Programs
Timing of Collection & Importance of Timeliness
For well babies, the blood spot collection should occur between 24 hours and 48 hours of age. Results of a newborn screen collected prior to 24 hours of age are considered invalid due to the analytes in the baby’s blood not yet being independent of the mother’s blood. An invalid result means another blood spot collection is required to complete the screening process. A NICU baby will have a blood spot collection taken based on hospital policy for admission. For NICU babies, a blood spot screening should be conducted again between 48 and 72 hours of age.
Some conditions on the newborn screening panel can cause permanent disability or even death in as little as 5 days. Timely collection and shipping of a satisfactory specimen is critical for early identification and intervention which may prevent progression of the condition. The Kansas Newborn Screening Program strives to meet national standards by reporting out time-critical results within 5 days of birth and all other results within 7 days of birth.
Quality Assurance for Unsatisfactory Specimens
All blood spots collection cards received by the state laboratory are reviewed by a lab technician for quality assurance. Blood spot collection cards must meet lab standards for testing. If a blood spot collection card is determined to be unsatisfactory, the lab is unable to report valid results, and a new blood spot specimen is needed. Many collection facilities conduct a quality check on the blood spot collection card as part of their internal processes. If a blood spot collection card should be determined unsatisfactory in that process, that blood spot card should be discarded and not sent with a second blood spot collection card. Every specimen that is sent to the state laboratory is assigned a unique identifying number. When two specimens are sent (for the same baby), reporting issues can occur as a result.
Demographic Information & Correcting Errors
All blood spots collection cards received by the state laboratory are reviewed by a lab technician for quality assurance. Blood spot collection cards must meet lab standards for testing. If a blood spot collection card is determined to be unsatisfactory, the lab is unable to report valid results, and a new blood spot specimen is needed. Many collection facilities conduct a quality check on the blood spot collection card as part of their internal processes. If a blood spot collection card should be determined unsatisfactory in that process, that blood spot card should be discarded and not sent with a second blood spot collection card. Every specimen that is sent to the state laboratory is assigned a unique identifying number. When two specimens are sent (for the same baby), reporting issues can occur as a result.
The demographic card is treated as a legal document, and the Kansas Health and Environmental Laboratories (KHEL) is required to use the information as it is listed. Complete all information on the blood spot collection card using a ballpoint pen. Print all requested information. To ensure all copies of the collection card are legible, it is necessary to apply pressure when writing. Please double check all the information on the demographic card to ensure everything is correct before sending it to KHEL. It is good practice to retain the “Submitter Copy” for internal tracking.
If there is an error that needs to be corrected, follow these steps:
- Draw a single horizontal line through the incorrect item(s).
- Either directly above or below the incorrect item(s), write the correct information.
- Place your initials and current date next to the corrected information.
LabXchange
LabXchange is a web-based, mobile friendly, test ordering system. KDHE originally partnered with the developer to support Kansans with a user-friendly test ordering system during the pandemic. It was used to process hundreds of thousands of COVID-19 test submissions and results quickly, easily, and most importantly, accurately.
We’ve made some adjustments to the system in order to effectively utilize it for newborn screening submissions. As you know, there is a lot of critical data contained on the newborn screening submission form. Missing or incomplete demographics can result in rejected specimens or delayed/invalid/misfiled results, needlessly causing infants to require recollection due to clerical errors.
The goal is to prevent these errors by submitting electronically. Information that is required for testing (Gestational Age, baby’s weight, etc.) are marked “required” in the system and complete information will be guaranteed in order to submit.
It may be a workflow adjustment for your staff, but after the user has familiarized themselves with the system, it should take a similar (or less) amount of time compared to handwriting the demographic form.
To sign up for LabXchange, please contact Shane Lahman at shane.lahman@ks.gov.
Already registered?
How to Collect Blood Spots
See the image below for the area on a baby that is safe for puncturing (shaded area). Avoid previous puncture sites or curvature of the heel.- Place the infant’s collecting leg in a position that is below the baby’s heart so that there is increased blood flow. In rare circumstances a collection can be done from the baby’s arm, and the same positioning would apply.
- Warm the collection site with a soft cloth (moistened with warm water up to 41°C) or heel warmer for 3-5 minutes.
- Cleanse and sterilize the site with alcohol prep or iodine solution. Allow the area to air dry.
- Reference the diagram below to see the appropriate lancet size to use for collection. Upon making the puncture, wipe away the first blood drop with a sterile gauze pad.
- Gently apply filter paper to a large drop of blood (it is important that the heel not touch the filter paper) while keeping the filter paper in a horizontal position (flat) at all times. Collecting in a vertical position may cause an uneven distribution of blood. Allow blood to soak through and completely fill the preprinted circle. The blood droplet should only be applied to one side of the filter paper. (Either side may be chosen for the collection.) Do not layer or apply blood more than once to the same collection circle. Also note, the collection paper can be contaminated by touching the filter paper with something other than the baby’s blood or the coverlet when dry.
- Repeat Step 6 to fill the remaining circles, allowing a new large blood droplet to form for each circle. If blood flow is diminished or there is clotting, puncture a new site and repeat steps 4 through 6. Care for the puncture site should be consistent with your facility’s procedures.