What is the appropriate handling of the filter card after completing a neonatal screening collection

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This page has been automatically translated from English. MSDH has not reviewed this translation and is not responsible for any inaccuracies.

Correct and timely newborn screening results depend on collecting samples accurately. Hospitals can ensure high performance by following these guidelines.

• Collect blood for newborn screening at 24-48 hours of age.
• Complete the required patient information on the collection card (filter paper) using ball point pen.
• Ensure that the expiration date of the collection card (filter paper) has not passed.
• Collect blood from the most medial or lateral portion of the plantar surface of the heel; allow blood to soak through to completely fill each of the preprinted circles; do not apply layers of successive blood drops to the same printed circle; inspect both sides of the collection card (filter paper) to be sure blood is soaked through to the back of the card.
• Allow blood specimen to air dry for a minimum of four hours on a horizontally level, nonabsorbent, open surface at an ambient temperature of 18 degrees C to 25 degrees C.
• For transport, the dried blood spots on the collection card should be rotated 180 degrees from the blood spots on the card in the stack immediately above and below.
• The collection card/dried blood specimen should be transported to the laboratory within 24 hours after specimen collection, and the appropriate tracking documentation maintained by the submitter with periodic review of timely delivery assurance.

CCHD Screening Data Tip

When screening for critical congenital heart disease, write the date/time the initial pulse ox screening was performed in the spaces provided on the dried blood spot card.

If pulse ox screen result indicates a "Failed" screen, DO NOT delay sending the dried blood spot specimen to the screening lab to provide CCHD screening data. Indicate whether an echocardiogram was performed. Complete the CCHD status tab in the Genetics Reporting Portal which can be found at https://resultsportal.perkinelmergenetics.com/MS_Genetics_Reporting.aspx.

If pulse ox was not performed, indicate the reason why (i.e. refused, expired, transferred, on O2. Etc.). Indicate whether an echocardiogram was performed. DO NOT delay sending the dried blood spot specimen to the screening lab to provide CCHD screening data. Complete the Update the DBS card tab in the Genetics Reporting Portal which can be found at https://resultsportal.perkinelmergenetics.com/MS_Genetics_Reporting.aspx.

Causes of Invalid Specimens

Possible causes for invalid or unsatisfactory specimens include, but are not limited to:

• Specimen quantity insufficient for testing.
• Specimen appears scratched or abraded.
• Specimen not dry before mailing.
• Specimen appears to be supersaturated.
• Specimen appears diluted, discolored or contaminated.
• Specimen exhibits serum rings.
• Specimen appears clotted or layered.
• No blood.

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On this page:
Personnel
Timing
Blood Spot Collection
Newborns Requiring Transfer
How to Collect Blood Spot Specimens from Newborns Video
Putting Babies First Video

Personnel

Blood spot collection can be performed by trained personnel such as hospital nursery staff, laboratory staff, or out-of-hospital birth providers.

Timing

Timing of blood spot collection is important for accurately interpreting test results. Tests for some of the disorders on the newborn screening panel have different cutoff values based on the infant’s age (in hours) at the time of blood spot collection. As a result, blood spots drawn too early or too late may increase the chance of false positive or false negative results.

Blood spots are best collected between 24 and 48 hours of age. Blood spots collected before 24 hours of age cannot be fully interpreted, which means some test results will be marked “unsatisfactory” on the newborn screening report. An unsatisfactory result will require another blood spot collection. Blood spots collected after 48 hours may not allow enough time for results to be interpreted before serious symptoms occur in newborns affected by certain disorders on the newborn screening panel. However, special circumstances may arise that require blood spot collection at earlier or later times.

Infant should be at least 24 hours old in elapsed time, not just in "clock" time. This distinction is important on the days surrounding the switch to Daylights Saving Time.

Accurate collection and recording of time is especially important with blood draws done right at 24 hours in order to avoid collecting blood before 24 hours of age. If you are collecting before 24 hours of age, please reference our Newborn Screening <24 Hour Discharge Guideline. It provides guidance about how to complete newborn screening for infants discharged to home before 24 hours of age.

Blood Spot Collection

The Minnesota Newborn Screening Program uses blood collection standards developed specifically for newborn screening programs by the Clinical and Laboratory Standards Institute.

The primary goal of these standards is to ensure the quality of blood spots collected from newborns. Poor quality specimens interfere with the screening process, potentially delaying the detection and treatment of an affected infant. If our staff receive a specimen of poor quality, we will request a repeat specimen from the birth provider.

Proper specimen collection technique as outlined by the Clinical and Laboratory Standards Institute include the following steps:

1. Ensure that the expiration date of the newborn screening card has not passed. Complete the required patient information fields requested on the demographic data portion of 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, feeding formulas, antiseptic solutions, glove powder, hand lotion, or other materials to come into contact with the specimen card before or after use.


2. 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
   • the earlobes
   • a swollen or previously punctured site
   • IV lines containing other substances (TPN, blood, drugs, etc.)
   
   Neonatal Screening Blood Specimen Collection and Handling Procedure (PDF) (includes diagram for proper heel-stick technique)
3. Warm the heel with a warm damp cloth or commercially available heel warmer and position the leg lower than the heart to increase venous pressure before collecting the blood spots. The infant should be swaddled in a blanket with only one foot exposed. Powder-free gloves are best worn while collecting the blood spots. Lotion, Vaseline, and other substances, which can interfere with blood spot analysis, should be kept off the infant’s skin. Wipe the skin clean with an alcohol wipe and allow to thoroughly air dry.


4. Use a sterile lancet or heel incision device to make an incision 1 mm deep and 2.5 mm long. When collecting from small, premature infants, it is safer to make a more shallow incision.


5. Wipe away the first drop of blood with a sterile gauze pad. Allow a large drop of lood to form. Using the thumb to intermittently apply gentle pressure to the heel may be helpful in encouraging the drop to coalesce.


6. Touch the first circle on the newborn screening card gently against the large blood drop, and in one step, allow the blood to soak through the filter paper and fill the circle. Do not press the paper directly against the baby’s heel. Each of the five circles need to be filled and saturated through. Apply the blood to only one side of the filter paper. It does not matter whether the blood is applied to the front or back of the filter paper.


7. Do not apply multiple layers of blood drops to the same circle. The circles are measured and should contain a set volume of blood. Layering can interfere with the accuracy of the test by providing a non-standard amount of blood or non-uniform analyte concentration. Excessive milking or squeezing of the puncture site can result in an unsatisfactory specimen because of hemolysis breaking down the blood cells to be analyzed or mixing tissue fluids in the specimen, which can dilute the blood.

   Simple Spot Check (PDF) (includes diagram of unsatisfactory specimens)

   Specimen Collection: Quantity Not Sufficient (PDF)



8. Allow the specimens to dry flat at room temperature for at least 3 hours. This is essential to maintaining the integrity of the blood spots. Keep them out of direct sunlight and away from other heat sources. Do not allow them to touch other surfaces or specimens. Avoid stacking the cards. Do NOT close the biohazard flap over the spots until they are completely dry.


9. Once the blood spots have dried completely, the biohazard flap can be closed and the newborn screening card can be sent to the Newborn Screening Program. Institutions that regularly submit specimens should have a procedure in place for pick-up by courier or other shipper established through the Newborn Screening Program. Our laboratory accepts specimens Monday through Saturday at the address below. We accept deliveries during weather emergencies, outbreaks, or government shutdowns; therefore blood spots should continue to be collected and delivered during these times. For questions about holiday deliveries or if special delivery plans are needed, please contact our program staff at: .

Delivery Address: Newborn Screening Program 601 Robert St. N

St. Paul, MN 55155

For clinics, out-of-hospital birth providers, and parents who submit specimens infrequently, specimens can be brought to the delivery address above or mailed to the address below. Since high heat and humidity can affect some of the tests, leaving specimens in hot mailboxes or other warm locations should be avoided.

Mailing Address: Newborn Screening Program P.O. Box 64899

St. Paul, MN 55164

Multiple newborn screening specimens may be sent together; however, a shipment should never be delayed or “batched” to wait for additional specimens. Additionally, newborn screening specimens should never be placed in the same container as other specimen types traveling to the Public Health Laboratory.

Newborns Requiring Transfer

Within Minnesota, birth hospitals are legally responsible for arranging to have newborn screening administered to every infant in its care. This can be accomplished by screening the newborn in the birth facility or by having a protocol in place with a receiving hospital to screen the infant.

The birth hospital should screen an infant before transport in the following situations:

• The infant is over 24 hours of age at the time of transport.
• The infant will be transfused before transport.
• There is a strong likelihood that the infant will not survive the transport.
• The infant will be transferred to an out-of-state hospital.

How to Collect Blood Spot Specimens from Newborns Video

The following video was produced by PerkinElmer Genetics with input from the Minnesota Newborn Screening Program. This less than 5 minute video covers how to properly collect blood spot specimens for newborn screening.

How to Collect Blood Spot Specimens from Newborns Video Text

Putting Babies First Video

The following video answers many frequently asked questions about blood spot collection, including the optimal timing of collection, drying of blood spots, and methods of collection. The video was produced in partnership by the Iowa State Hygienic Laboratory and Baby's First Test

Note: This video is based on Iowa’s newborn screening protocol. Although the video states that a repeat newborn screen should be collected eight weeks after an infant’s last transfusion, we recommend that a repeat specimen be collected 90 days after the last transfusion. Please feel free to contact us with any questions.

Putting Babies First Video Text