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
AMENDMENTS RECORD
DATE / PAGE / COMMENTS / APPROVED BY
04/10/05 / New guideline amalgamation of two previous guidelines / 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

  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.
  1. 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
  1. Scope
Women who access Portsmouth NHS trust maternity services during the first 8 days postnatal period.
  1. 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 / Rationale
During Pregnancy: in the 3rd trimester of pregnancy women and their partners should be given information regarding neonatal blood spot screening / To allow for informed consent or refusal to be gained prior to completing the test.
Complies with NHS Plan regarding patient centred consent
All verbal information given is supported by literature in the form of a Portsmouth Hospital NHS approved leaflet / 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
All actions regarding the giving of information should be recorded in the clients hand held notes / Ensures compliance with NMC standards for documentation
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 / To confirm understanding and answer any outstanding questions
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 / To provide a record of the decision and allows for audit of compliance
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) / Ensures that parents are fully informed and have accepted/declined further research/screening
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 / 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
Performing the test:: Procedure should be explained to the parent(s) / 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 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 / To minimise risk of infection
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 / Colder skin will have less blood flowing through the capillary beds.
To prevent possibility of having to repeat heel prick
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 / To ensure minimal physical and emotional discomfort is experienced by the baby
Supply all information required on blood spot form in black biro ink / 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
Wash hands and put on gloves / Reduces risk of cross infection and promotes safe infection control practice
Allow the foot to hang / Facilitates optimal blood flow
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 / To avoid puncture of the heel bone and subsequent infection
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 / 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
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 / This prevents damage to the blood spot card
This reduces time delay in diagnosis and initiation of routine treatment
The blood spot card should be stored away from strong light, highlighter pen should not be used on the card / This prevents contamination and inaccuracies in test results
A record should be made in the hand held clinical notes that the test has been performed / To maintain contemporaneous documentation and allows for effective audit
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 / 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
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: 08/08/08Page 1 of 4