The South Australian Neonatal Screening Centre has produced a comprehensive guide to the Neonatal Screening Test in the form of a program entitled "Spot On". The program is divided into two parts. The first part provides on overview of how and why the tests are done and how neonatal screening fits into the broader context of public health care. This section of the program also provides an explanation of the disorders tested for by neonatal screening.

The second part of the program is designed as an instructional guide in the collection of samples for screening.

The program is designed to assist both practitioners who seek to learn about the screening program and the methodology used to undertake a heel prick blood collection, and as an educational program for use in schools and other educational environments.

The program is available in both VHS video or CD Rom format.

The program is available to order from the SA Neonatal Screening Centre. If you are interested in placing an order for the video, click on the video image on the right for a copy of our order form. (requires PDF plug-in)

The order form can be printed out and faxed or sent off to the SA Neonatal Screening Centre address on the form. Once payment has been confirmed, videos are dispatched within 2 weeks.

If you have any further queries about the video please contact:

Clare Kiesewetter
Telephone: 61 8 8161 7295
Fax: 61 8 8161 7100
Email : neonatalscreen@wch.sa.gov.au
kiesewettc@mail.wch.sa.gov.au

It is important to obtain informed parental consent prior to the procedure being undertaken. Explain the procedure to the parents and make sure that they understand the reasons for the test. Information for parents booklets are available from the laboratory or can be down loaded and printed from the image below. These booklets should be given to parents at the time of collection to ensure that they are fully informed of the tests and their outcomes.

Parents may refuse to have their infant screened. This must be documented in the infant’s medical records. It is also advisable that the parents sign the appropriate documentation indicating their refusal and that this is recorded in the baby’s case notes.

Before commencing the procedure complete ALL the details on the Neonatal Screening Collection Card using a ballpoint pen. It is important in order to process the sample accurately to record

• The time of birth
  
• The time of collection
  
• Details of the feed type
  
• Any relevant clinical details
  
• Surnames of both parents if different.

It is important that a screening card from the South Australian Neonatal Screening Centre is used. This is because the card has been designed to capture four blood spots and has space for all the IMPORTANT details regarding the infant’s background, the sample and the referring doctor or hospital. Without all of this information, the laboratory will be unable to process the test.

WHEN HANDLING THE CARD BE CAREFUL NOT TO TOUCH THE CIRCLE AREA ON THE FILTER PAPER AS THIS MAY CAUSE CONTAMINATION OF THE SAMPLE.

Preparation

It is important to be completely prepared with all the necessary equipment prior to commencing the procedure. The choice of skin puncturing device is important. The length should not exceed 2.4mm.

The puncture

Heel punctures should be performed on the plantar surface of the heel. The actual collection technique is an acquired skill that takes time to master.

Collecting blood on the card

Blood is applied to the back of the card, that is the side of the card that you have not written on.

The first drop is applied to the centre of the first circle. This almost never fills the circle completely.

Place the second drop in a blank area within the circle and continue doing so until the first circle is filled. Then move onto the other circles, filling them in the same manner.

Completing the documentation

Once the collection has been completed, further documentation is required. This records that the collection has been completed. There is a red number on the card. This is recorded in the infant’s medical records, and in the personal health record book. All other details as required by your institution must also be recorded.

Drying and sending the card

The screening collection card must be air dried for a minimum of 4 hours at a room temperature no greater than 30 degrees Celsius on a non absorbent surface.

There are many ways of drying the cards safely.

Cards can be dried in a drying rack.

Cards can also be left to dry on the edge of a bench or ledge.

The collection card must be TOTALLY dry before being placed in an envelope for mailing.

Cards should be packed alternating the spots so that the blood spots from any one card are resting on the bottom of the cards packed before and after it. This helps to prevent contamination between samples.

The Neonatal Blood Spot Collection cards should then be packed inside an envelope, or wrapped carefully with white paper.

This first envelope should then be placed inside a second envelope and sealed. The second envelope should be addressed to the laboratory as per the directions outlined in the section "How to organise a test". Placing the cards inside two envelopes helps to protect the cards should the outside envelope get damaged in transit. Cards should never be packaged in plastic bags as this may cause sweating.

All samples should be dispatched to the laboratory on the day of collection.

For those sending samples from overseas, please refer to mailing directions in the section "How to organise a test".

Common Collection Problems

There are a number of common collection problems that can occur when undertaking a heel prick blood collection. When these problems occur, the infant will often need to be recalled for another collection.

The ultimate aim of undertaking a heel prick blood collection is to ensure that each circle on the card is completely covered with a uniform amount of blood. This ensures that the reliability of the test is not compromised by problems with the sample.

Each circle should be completely filled and the blood should be sufficient in volume to soak through the card. The collection should occur reasonably quickly so that fresh blood is never placed on top of partially dried blood.

The most common collection problems that will require another sample to be collected are explained below.

Insufficient Blood Volume

Often there is insufficient blood collected on the card. In this example only one circle has been filled. There is no opportunity for further testing to either confirm or exclude a borderline or positive result.

Lack of Blood Coverage

In this example the circle is filled with many small spots of blood. This is a very common problem that can be caused if the operator is inexperienced and afraid of pricking the infant too hard. If the lancet is not inserted deep enough there will not be enough blood flow to fill the card.

This problem may also occur if the operator attempts to collect blood too quickly, not allowing time for large drops to form.

Layering of Blood

Lack of uniformity of blood sample application is also a common problem. In the example shown here, there are darkened areas within the circles. This usually indicates that the operator has performed a double collection, placing fresh blood on top of already partially dried blood. This causes a range of problems with the analysis of the specimen and will result in the need for a second collection.

Incomplete Blood Saturation

Complete blood saturation is also important. In this example one side of the card appears acceptable, but when the card is turned over the blood is not soaked through. The analysis of blood spots in the laboratory is based on receiving a sample that has a consistent volume of blood on each spot. Samples with incomplete saturation will cause problems during analysis and will therefore need to be recollected.

Contamination

Contamination of the specimen can occur during collection, storage, or mailing. Exposure of the specimen to potential interfering agents such as water, faeces, talc, betadine, dirt, alcohol or soaps will render the test unreliable.

Inappropriate Drying Conditions

Drying the cards inappropriately is also a problem. Excessive cold separates the red blood cells and serum while excessive heat and exposure to direct sunlight has the effect of baking the sample. All samples should be dried in an appropriate drying rack at room temperature no greater than 30 degrees Celsius for a minimum of four hours.

Separation

Placing a sample which is not thoroughly dried into an envelope for sending may cause it to sweat.

In this example note the periphery of the circles illustrating separation of red blood cells and serum. Specimens showing the slightest evidence of separation must be recollected.