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:

• The 1st newborn screen should be collected between 24 - 48 hours of age, or before hospital discharge.
• The 2nd newborn screen should be collected on every infant at 7-14 days, a minimum of 168 hours, of age.

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

For more information regarding 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:

• NBS 3 (Medicaid) or NBS 4 (Private Pay) 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

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 Texas Administrative Code, Title 25 section 37.55.  
    o    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. 
     

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 Care (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 Texas Administrative Code, Title 25 section 37.55.   
  • Uninsured care, 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.

Instructions for Pages 1-3 of the Newborn Screening Kit

Texas Newborn Screening Parent Information (Page 1):

• Fill out baby’s information on the top PARENT COPY form
• Give copy to parent for all screens. For 1st screens explain that the form must be taken to the baby’s doctor at the baby’s 7-14 day checkup.

Parental Decision for Storage/Use of Newborn Screening Blood Spot Cards (Page 2):

• Parent or submitter may fill out Section 1. A patient label with the requested information is acceptable.
• Parent reviews, completes, and signs form.
• Submitter returns the form to DSHS with blood spot cards if parent requests.
• It is the parent’s option to take the form home and return to DSHS by mail at a later date.

Demographic Form (Page 3):

• Legibly print ALL information. USE BLACK INK AND BLOCK CAPITAL LETTERS. Press hard for good copies. Do not touch the filter paper blood collection spots.
• For 2nd screens: If available, fill in the serial number for the baby’s 1st screen in the box “Previous Specimen Serial Number.”
• Fill in the number to indicate baby’s ‘Sex’, ‘Feed’, ‘Ethnicity’, ‘Status’, and ‘Baby’s Age at Time of Collection/Test.’
• If the specimen is a repeat for a previous abnormal, fill in the Texas DSHS laboratory number in appropriate spaces.
• Under Submitter Information, fill in the address where the results are to be sent. Labels for this may be ordered using the Order Form for Newborn Screening Supplies (above).
• After information and Decision Form have been provided, check the box on demographic information sheet that indicates “Check to verify parent information & decision form distributed.”
• Remove and keep the yellow submitter copy of the demographic information.

**Accurate information on the demographic form is vital to testing and result follow-up. Please take extra care when completing this information. **

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

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

Recommended Specimen Collection Technique

Gloves should be worn for personal safety. Care should be taken to avoid contamination of blood collection circles with antiseptic solutions, powders, lotions or other materials which may contaminate and adversely affect the testing process.

• Place baby’s limb in dependent position.
• Cleanse skin with alcohol, DRY, and puncture with disposable heel lancet (<2.0mm length).
  • DO NOT use any product with chlorhexidine gluconate, such as Chlorascrub Swabs.
  • DO NOT use alcohol swabs with topical pain killers such as benzocaine.
• Wipe off first drop of blood.
• Allow a drop of blood to form and apply DIRECTLY to filter paper. Apply to one side only while viewing from the other side to ensure COMPLETE SATURATION OF THE ENTIRE CIRCLE.
• Complete one circle at a time and FILL ALL FIVE (5) CIRCLES.
• Allow card to dry thoroughly at room temperature in a horizontal position for at least 3 hours. Do NOT allow specimen to touch any surface.
• Cover dried specimen with attached flap.
• Ship dried specimen AS SOON AS POSSIBLE WITHIN 24 HOURS, preferably via overnight courier. If mail or carrier services are unavailable, ship as quickly as possible. See shipment information section below.

The heel-stick is always the preferred method for 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 specimens is imperative. Some disorders need to be identified, diagnosed and treated as soon as possible to prevent 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 facilitate timely identification and treatment of critical disorders, it is recommended that specimens be shipped via overnight courier and received in the laboratory for testing the day after collection.

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

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

For USPS Regular and Priority Mail:

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

Refusal to Newborn Screen Blood Test 

A parent/guardian can only refuse the newborn screen 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. 

Healthcare providers play an important 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/guardians who are considering refusing the screen. The only legal reason to refuse newborn screening is if it conflicts with the parent/guardian’s religious tenets or practices. 

After education and discussion with the parent/guardian, answering all questions, the parent/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 Screen Blood Test Refusal Form provides: 

• Instructions on how to complete the form. 
• QR Code to view short video featuring families affected by disorders on the Texas NBS panel. 
• Discussion prompts for parent education. 
• Parent/Guardian acknowledgement statements and signature for record keeping. 

Newborn Screen Blood Test Refusal Form: English / Spanish 

Additional Specimens Following Abnormal or Unsatisfactory Screen Results

Newborn Screening Result Reports are mailed, faxed or electronically transmitted (Texas Newborn Screening Web Application or HL7) to the submitter (the facility that collected the screen) 4 to 8 days after receiving the specimen.

Abnormal Results

• Newborn Screening Clinical Care Coordination staff will communicate abnormal newborn screening results to assure appropriate follow-up.  
• If you have questions regarding 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 is responsible for ensuring that a follow-up specimen is submitted for any unsatisfactory 1st screen.

If a baby has had two newborn screens and one was “unsatisfactory,” refer to the chart below when determining the necessity to collect a 3rd 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.