for your

Mail Zone at

http://pe.usps.gov/

Collecting a Blood Sample

Equipment

•Sterile lancet with tip (2.0 – 2.40 mm)

•sterile alcohol prep

•sterile gauze pads

•soft cloth

•blood collection form

•gloves

Increase Blood Flow

Wrap a warmed, moist towel around the heel puncture site for 3 to 5 minutes.

Positioning the infant with feet lowered below the heart will help to increase

blood flow.

Clean & Dry

Cleanse site with sterile alcohol pad.

Allow site to air dry.

(Alcohol residue left on the skin may dilute the specimen

and affect test results)

Puncture Site

Hatched area indicates safe areas for puncture

site.

Puncture

Position a sterile

disposable lancet (2.0 –

2.4 mm tip) or an

automatic lancet at a

slight angle to perform a

swift clean puncture.

Wipe away the first drop

of blood with dry sterile

gauze.

Fill Circle

Allow a second large drop of blood to form.

Lightly touch blood drop to filter paper.

Allow blood to soak through and completely

fill circle.

Fill Remaining Circles

Fill remaining circles with successive blood

drops.

If blood flow slows, repeat procedure

selecting a different site and using sterile

equipment.

Why are so many specimens marked unsatisfactory when I can see plenty of

blood in the circles?

There must be an even penetration of blood for the test to be accurate. This means soaking through the

filter paper with one application and filling the whole circle so the blood is evenly distributed on

both sides of the filter paper.

Apply blood to one side of the filter paper only, allowing full saturation of each circle before proceeding to the next circle.

To enhance blood flow during collection, very gentle intermittent pressure may be applied to the area surrounding the puncture site.

Excessive “milking” causes an admixture of tissue fluids with the blood specimen, invalidating the specimen.

Do not layer successive small drops of blood on top of each other. Let each drop touch the paper about 1/8 inch away from the previous one. This prevents layering of the paper, which is one cause of unsatisfactory results.

Drying Specimen

Allow the blood specimens to air-dry for at least 4 hours on a flat, nonabsorbent surface protected from heat or direct sunlight.

Do not refrigerate the

samples or put in plastic sleeves. (Plastic sleeves

allow accumulation of

condensation and can contribute to

contamination, elution, and

bleeding of the blood spots).

Place dried specimen collection form in special envelope and mail within 24

hours.

The Voice Response System

Voice Response System(VRS)

The VRS provides 24-hour access to newborn screening laboratory

information on all patients screened at the DSHS Laboratory.

Requirements:

(1) Licensed Texas newborn screening submitter number

(2) Personal identification number (PIN)

(3) Newborn screening form serial number or social security number of infant’s mother

(4) Touch tone phone

Instructions for use of the VRS are presented in logical order during the call. Interaction with the system is by means of the telephone key pad. Keys are identified as follows:

Numbers……………………….1-9 and 0Pound………………………….#Star…………………………….*

Information about the infant is presented as:

Form serial number (from specimen form)Last name (spelled)Sex (male, female, unknown)Date of birthTest resultsInterpretation

How do I get a PIN number?

Call: 512-458–7111extension 6988

or1-888-963-7111extension 6988

orEmail: labappsupport@dshs.state.tx.us

May I receive a hard copy of the screen?

Yes. An add-on feature to the VRS allows results to be sent via FAX to a physician

requiring a hard copy of the voice session.

A message may be repeated at any time by pressing the pound (#) key.

After hearing results for an infant, you will be given the opportunity to speak with a member of the newborn screening staff. Then, or at any time thereafter during normal business hours (8:00-5:00), you may press the star (*) key to have your call transferred to a staff member.

If you are calling after hours, or if all the lines are busy,you will be invited to leave a message with a member of the newborn screening staff.

VRS Message

Where do I find our submitter number?

Call: 512 – 458 – 7111extension 2421

Texas Newborn Screening Program

Voice Response System

(512) 458-7300(512) 458-7300

oror

1-888-963-71111-888-963-7111

extension 7300extension 7300

24 - HOUR ACCESS

The Newborn Screening Program

Case Management Staff can be reached at

Telephone:Telephone: 1- 800 – 252 - 80231- 800 – 252 - 8023

Fax:Fax: 512 - 458 -7450512 - 458 -7450

For information regarding newborn screening results between the hours of 8:00 - 5:00, Monday - Friday you

may call the DSHS Lab at

512 - 458 - 7578512 - 458 - 7578

FYI

Cases confirmed by testing done at laboratories other than the Texas Department of State Health

Services Laboratory must be reported to the Newborn Screening Case Management Program at

1-800-252-8023

Newborn Screening Literature

Educational materials for providers and parents are available free of charge from the Newborn Screening Program.

1-800-252-8023

extension 2129

or

Email: newborn@dshs.state.tx.us

Newborn Screening Website

www.dshs.state.tx.us/newborn