PORTSMOUTH HOSPITALS NHS TRUST
MULTI PROFESSIONAL GUIDELINES
Neonatal Blood Spot screening: Issue 1. 10.11.05
TITLE
Neonatal Bloodspot Screening for Phenylketonuria (PKU), Congenital
Hypothyroidism, Sickle cell and Thalassaemia.
REFERENCE NUMBER
N/A
MANAGER /
COMMITTEE
RESPONSIBLE
Antenatal/Postnatal Services Manager
Antenatal Clinic team Leader
DATE ISSUED
10th November 2005
VERSION
ISSUE 1.
REVIEW DATE
September 08
AUTHOR
Denyse Moore – Antenatal Clinic Team Leader
Pat Mooney – Antenatal/Postnatal Services Manager
RATIFIED BY
Professional Advisory Committee
DATE
04/10/05
PAGE
AMENDMENTS RECORD
COMMENTS
New guideline
amalgamation of two
previous guidelines
APPROVED BY
Labour Ward Forum
Contents
1. Introduction
2. Status
3. Purpose
4. Scope
5. Definitions
6. Clinical practice guideline or process
7. Supporting evidence
8. Duties and responsibilities
9. Training
Appendices
None
Control Date: 12/02/16
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PORTSMOUTH HOSPITALS NHS TRUST
MULTI PROFESSIONAL GUIDELINES
Neonatal Blood Spot screening: Issue 1. 10.11.05
1. Introduction
Newborn Blood Spot Screening should be offered to all new parents as a screening test for their baby. The test should
be carried out 5-8days after birth (day of birth is counted as day 0). Day 5 is considered as the optimum day for the
screening to be done when possible.
2. Status
Clinical Guideline
Purpose
To offer clients information to facilitate informed consent or refusal for infant screening. It is important that communication about the
screening is of a high standard including how and when results will be given
3. Scope
Women who access Portsmouth NHS trust maternity services during the first 8 days postnatal period.
4. Definitions
Blood tests that include screening for Phenylketonuria (PKU), Congenital Hypothyroidism, Sickle cell and Thalassaemia.
6. Clinical Practice Guideline or Process
6.1. Clinical Practice Guideline
Action
During Pregnancy: in the 3rd trimester of pregnancy women and
their partners should be given information regarding neonatal
blood spot screening
All verbal information given is supported by literature in the form
of a Portsmouth Hospital NHS approved leaflet
All actions regarding the giving of information should be
recorded in the clients hand held notes
Following birth: The midwife should ensure that the parent(s)
have a copy of the literature: at least 24hours prior to performing
blood spot test
Once consent /refusal for the screening test has been obtained it
must be documented in the hand held notes by attaching the
consent form from the newborn screening leaflet
Parents should be informed that the blood spot test will be stored
and that they may be contacted in the future to participate in
further screening and/or research. If the parents declines
participation this should be documented on the Blood Spot card
(writing NO RESEARCH)
If any part of the test is declined parents should be made aware
of the risks to their baby and documented in the hand held
clinical notes, a blood spot screening card should be completed
in all cases of refusal of all or part of the test.
In the event of refusal for blood spot screening, the laboratory
staff will contact the woman’s GP to ensure that the parents
complete a form declaring their intent to decline the test
Performing the test:: Procedure should be explained to the
parent(s)
Rationale
To allow for informed consent or refusal to be gained prior to
completing the test.
Complies with NHS Plan regarding patient centred consent
Ensures that the parent(s) understand the recommendations
surrounding routine testing, and that they have time to read the
leaflet and ask questions prior to making an informed decision
Ensures compliance with NMC standards for documentation
To confirm understanding and answer any outstanding questions
To provide a record of the decision and allows for audit of
compliance
Ensures that parents are fully informed and have
accepted/declined further research/screening
To confirm understanding and ensure good documentation
To ensure that the laboratory perform only the test for which
consent has been obtained and identify babies for which the test
has been declined
Absolves the Trust against any future legal action
To ensure parents are aware of procedure and are prepared to
assist if required
Disinfection of the test area is not necessary on a visibly clean
Control Date: 12/02/16
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PORTSMOUTH HOSPITALS NHS TRUST
MULTI PROFESSIONAL GUIDELINES
Neonatal Blood Spot screening: Issue 1. 10.11.05
foot. If the foot is visibly dirty it should be washed in plain water
or disinfected with an alcohol swab for 30 seconds and allowed
to dry for 30 seconds prior to the test being performed
Pre warming of the foot is not necessary although a foot warm to
touch is ideal. The use of a heel warmer such as the Heel
Snuggler can be considered if the foot is not warm to touch
Recommend measures to comfort the baby during the blood
taking procedure, such as feeding, non nutritive sucking or
engaging baby through face to face contact, voice and touch
Supply all information required on blood spot form in black biro
ink
Wash hands and put on gloves
Allow the foot to hang
An automated heel puncture device should be used on either
side of the bottom of the foot. The middle of the heel and back of
the foot should be avoided. See diagram on reverse of blood
spot card
The suggested guidance is to wipe away the first drop of blood
and then allow the blood to fill the circle on the blood spot card
by natural flow, allowing one spot of blood to fill each circle in
turn (all spots should be filled). The circle should not be layered
with several drops of blood
If a second heel prick is necessary it should be performed in a
different area on the same foot or on the other foot
Once the blood spots are dry the card should be stored in the
glassine envelope provided, and sent to the laboratory within 24
hours of the test being completed
The blood spot card should be stored away from strong light,
highlighter pen should not be used on the card
A record should be made in the hand held clinical notes that the
test has been performed
If the test is normal parent should be informed that they will
receive the result within 28days via their health visitor at a
routine visit
To minimise risk of infection
Colder skin will have less blood flowing through the capillary
beds.
To prevent possibility of having to repeat heel prick
To ensure minimal physical and emotional discomfort is
experienced by the baby
To ensure that the laboratory has the correct information to help
process the test efficiently and meet national standards and
targets for giving risk results
Reduces risk of cross infection and promotes safe infection
control practice
Facilitates optimal blood flow
To avoid puncture of the heel bone and subsequent infection
Allows for sufficient sample to ensure effective screening
Layering should be avoided as this may lead to inaccurate
reporting of results for certain conditions
To reduce trauma to the first heel prick site
This prevents damage to the blood spot card
This reduces time delay in diagnosis and initiation of routine
treatment
This prevents contamination and inaccuracies in test results
To maintain contemporaneous documentation and allows for
effective audit
This will ensure that parent receive results in a timely manner
Should any results require further investigation, they will be
contacted by the haemoglobinopathy link nurse/health visitor
Any further investigations and information can be given in a
timely manner
If a repeat sample is required:
Baby under 28days of age – Midwives are responsible for
repeating the test. The midwife should ensure she is aware of
the reason for a repeat test and document accordingly
Baby over 28days of age: the baby is referred by the health
visitor to the paediatric out patients for repeat test
This will ensure that the midwife is able to inform the parents
why the test requires repeating, and consent can be gained to
for second test
Midwives professional responsibility for mother and baby does
not continue beyond 28days post birth
Process
All health care professionals providing antenatal/postnatal care will be informed of the updated process
regarding blood spot screening for neonates
7. Supporting evidence
Good Practice in consent: Achieving the NHS Plan commitment to patient-centred consent practice DoH 2001
Control Date: 12/02/16
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PORTSMOUTH HOSPITALS NHS TRUST
MULTI PROFESSIONAL GUIDELINES
Neonatal Blood Spot screening: Issue 1. 10.11.05
Confidentiality: Protecting and Providing Information. General Medical Council September 2000
Screening for infectious diseases in pregnancy UK NSC 2003
Sickle Cell, Thalassaemia and other Haemoglobinopathies. Report of a working party of the Standing Medical Advisory Committee.
DOH 1999
RCOG guideline no 8 Amniocentesis 2003
UK National Screening Committee Antenatal Working Standards January 2003
NMC
8. Duties and responsibilities
Responsibility of antenatal screening coordinator reporting to Modern Matron for antenatal and postnatal services
Training
Annual mandatory training on Maternity Updates – to be recorded on training database
Control Date: 12/02/16
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