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Newborn Screening - Specimen Collection Requirements

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Healthcare Provider Requirements to Collect the Newborn Screen

Texas rules state that:

  • The 1st newborn screen should be collected between 24 - 48 hours of age, or before hospital discharge.
  • The 2nd newborn screen should be collected on every infant at 7-14 days, a minimum of 168 hours, of age.

For more information regarding the rules outlining a Healthcare Provider’s requirement to collect the newborn screen, see the Texas Administrative Code for Newborn Screening.

For more information regarding collection of the newborn screening specimen when special circumstances exist such as premature infants, transfusions, facility transfers, TPN, etc. visit Specimen Collection - Special Circumstances.

Newborn Screening (NBS) Specimen Collection Supplies

Supplies required:

  • NBS 3 (Medicaid) or NBS 4 (Private Pay) Specimen collection kit
  • Heel Lancet
    • For average weight newborns, do not exceed a puncture depth of 2.0 mm.
    • For preterm and low birth weight newborns, do not exceed a puncture depth of 0.85 mm or length of 1.75 mm.
  • Alcohol
  • Sterile Gauze or Cotton Ball
  • Gloves

Optional supplies:

  • Heel Warmer
  • Mailing envelopes
  • Provider address labels

Order Form for Newborn Screening Supplies

Instructions for Pages 1-3 of the Newborn Screening Kit

Texas Newborn Screening Parent Information (Page 1):

  • Fill out baby’s information on the top PARENT COPY form
  • Give copy to parent for all screens. For 1st screens explain that the form must be taken to the baby’s doctor at the baby’s 7-14 day checkup.

Parental Decision for Storage/Use of Newborn Screening Blood Spot Cards (Page 2):

  • Parent or submitter may fill out Section 1. A patient label with the requested information is acceptable.
  • Parent reviews, completes, and signs form.
  • Submitter returns the form to DSHS with blood spot cards if parent requests.
  • It is the parent’s option to take the form home and return to DSHS by mail at a later date.

Demographic Form (Page 3):

  • Legibly print ALL information. USE BLACK INK AND BLOCK CAPITAL LETTERS. Press hard for good copies. Do not touch the filter paper blood collection spots.
  • For 2nd screens: If available, fill in the serial number for the baby’s 1st screen in the box “Previous Specimen Serial Number.”
  • Fill in the number to indicate baby’s ‘Sex’, ‘Feed’, ‘Ethnicity’, ‘Status’, and ‘Baby’s Age at Time of Collection/Test.’
  • If the specimen is a repeat for a previous abnormal, fill in the Texas DSHS laboratory number in appropriate spaces.
  • Under Submitter Information, fill in the address where the results are to be sent. Labels for this may be ordered using the Order Form for Newborn Screening Supplies (above).
  • After information and Decision Form have been provided, check the box on demographic information sheet that indicates “Check to verify parent information & decision form distributed.”
  • Remove and keep the yellow submitter copy of the demographic information.

**Accurate information on the demographic form is vital to testing and result follow-up. Please take extra care when completing this information. **

Impact of incorrect demographic information includes but is not limited to:

  • Rejection of specimen for testing
  • Wrong result reported (normal vs. abnormal)
  • Result released to wrong healthcare provider.
  • Delay in initiation of follow-up for an abnormal result.

Recommended Specimen Collection Technique

Gloves should be worn for personal safety. Care should be taken to avoid contamination of blood collection circles with antiseptic solutions, powders, lotions or other materials which may contaminate and adversely affect the testing process.

  • Place baby’s limb in dependent position.
  • Cleanse skin with alcohol, DRY, and puncture with disposable heel lancet (<2.0mm length).
    • DO NOT use any product with chlorhexidine gluconate, such as Chlorascrub Swabs.
    • DO NOT use alcohol swabs with topical pain killers such as benzocaine.
  • Wipe off first drop of blood.
  • Allow a drop of blood to form and apply DIRECTLY to filter paper. Apply to one side only while viewing from the other side to ensure COMPLETE SATURATION OF THE ENTIRE CIRCLE.
  • Complete one circle at a time and FILL ALL FIVE (5) CIRCLES.
  • Allow card to dry thoroughly at room temperature in a horizontal position for at least 3 hours. Do NOT allow specimen to touch any surface.
  • Cover dried specimen with attached flap.
  • Ship dried specimen AS SOON AS POSSIBLE WITHIN 24 HOURS, preferably via overnight courier. If mail or carrier services are unavailable, ship as quickly as possible. See shipment information section below.

The heel-stick is always the preferred method for collection of the newborn screening. If it is not possible to perform a heel-stick, please see the Alternative Methods for Collecting a Newborn Screen page for detailed information and instructions.

Additional Information on Recommended Specimen Collection Techniques

Shipment of the Newborn Screening Specimen

Quick delivery of specimens is imperative. Some disorders need to be identified, diagnosed and treated as soon as possible to prevent onset of clinical symptoms. For example, congenital adrenal hyperplasia and galactosemia may cause life-threatening symptoms by the first week of life.

It is important that submitting facilities are mindful of the time between collection and shipment. New national recommendations state that first screen specimens should arrive at the DSHS Laboratory within 24 HOURS AFTER COLLECTION. To facilitate timely identification and treatment of critical disorders, it is recommended that specimens be shipped via overnight courier and received in the laboratory for testing the day after collection.

For Overnight/Courier Shipping (UPS, FedEx, etc.):

Texas Department of State Health Services
Laboratory Services Section, MC 1947
1100 W. 49th Street
Austin, TX 78756-3199

For USPS Regular and Priority Mail:

Texas Department of State Health Services
Laboratory Services Section, MC 1947
PO Box 149341
Austin, TX 78714-9341

Refusal to Newborn Screen Blood Test 

A parent/guardian can only refuse the newborn screen blood test for religious reasons (Texas Health & Safety Code Sec. 33.012). 

There are important medical benefits of newborn screening to consider: 

  • All disorders have intervention or treatment options available. 

  • Prevention of complications.  

  • Improved long-term health for the child. 

Healthcare providers play an important role in educating families. Ensure all staff are familiar with the benefits of screening and the negative outcomes that can occur if the baby is not screened. Provide the information outlined above to parents/guardians who are considering refusing the screen. The only legal reason to refuse newborn screening is if it conflicts with the parent/guardian’s religious tenets or practices. 

After education and discussion with the parent/guardian, answering all questions, the parent/guardian may still refuse. The provider must document the refusal in the patient medical record. Providers can use a self-developed form or may use the form provided by DSHS. 

The DSHS Newborn Screen Blood Test Refusal Form provides: 

  • Instructions on how to complete the form. 

  • QR Code to view short video featuring families affected by disorders on the Texas NBS panel. 

  • Discussion prompts for parent education. 

  • Parent/Guardian acknowledgement statements and signature for record keeping. 

Newborn Screen Blood Test Refusal Form: English / Spanish 

Additional Specimens Following Abnormal or Unsatisfactory Screen Results

Newborn Screening Result Reports are mailed, faxed or electronically transmitted (Texas Newborn Screening Web Application or HL7) to the submitter (the facility that collected the screen) 4 to 8 days after receiving the specimen.

Abnormal Results

  • Newborn Screening Clinical Care Coordination staff will communicate abnormal newborn screening results to assure appropriate follow-up.  

NBS collection follow-up instructions

Unsatisfactory Results
The result report for unsatisfactory specimens will state "UNSATISFACTORY - PLEASE RESUBMIT". The submitting facility is responsible for ensuring that a follow-up specimen is submitted for any unsatisfactory 1st screen.

If a baby has had two newborn screens and one was “unsatisfactory,” refer to the chart below when determining the necessity to collect a 3rd newborn screen:

1st screen

2nd screen

3rd screen necessary?

unsatisfactory

normal

No, if full term baby with a birth weight ≥2,500g

Yes, if low birth weight or premature baby with a birth weight of <2,500g

normal

unsatisfactory

yes, up to 12 months of age.

unsatisfactory

abnormal

Please follow recommendations received from DSHS Newborn Screening Clinical Care Coordination Team.

abnormal

unsatisfactory

Please follow recommendations received from DSHS Newborn Screening Clinical Care Coordination Team.

Please Note: Submitting unsatisfactory specimens causes the inconvenience of retesting and delays the screening of the newborn, placing the newborn at risk for delayed diagnosis of a screened condition. Please make every effort to follow proper specimen collection techniques.

Laboratory Services

Laboratory Services

Newborn Screening - Healthcare Provider Resources