Phlebotomy · Special Collections · 8 min read
Newborn Screening and Point-of-Care Tests
- Identify state-mandated requirements, anatomical collection sites, and handling protocols for newborn screening blood spots.
- Describe the procedural steps, specimen collection requirements, and quality control measures for point-of-care blood and urine testing.
- Explain the phlebotomist's professional responsibility regarding patient identification, equipment quality assurance, problem reporting, and staying within the non-diagnostic scope of practice.
Newborn Screening Requirements and Infant Preparation
Newborn screening panels are essential public health measures designed to detect congenital, metabolic, and genetic disorders before clinical symptoms appear in an infant. Early detection allows healthcare teams to intervene before irreversible damage occurs. Among the conditions evaluated is phenylketonuria, a genetic metabolic disorder in which the infant cannot properly metabolize the amino acid phenylalanine. Do not delay a state-required newborn screening collection solely because the infant has not fed; document feeding status and follow the screening program's instructions for any repeat specimen, because limited protein intake can affect phenylketonuria screening. Collect the specimen within the state screening program's required timeframe and follow its instructions for circumstances such as early collection, feeding status, or transfusion that may require special handling or repeat collection.
State requirements typically dictate that newborn screening blood spots are collected when the infant is between 24 to 48 hours of age. Timing is critical to ensure screening validity. If an infant is discharged early or if clinical circumstances require that a newborn screening specimen is collected before 24 hours of age, the phlebotomist must follow the state screening program's specific requirements regarding the collection of a repeat specimen. Following the state screening program's collection schedule improves the likelihood of detecting screened conditions, but early collection, feeding status, transfusion, or other circumstances may require a repeat specimen.
Positive patient identification is the first and most critical step before beginning any collection procedure. Before collecting blood from a neonate, verify two infant identifiers on the infant's identification band directly against the test requisition. In a nursery setting, crib cards and bassinet labels are frequently visible, but a crib card or bassinet label must not be used as the primary source of infant identification because bassinets can be moved or swapped. The phlebotomist must always rely on the identification band attached to the infant.
Common mistakes
- Using a crib card or bassinet label as the primary patient identifier instead of checking the infant's attached identification band against the requisition.
- Applying successive drops of blood on top of an existing blood spot on a newborn screening card, which causes uneven concentration and invalidates the test.
- Cleaning a newborn heelstick site with povidone-iodine, which is absorbed through the skin and interferes with thyroid-screening results.
- Holding a urine dipstick vertically after removal from the specimen, allowing chemical reagents to run into adjacent pads and contaminate test results.
Key points
- Newborn screening aims to identify disorders such as phenylketonuria before symptoms appear; follow state collection schedules, document feeding status, and follow program instructions for any repeat specimen.
- Capillary blood for newborn screening must be collected from the medial or lateral plantar surfaces of the heel at a depth not exceeding 2.0 mm, avoiding the arch and posterior curvature.
- Newborn screening circles must each be filled with a single, free-flowing drop that penetrates through to the back; cards must never be layered, touched, dried with heat, or sealed in plastic.
- Point-of-care blood testing requires strict quality control, careful fingerstick technique perpendicular to ridges, bubble-free microcuvette filling, and balanced microhematocrit centrifugation.
- Urine point-of-care testing requires tight bottle closure, brief immersion in uncentrifuged urine, horizontal strip orientation, and exact timing per manufacturer guidelines.
- Phlebotomists must promptly report critical values and unacceptable specimens to a nurse or supervisor, document all quality control and patient data, and refer all diagnostic questions to the licensed healthcare provider.
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