Quick Links

• Healthcare Provider Requirements to Collect the Newborn Screen
• Newborn Screening (NBS) Specimen Collection Supplies
• Choosing the Correct Newborn Screening Collection Kit
• Instructions for Pages 1-3 of the Newborn Screening Kit
• Recommended Specimen Collection Technique
• Shipment of the Newborn Screening Specimen
• Refusal to Newborn Screen Blood Test
• Additional Specimens Following Abnormal or Unsatisfactory Screen Results
• Specimen Collection - Special Circumstances

Healthcare Provider Requirements to Collect the Newborn Screen

Texas rules state that:

• Collect the first newborn screen between 24 and 48 hours of age or before hospital discharge.
• Collect the second newborn screen between 7 and 14 days of age, with a minimum of 168 hours.

For more information regarding the rules outlining a health care provider’s requirement to collect the newborn screen, see the Texas Administrative Code for Newborn Screening.

For more information about the collection of the newborn screening specimen when special circumstances exist, such as premature infants, transfusions, facility transfers, TPN, etc. visit Specimen Collection - Special Circumstances.

Newborn Screening (NBS) Specimen Collection Supplies

Supplies required:

• Medicaid/CHIP/Uninsured (NBS 3) or Insurance/Self-Pay (NBS 4) Newborn Screening Specimen Collection Kit.
• Heel Lancet
  • For average weight newborns, do not exceed a puncture depth of 2.0 mm.
  • For preterm and low birth weight newborns, do not exceed a puncture depth of 0.85 mm or length of 1.75 mm.
• Alcohol
• Sterile gauze or cotton ball
• Gloves

Optional supplies:

• Heel Warmer
• Mailing envelopes
• Provider address labels

Order Form for Newborn Screening Supplies

Choosing the Correct Newborn Screening Collection Kit

There are two types of Newborn Screening Collection Kits 

• Insurance/Self-Pay (NBS 4) 
  • Use this type of Newborn Screening Collection kit for newborns covered by private insurance or for those with families planning to pay out of pocket. 

• Medicaid/CHIP/Uninsured (NBS 3) 

  • Use this type of Newborn Screening Collection kit for newborns eligible for Medicaid, covered by CHIP (Children’s Health Insurance Program), or without any other payment options as required in the Texas Administrative Code, Title 25 section 37.55.   
  • Uninsured, previously called charity care, applies to patients without insurance or self-pay who do not qualify for coverage of newborn screening services through Medicaid, CHIP, or any other government program.

  *Note: Use "uninsured" for families who do not have insurance, cannot afford to pay out of pocket, and do not qualify for any government programs. This represents an exception rather than standard practice.

Instructions for pages 1-4 of the Texas Newborn Screening Collection Kit

***Keep the protective flap over the filter paper until you collect the specimen. Once you collect the specimen and let it dry, close the protective flap over it. This stops hand contaminants, such as lotions and hand sanitizers, from touching the collection surface.

Newborn Screening Parent Information (Page 1):

• Fill out the baby’s information on the top PARENT COPY form.
• Give this copy to a parent or guardian for all screens. For the first newborn screen, explain that the parent or guardian may take the form to the baby’s doctor during the baby’s 7-14 day, a minimum of 168 hours checkup where the doctor will perform the second newborn screen.

Storage and Use of Newborn Screening Blood Spots (Page 2):

• A parent, guardian, or submitter may fill out Section 1. A label with the requested information is acceptable. Make sure the protective flap is covering the filter paper to avoid contamination of the collection surface. 
• Parent or guardian reviews, completes, and signs the form.
• Submitter returns the Storage and Use of Newborn Screening Blood Spots form to DSHS with any newborn screening specimen shipment.
• It is the parent or guardian’s option to take the form home and return it to DSHS by mail later.

Demographic Form (Page 3):

• Make sure the protective flap is covering the filter paper to avoid contamination of the collection surface. 
• Confirm the newborn’s identity and ensure that all data is complete. Accurate information on the demographic form is vital for testing and result follow-up. Please take extra care when completing this information. 
• Legibly print ALL information. USE black or blue ballpoint pen AND BLOCK CAPITAL LETTERS. Press hard for good copies.
• Mother’s Information
  • The information should be the biological mother’s information. If adopted, fostered, born via surrogate, or a ward of the state, the information should reflect who will care for the baby after release from the health care facility. 
• Baby’s Primary Care Provider Information
  • Provide the name and contact information for the baby’s primary care provider. This information is essential for follow-up if the newborn screening result is abnormal. 
• Newborn Information
  • Record the Birthweight in grams. For second screens, record the baby’s birthweight at the time of birth, not the current weight. 
  • Enter both the Date of Birth and Date of Collection, including the Military Time. 
  • For second screens, if available, include the serial number of the first screen in the Previous Specimen Serial Number box. 
  • Indicate the baby’s Sex, Feed, Ethnicity/Race, and Status using the appropriate codes.
    • Indicate the baby’s feed status by selecting applicable code listed on the demographic form. Options include breastmilk only, formula only, TPN +/- milk (total parental nutrition with or without milk), breastmilk & formula and NPO (nothing by mouth).
      • TPN is the most important feed status to report, as it can significantly affect newborn screening results, even if the baby only received it temporarily. If the baby received TPN at any time before or during specimen collection, you must include this information. 
  • Health care professionals define gestational age at birth as the weeks from the mother's last menstrual period to delivery. It is a crucial measure used to determine the maturity of the fetus and is essential for assessing the baby's health at birth. Document the Gestational Age in weeks and days at birth. For second screens, enter the gestational age at birth, not the baby’s current age. Gestational age does not change once the baby is born.
  • If the infant received a blood transfusion, enter the Last Transfused Date. Transfusions-including red blood cells, platelets, fresh frozen plasma, or cryoprecipitate-even those received in utero, can affect test results.
  • Meconium ileus is a bowel obstruction in newborns caused by excessively thick and sticky meconium. The first stool blocks the small intestines, specifically the ileum. When meconium ileus is present, it can impact newborn screening by giving inaccurate results for the cystic fibrosis test. Check ‘Yes’ if the infant has meconium ileus. If there is no meconium ileus, leave blank. 
• Submitter Information
  • Provide the full address where you want us to send the results. You can order pre-printed labels using the Order Form for Newborn Screening Supplies.
• After you provide the Parent Information and Storage and Use Form, check the box on the demographic information sheet that indicates “Check to verify parent information & decision form distributed.”
• Remove the yellow submitter’s copy of the demographic form (page 4) and keep it for tracking results.

Impact of incorrect demographic information includes, but is not limited to:

• Rejection of specimen for testing.
• Wrong result reported (normal vs. abnormal).
• Results released to the wrong health care provider.
• Delay in the initiation of follow-up for an abnormal result.

Recommended Specimen Collection Techniques

Avoid contaminating the pre-printed blood collection circles on the filter paper in the Newborn Screening Collection Kit. Do not use antiseptic solutions, powders, lotions, or other materials that could affect the testing process.

• Wash hands vigorously. Wear gloves and change gloves between newborns.
• Warm the newborn’s heel around the intended area of the skin puncture site. You can use commercially available heel-warming devices or a warmed, moist towel to do this. Warm the puncture site for three to five minutes to a temperature of no higher than 42 °C.
• Position the newborn’s leg at the level of the heart or lower to increase venous pressure. 
• Clean the puncture site with alcohol. 
  • DO NOT use any product with chlorhexidine gluconate, such as Chlorascrub swabs.
  • DO NOT use alcohol swabs with topical painkillers such as benzocaine.
• Allow the skin to thoroughly air-dry.
• Applying gentle pressure, puncture with a sterile retractable disposable heel lancet <2.0 mm for average-weight newborns and <0.85 mm for preterm and low birth weight term newborns. You must follow the manufacturer’s instructions for the orientation of the lancet. If there are no instructions provided, the puncture should be perpendicular to the heel prints, not parallel to them, which enables bigger drops of blood to form. The perpendicular puncture prevents blood from running down the grooves of the heel prints. 
• Wipe off the first drop of blood; this eliminates the risk of dilution of the blood by tissue fluids and any residual alcohol.
• Gently squeeze the newborn’s heel to allow a LARGE round drop of blood to form. Gently touch the drop of blood to the center of a preprinted circle on the filter paper. Do not use the heel as an application device. Apply to one side only while viewing from the other side to ensure COMPLETE SATURATION OF THE ENTIRE CIRCLE.
• If, after blood application, the preprinted circle is not full, do not apply more blood. This often causes the blood to cake, clot, or layer. Continue to the next circle, and make sure that you form a LARGE drop of blood.
• Complete one circle at a time and FILL ALL PREPRINTED CIRCLES. Examine both sides of the filter paper to ensure that the blood uniformly penetrates and saturates the paper. If the blood flow diminishes, repeat the specimen collection procedure using a new lancet.
• Allow the card to dry thoroughly at room temperature in a horizontal position for at least three hours. Do NOT allow the specimen to touch any surface.
• Cover the dried specimen with the attached protective flap.
• Ship dried specimens as soon as possible, preferably with an overnight courier. Recommendations state specimens should arrive WITHIN 24 HOURS of collection. If mail or courier services are unavailable, ship as quickly as possible. See the shipment information section below.

The heel stick is always the preferred method for the collection of the newborn screening. If it is not possible to perform a heel stick, please see the Alternative Methods for Collecting a Newborn Screen page for detailed information and instructions.

Additional Information on Recommended Specimen Collection Techniques

• Specimen Collection - Special Circumstances
• FREE Specimen Collection Training Materials
• Specimen Collection Training Video

Shipment of the Newborn Screening Specimen

Quick delivery of the newborn screening specimens is imperative. Health care professionals need to identify, diagnose, and treat some disorders as soon as possible to prevent the onset of clinical symptoms. For example, congenital adrenal hyperplasia and galactosemia may cause life-threatening symptoms by the first week of life.

It is important that submitting facilities are mindful of the time between collection and shipment. New national recommendations state that first screen specimens should arrive at the DSHS Laboratory within 24 HOURS AFTER COLLECTION. To ease timely identification and treatment of critical disorders, we recommend that you ship specimens via overnight courier and ensure they arrive in the laboratory for testing the day after collection.

For Overnight/Courier Shipping (UPS, FedEx, etc.):

Texas Department of State Health Services
Public Health Laboratory Division, MC 1947
1100 W. 49th Street
Austin, TX 78756-3199

For USPS Regular and Priority Mail:

Texas Department of State Health Services
Public Health Laboratory Division, MC 1947
PO Box 149341
Austin, TX 78714-9341

Refusal to Newborn Screen Blood Test 

A parent or guardian can only refuse the newborn screening blood test for religious reasons (Texas Health & Safety Code Sec. 33.012). 

There are important medical benefits of newborn screening to consider: 

• All disorders have intervention or treatment options available. 
• Prevention of complications.
• Improved long-term health for the child. 

Health care providers play a significant role in educating families. Ensure all staff are familiar with the benefits of screening and the negative outcomes that can occur if the baby is not screened. Provide the information outlined above to parents or guardians who are considering refusing the screen. The only legal reason to refuse newborn screening is if it conflicts with the parent or guardian’s religious tenets or practices. 

After education and discussion with the parent or guardian, answering all questions, the parent or guardian may still refuse. The provider must document the refusal in the patient medical record. Providers can use a self-developed form or may use the form provided by DSHS. 

The DSHS Newborn Screening Blood Test Refusal Form provides: 

• Instructions on how to complete the form. 
• QR code to view a short video featuring families affected by disorders on the Texas NBS panel. 
• Discussion prompts for parent or guardian education. 
• Parent or guardian acknowledgment statements and signatures for record keeping. 

Newborn Screening Blood Test Refusal Form: English / Spanish 

Additional Specimens Following Abnormal or Unsatisfactory Screen Results

The submitter (the facility that collected the screen) receives the Newborn Screening Result Reports by mail, fax, or electronic transmission (Texas Newborn Screening Web Application or HL7) 4 to 8 days after receipt to DSHS Laboratory.

Abnormal Results

• Newborn Screening Clinical Care Coordination staff will communicate abnormal newborn screening results to ensure appropriate follow-up.
• If you have questions about an abnormal screen or would like disorder-specific information, please visit the Newborn Screening Clinical Care Coordination home page, or call 1-800-252-8023 ext. 3957.

Unsatisfactory Results
The result report for unsatisfactory specimens will state "UNSATISFACTORY - PLEASE RESUBMIT". The submitting facility must ensure that it submits a follow-up specimen for any unsatisfactory first screen.

If a baby has had two newborn screens and one was “unsatisfactory,” refer to the chart below when determining the necessity of collecting a third newborn screen:

Please Note: Submitting unsatisfactory specimens causes the inconvenience of retesting and delays the screening of the newborn, placing the newborn at risk for delayed diagnosis of a screened condition. Please make every effort to follow proper specimen collection techniques.