Texas
Department of State
Health Services
Newborn Screening
Branch
Newborn Screening
Program
Specimen Collection
Presentation
January 2007
Texas Newborn
Screening
Table of Contents:
• The Specimen Collection Form
• Blood Sample Collection
• The Voice Response System
The
Newborn Screening
Specimen Collection Form
What is a screening test kit?
The newborn screening test kit includes a specimen
collection device, a form for demographic
information and a special envelope.
How do I order lab supplies?
CALL: 512 – 458 - 7661
NBS Collection Form
Parent Copy
Allows for ‘linking’ of multiple specimens
New form available in December
NBS Collection Form
Demographics Form
Time of Birth
Time of Collection
PCP information
1st Screen Serial No.
NBS Collection Form
Filter Paper for Blood Collection
NBS Collection Form
Collection Instructions
Is the form we have current?
The expiration date on all newborn screening kits
is shown on the cover, demographic sheets and the
filter paper.
Expiration Date
Expiration Date
Can I use the mother’s Medicaid
number for the newborn?
Yes. The mother’s Medicaid number may be
used on the form to indicate that the newborn
is Medicaid-eligible. DSHS recognizes that it
may take months to issue a Medicaid number
for the newborn.
Medicaid Eligible
(1=Yes, 2=No)
Medicaid No.
How does DSHS define
charity care?
The charity care newborn is a patient who is
not insured and is not covered or eligible to be
covered for newborn screening services by
Medicaid or any other government program.
Specimen Collection
Check List

Wear gloves when handling form.

Use black ink and print in block capital letters.

Use the same “baby’s last name” on the first and
second filter collection form.
Specimen Collection Kit
Cover Sheet
Provider/Submitter Instructions:
Complete Infant’s Last Name, First
Name and Date of Birth
Specimen Collection Kit
Cover Sheet (con’t.)
Provider/Submitter Instructions:
For 1st screen:
Remove the PARENT COPY and give to
the parent. Inform the parent that they
MUST take this form to their infant’s
doctor at the baby’s 1-2 week check-up.
Specimen Collection Kit
Cover Sheet (con’t.)
Provider/Submitter Instructions:
For 2nd screen:
Write the serial number from the 1st screen
PARENT COPY (brought to you by the parent) in
the box labeled “Serial Number” in the Newborn
Information area of the demographic form for the
specimen being submitted.
Retain the PARENT COPY from the 2nd screen in
the patient chart. If an additional screen is
requested, use this serial number on the additional
screen form.
Baby’s Last Name
 When filling out the filter collection form for the second
screen, ask mom what name was used on the form for the
first screen in the “Baby’s last name” box and use the
same name.
 The NBS case management staff uses the baby’s last
name, mother’s last name, and date of birth to link the
second screen to the first.
 This information is vital for identification and location
of infants for follow-up of abnormal tests results.
Gloves
To prevent specimen contamination, do not
touch any part of the filter paper circles
before, during or after collection. Disposable
gloves can contaminate the specimen and
powdered residue from the gloves can
contaminate the hands.
Why do I have to fill out all the
information when I know the
baby?
It may be necessary to reach the family in a
hurry when you are not available. Also, the
State Laboratory receives so may specimens
that often there are several babies with the
same last name and the same birth date.
Why is it necessary to retest some
babies several times?
Premature babies may have immature enzyme
systems or thyroid functioning. It may be
necessary to monitor their progress to be
certain they reach normal levels.
AND
 A normal
screen in an infant who has
insufficient enteral intake does not rule
out metabolic disease.
 Total parenteral nutrition may cause
a false positive result.
Check List


Fill in both first and last name in the
“Physician’s Name” box.
Use grams in the “Birthweight” box.
(This information is crucial for newborn screening
disorders because many interpretations of results
are based on the birth weight of the infant).

Fill in the physician’s telephone number in the box
directly below the medical record number box.
Birth Weight
A free weight conversion chart is
available from the Newborn
Screening Program.
1-800-252-8023
extension 2129
Check List






Fill in the boxes for:
Status
Test
Date of birth
Date of specimen (specimen will be rejected
without a date of collection)
Infant’s age at specimen collection

Mother’s social security number
Repeat Screen
The NBS follow-up staff may contact
submitters by fax, phone, and/or letter
to request a repeat screen.
Check List
Make sure all boxes are:
 legible,
 accurate, and
 complete.
What if the screening test kit is no
good?
Each screening test kit qualifies as a medical device.
If a kit does not perform as it should, please notify
the Quality Assurance Officer at 512-458-7318.
DSHS will replace defective kits free of charge.
Will DSHS pay postage?
DSHS has never paid postage for the newborn
screening test kits and does not contemplate doing
so in the future.
NBS Specimen Rejection Possible
due to
NEW POSTAL REGULATIONS
Effective May 14, 2007 the USPS raised
postage rates, and initiated new postage
pricing rules based on mail size and
shape. The changes will require you to
carefully evaluate your newborn screening
specimen shipping practices to ensure that
correct postage is used. Envelopes with
insufficient postage may be returned, leading
to critical newborn screening delays or
rejection of specimens.
General Information
• 1 specimen card in an envelope (Letter) used
to cost $0.39 but will now cost $0.41 to ship.
• The price increases as you add cards.
• 6 cards or more will require the more
expensive flat rate pricing.
• Envelopes with metal clasps will be charged
an additional $0.17 surcharge if the clasps are
used to close the envelope. Leave the clasp
flat and close with tape only.
The following are examples only.
Please verify exact postage from
your facility.
• 1 specimen card in an envelope (Letter) will
now cost $0.41 to ship.
• 2 specimen cards in an envelope (Letter) will
cost $0.58 to ship.
• 10 specimen cards in an envelope (now
considered Flats) used to cost $1.35 but will
now cost $1.48 to ship.
Obtain a copy of the new
pricing schedule for your
Mail Zone at
http://pe.usps.gov/
Collecting a Blood
Sample
Equipment
•Sterile lancet with tip
(2.0 – 2.40 mm)
•sterile alcohol prep
•sterile gauze pads
•soft cloth
•blood collection form
•gloves
Increase Blood Flow
Wrap a warmed, moist
towel around the heel
puncture site for 3 to 5
minutes.
Positioning the infant with feet lowered
below the heart will help to increase
blood flow.
Clean & Dry
Cleanse site with sterile
alcohol pad.
Allow site to air dry.
(Alcohol residue left on the
skin may dilute the specimen
and affect test results)
Puncture Site
Hatched area indicates
safe areas for puncture
site.
Puncture
Position a sterile
disposable lancet (2.0 –
2.4 mm tip) or an
automatic lancet at a
slight angle to perform a
swift clean puncture.
Wipe away the first drop
of blood with dry sterile
gauze.
Fill Circle
Allow a second large
drop of blood to form.
Lightly touch blood drop
to filter paper.
Allow blood to soak
through and completely
fill circle.
Fill Remaining Circles
Fill remaining circles
with successive blood
drops.
If blood flow slows,
repeat procedure
selecting a different site
and using sterile
equipment.
Why are so many specimens marked
unsatisfactory when I can see plenty of
blood in the circles?
There must be an even penetration of blood for the
test to be accurate. This means soaking through the
filter paper with one application and filling the
whole circle so the blood is evenly distributed on
both sides of the filter paper.
Apply blood to one side of the filter
paper only, allowing full saturation of each
circle before proceeding to the next circle.
To enhance blood flow during collection,
very gentle intermittent pressure may be
applied to the area surrounding the
puncture site.
Excessive “milking” causes an admixture
of tissue fluids with the blood specimen,
invalidating the specimen.
Do not layer successive
small drops of blood on
top of each other. Let
each drop touch the paper
about 1/8 inch away from
the previous one. This
prevents layering of the
paper, which is one cause
of unsatisfactory results.
Drying Specimen
Allow the blood
specimens to air-dry
for at least 4 hours on
a flat, nonabsorbent
surface protected
from heat or direct
sunlight.
Do not
refrigerate the
samples or put in
plastic sleeves.
(Plastic sleeves
allow
accumulation of
condensation and
can contribute to
contamination,
elution, and
bleeding of the
blood spots).
Place dried specimen collection form
in special envelope and mail within 24
hours.
The Voice Response System
Voice Response System
(VRS)
The VRS provides 24-hour access
to newborn screening laboratory
information on all patients
screened at the DSHS Laboratory.
Requirements:
(1)
Licensed Texas newborn screening
submitter number
(2)
Personal identification number (PIN)
(3)
Newborn screening form serial number or
social security number of infant’s mother
(4)
Touch tone phone
Instructions for use of the VRS are presented in
logical order during the call. Interaction with the
system is by means of the telephone key pad.
Keys are identified as follows:
Numbers……………………….1-9 and 0
Pound………………………….#
Star…………………………….*
Information about the infant is presented as:
Form serial number (from specimen form)
Last name (spelled)
Sex (male, female, unknown)
Date of birth
Test results
Interpretation
How do I get a PIN number?
Call: 512-458–7111
extension 6988
or
1-888-963-7111
extension 6988
or
Email: labappsupport@dshs.state.tx.us
May I receive a hard copy of the
screen?
Yes. An add-on feature to the VRS allows
results to be sent via FAX to a physician
requiring a hard copy of the voice session.
VRS Message
 A message may be repeated at any time by pressing
the pound (#) key.
 After hearing results for an infant, you will be given the
opportunity to speak with a member of the newborn
screening staff. Then, or at any time thereafter during
normal business hours (8:00-5:00), you may press the
star (*) key to have your call transferred to a staff
member.
 If you are calling after hours, or if all the lines are busy,
you will be invited to leave a message with a member of
the newborn screening staff.
Where do I find our submitter
number?
Call: 512 – 458 – 7111
extension 2421
Texas Newborn Screening Program
Voice Response System
24 - HOUR ACCESS
(512) 458-7300
or
1-888-963-7111
extension 7300
The Newborn
Screening Program
Case Management Staff
can be reached at
Telephone: 1Fax:
800 – 252 - 8023
512 - 458 -7450
For information regarding
newborn screening results
between the hours of 8:00 5:00, Monday - Friday you
may call the DSHS Lab at
512 - 458 - 7578
FYI
Cases confirmed by testing done at laboratories
other than the Texas Department of State Health
Services Laboratory must be reported to the
Newborn Screening Case Management Program at
1-800-252-8023
Newborn Screening Literature
Educational materials for providers and parents are
available free of charge from the Newborn Screening
Program.
1-800-252-8023
extension 2129
or
Email: newborn@dshs.state.tx.us
Newborn Screening Website
www.dshs.state.tx.us/newborn