Princess Margaret Hospital
WA Newborn Screening Program
The aim of newborn screening is early detection, diagnosis
and treatment. The success of newborn screening is largely
dependent on the quality of the samples collected i.e. dried-blood
samples taken at the correct time and in the correct manner.
The best practice is to take the sample between 48 and 72 hours of age or on discharge, whichever is sooner. If the infant is discharged before 48 hours, another sample will need to be collected later. False negative results can be produced if the sample is taken too early.
Provide the information pamphlet Your Newborn Baby’s Screening Test to parents prior to collection and ensure they understand the contents. Discuss the collection and testing with parents, obtain their verbal consent, and complete all relevant documentation. Inform the parents that they will only be contacted if the test is positive or if another sample is required for technical reasons.
The parent’s consent to sample collection and testing should be recorded in the medical record. The record must show the date of consent, who consented and who obtained the consent. It is also important to record the sample collection date and time, card number, and who collected the sample in the baby’s medical record/personal health record.
It is the responsibility of the hospital and/or midwife to ensure that a sample is collected and sent to the screening laboratory in a timely manner. Rapid identification of potentially affected babies by screening leads to further diagnostic tests and early treatment.
The Collection Procedure
You will need the following items:
- A sterile, disposable lancet or automated lancet device
(max. tip length 2.4 mm)
- 70% alcohol swab
- 3 sterile cotton wool balls or gauze swabs
- Disposable gloves
- Newborn screening card
- Baby’s medical record and/or personal health record
Universal precautions must be observed when collecting
all blood samples. Health professionals should also be aware of guidelines for reducing pain during heel lancing.1
- Identify whether the baby is due for the test and that
the timing is acceptable.
- Check the baby’s identification band against the medical record or confirm the baby’s identity with the parents. Then complete ALL the information on the sample card using a ballpoint pen and print clearly. Do not touch the sample area of the card at any stage.
- Wash your hands and put on gloves. Wipe the collection site with alcohol and then dry with cotton wool or gauze. Do not leave any alcohol on the skin as this may dilute the sample and adversely affect the test results. Never use Vaseline or any other material on the collection site.
- Hold the foot firmly to expose the collection site. Use only the inner or outer aspects of the plantar surface of the heel to avoid damaging the heel bone (see Figure 1). Try to avoid any previous puncture holes and do not apply excessive pressure to the lower limb or foot as this can cause bruising.
- Hold the lancet and puncture the skin in a single motion.
Only puncture once and do not twist or slice the lancet
in the skin. The puncture depth should be no more than
- After the puncture, wait five seconds as vasoconstriction
occurs initially. Then gently apply intermittent pressure
with your thumb to the area surrounding the puncture site.
Avoid excessive pressure as this may graze or bruise the
- Wipe away the first drop of blood as this contains
tissue fluids that may dilute the sample. Wait for another
large drop of blood to form and then touch this to the
centre of the first circle on the back of the sample card.
Place the next drop of blood in a blank part of the
first circle until the circle is full. Examine both sides
of the sample card to ensure that blood has penetrated
and saturated the paper.
- Then continue to collect drops of blood until the second
and third circles are full. Do not rush the procedure
and allow sufficient time for the blood drops to collect.
Avoid contaminating the sample area on the card with talc
from your gloves.
- If you have difficulties during collection,
attempt a second puncture with a new lancet and apply
the blood to a new circle on the card. Do not layer new
blood over partially dry blood from the previous attempt.
If you are still experiencing problems stop and seek help.
- Place cotton wool over the puncture site until
bleeding stops. It is not advisable to place adhesive
bandages over skin puncture sites in newborns.
- Dry the sample card for a minimum of four hours, at room
temperature, in a drying rack or on a non-absorbent surface.
It is best if the card is dried in a horizontal position.
- Keep the cards separate and avoid touching or smearing
the blood spots.
- Avoid excess heat or direct sunlight and never
store the cards in a closed area, such as a drawer,
or in a refrigerator.
- The sample must be totally dry before placing the
card in the envelope.
- If the cards are collected outside of a hospital,
an insulated container may help protect the samples
from extremes of temperature.
1. See the Royal Australasian College of Physicians Paediatric Policy Guideline Statement: Management of procedure-related pain in neonates