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Hospital & Midwives Training. Newborn Screening - Heelstick. Why Do Newborn Screening?. Required by Indiana law (Indiana Code 16-41-17) Early detection & early treatment of newborn screening disorders: Lessens severity of complications Improves quality of life
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Hospital & Midwives Training Newborn Screening - Heelstick
Why Do Newborn Screening? • Required by Indiana law (Indiana Code 16-41-17) • Early detection & early treatment of newborn screening disorders: • Lessens severity of complications • Improves quality of life • Lack of early detection & treatment can lead to: • Severe mental retardation • Inadequate growth & development • Death
Mission of ISDH Newborn Screening Program • Ensure that every newborn in Indiana receives state-mandated screening for all designated conditions • Includes screening for hearing loss • Includes pulse oximetry screening for critical congenital heart disease (CCHD) • Maintain centralized program to ensure that: • Infants who test positive for screened condition(s) receive appropriate diagnosis & treatment • Families receive genetic counseling • Promote genetic services, public awareness, & education concerning genetic conditions
Indiana’s Newborn Screen Three Required Screens • Heelstick • Early Hearing Detection & Intervention (EHDI) • Pulse oximetry screening for critical congenital heart disease (CCHD)
Birthing Facility Roles/Responsibilities(includes hospitals & midwiferies) • Collect heelstick specimen per Indiana collection guidelines • After 48 hours of age and after 24 hours of protein feed for non-NICU infants • Per NICU routine re-screening guidelines for NICU infants • For infants who are discharged prior to receiving a valid heelstick OR for any repeat screen: • Notify infant’s parents & PCP that infant will require repeat NBS • Notify IU NBS Lab & ISDH if parents cannot be contacted • For infants who are born at a facility other than a licensed hospital: • Midwife or physician in attendance should refer infant to appropriate facility for NBS • Educate parents about importance of NBS • Ensure that infants’ primary care provider (PCP) receives copy of NBS results • Maintain NBS log
Newborn Screening Log • All birthing facilities are required (per Indiana’s NBS law & its associated legal rules) to maintain a newborn screening log • Your facility’s NBS log should include, at a minimum, the following information for each infant: • Name • Attending physician • Medical record number (MRN) • Form number (requisition number) of heelstick card sent to IU NBS Lab • Date heelstick sample was collected • Date heelstick sample was sent to IU NBS Lab • Date each infant’s NBS results were received • Results of each infant’s NBS • Name of person who was notified of positive NBS results & date & time of notification
Heelstick Screening • Performed on a blood specimen taken from the heel of an infant shortly after birth • See next slide for more details on valid heelstick specimens • Used to screen for: • Cystic fibrosis • Endocrine conditions (congenital adrenal hyperplasia & congenital hypothyroidism) • Hemoglobinopathies (e.g., sickle cell anemia) • Metabolic conditions (e.g., PKU, fatty acid oxidation disorders, biotinidase deficiency)
Valid Heelstick Specimens • In order for a heelstick specimen to be valid, the specimen must be collected: • After the infant is at least 48 hours old • AND • After the infant has been on protein feeding for at least 24 hours • BUT • No later than 120 hours after birth • For infants who are discharged prior to receiving a valid heelstick screen: • Collect a heelstick specimen prior to discharge • A second, valid heelstick specimen will need to be collected • Notify family that a 2nd heelstick specimen is required! • NOTE: NICU infants have additional routine re-screening guidelines • See next slide for more information
Refusal of Newborn Screening • Per Indiana’s newborn screening law: • ONLY legal reason parents can refuse any/all portion(s) of newborn screening is if the parent(s) object(s) to the screen based on his/her/their religious beliefs • Objection must be made in writing • If parent(s) refuse NBS, birthing facility is responsible for: • Obtaining a complete, signed religious refusal • Sending a copy of religious refusal to ISDH Newborn Screening Program • ISDH’s Religious Refusal form is available on the NBS Professionals’ website at http://www.in.gov/isdh/20381.htm • NOTE: If your facility has its own NBS refusal form, the form MUST clearly state that parent(s) is/are refusing newborn screening due to his/her/their religious beliefs • ISDH cannot accept generic “Refusal of Newborn Care” or “Refusal of Medical Treatment” forms
Heelstick Procedure NOTE: The following procedures are modified from the heelstick procedures slides provided by the New York State Department of Health
Heelstick ProcedureStep 1 • Complete all information on blood spot card. • Do not contaminate filter paper circles by allowing the circles to come into contact with spillage or by touching before or after blood collection.
Heelstick ProcedureStep 2 • Equipment: • Sterile lancet with tip appropriately 2.0 mm - sterile alcohol prep • Sterile gauze pads • Soft cloth • Blood spot card • Gloves
Heelstick ProcedureStep 3 • Hatched areas (arrows) indicate safe areas for puncture site.
Heelstick ProcedureStep 4 • Warm site with soft cloth moistened with warm water (up to 41o C) for 3 to 5 minutes.
Heelstick ProcedureStep 5 • Cleanse site with alcohol prep. • Wipe dry with sterile gauze.
Heelstick ProcedureStep 6 • Puncture heel. • Wipe away first blood drop with sterile gauze pad. • Allow another LARGE blood drop to form.
Heelstick Procedure Step 7 • Lightly touch filter paper to LARGE blood drop. • Allow blood to soak through and completely fill circle with SINGLE application of LARGE blood drop. • To enhance blood flow, VERY GENTLY apply intermittent pressure to area surrounding the puncture site). • Apply blood to one side of filter paper only.
Heelstick ProcedureStep 8 • Fill remaining circles in the same manner as step 7, with successive blood drops. • If blood flow is diminished, repeat steps 5 through 7. • Provide care to the skin puncture site. Note: Use of capillary tubes to collect heel stick specimens is not recommended or included as part of Indiana’s NBS protocols.
Heelstick ProcedureStep 9 • Dry blood spots on a dry, clean, flat, non-absorbent surface for a minimum of four (4) hours.
Heelstick Procedure Step 10 • Mail completed blood spot card to IU Newborn Screening Lab within 24 hours of collection. • NOTE: Heelstick specimens must be received by the IU NBS Lab within 10 days of collection in order to be valid!
Tips for Collecting a Valid Heelstick Specimen • Be sure to fill ALL required circles! • Allow blood to soak through to other side of filter paper. • Checkboth sides of the heelstick card in order to ensure that blood has completely soaked through card. • Do not layer successive drops of blood. • Avoid touching/smearing blood spots. • Extra blood drops can be placed anywhere on heelstick card. • However, extra blood drops should not overlap sample circles.
Tips for Successfully Completing Heelstick Card • Write legibly! • Information on the heelstick card is manually entered into a database at the IU NBS Lab for specimen processing & reporting results. • Be sure to list the correct physician for infant. • Primary care provider name is preferred. • Use first AND last name of physician! • Use the “multiple birth” area of the heelstick card correctly. • Leave area blank if infant was a single birth. • Always designate A, B, etc. if infant was part of a multiple birth (even if children have different names/genders). • Do NOT tear off any portion of the heelstick card & staple to a 2nd heelstick card. • Do NOT place tape or labels over the fold-over flap that covers the blood samples.
Tips for Successfully Completing Heelstick Card (cont.) • Designate someone at your facility to check heelstick card requisitions before the specimens are sent to IU NBS Lab to ensure they are complete & accurate. • Keep the yellow (“hospital”) copy in your files until you receive the infant’s NBS results from IU NBS Lab. • Some facilities place a specimen label on this copy & reference with the heelstick card requisition number for your records. • If an infant’s NBS results have not been received from IU NBS Lab within one week, please call the IU NBS Lab at (800) 245-9137.
Follow-up Guidelines • NOTES: • Follow routine re-testing guidelines for NICU patients. • Abnormal results on any specimen (including NICU patients) should be followed as outlined in this chart.
Reporting to ISDH • Birthing facilities must submit Monthly Summary Reports (MSRs) to the ISDH NBS Program • MSRs include detailed information on any infants who did not receive a valid heelstick screen for one of the following reasons: • Infant transferred to another birthing facility before receiving valid initial heelstick • NICU • Infant died before he/she was eligible for a valid heelstick • Parent(s) of infant signed Religious Waiver • Infant was discharged home before he/she received a valid heelstick • MSRs are due to ISDH by 5 pm EST on 1st business day after the 14th of the following month • Most MSRs are due to ISDH by 5 pm EST on the 15th of the following month • If the 15th is on a Saturday/Sunday, MSRs are due to ISDH by 5 pm the following Monday • Example: January’s Heelstick MSR is due to ISDH by 5 pm EST on February 15th • MSRs are submitted to ISDH via the Indiana Newborn Screening Tracking & Education Program (INSTEP) • Web-based application (online) • Contact ISDH for more information
