1. Newborn Screening:
Because you touch the future everyday

2. Purpose of Newborn Screening
 Screens for congenital and heritable disorders
 These disorders may cause severe mental
retardation, illness, or death if not treated
early in life
 If treated, infants may live relatively normal
lives
 Results in savings in medical costs over time

3. If Untreated, Disorders
 Can result in:
 Growth problems
 Developmental delays
 Behavioral/emotional problems
 Deafness or blindness
 Retardation
 Seizures
 Coma, sometimes leading to death

4. Texas Newborn Screening Facts
 Texas has been screening newborns since late 1963,
pilot & beta testing done. It was required by law in
1965.
 PKU was first test available by using dried blood
spot. Texas now tests for 27 disorders.
 All disorders are autosomal recessive disorders
except Congenital Hypothyroid.
 CH has higher incidence in Hispanic females.
Nationwide rate 1: 3,500; Texas rate 1:1,800

5. Texas Facts Continued
 Texas is 1 of 8 states currently requiring 2
NBS tests. Many states recommend 2nd
NBS.
NBS Program identifies about 10% of
diagnosed cases on 2nd
NBS.
 DSHS Lab processes 3000- 3.500 specimens
per day.

6. Changes in NBS Program
 Lab and Case Management have gone to 6
day work week. Only “Panic Codes” will be
called out on Saturdays
 DSHS Regional staff increased to assist in
locating hard to find infants and referring to
additional programs
 Lab using mailbox to speed up delivery of
specimens

7. Abnormal/Normal Results
 Normal results: Mailer will be sent out by
regular postal service. Typically received in
submitting facility in 10 working days
 Abnormal results: Health care provider
notified as soon as result is available and
provider is located.
 Web Based system: NBS results available
online when NBS completed-approx. 5
working days after receipt of specimen.

10. Abnormal Specimen
 Case Management will send:
 Lab results for that disorder
 ACT sheet specific to that disorder
 FACT sheet for families
 List of Specialists

11. Abnormal Results
for each disorder
 Panic Codes
 are reported to RN in NBS Case Management
 RN will notify MD ASAP. If MD unavailable RN
will notify mother
 Abnormal Codes
 Health Tech will notify MD or facility
 Mother notified by letter

14. Estimated Expansion Statistics
 Approximately 412,000 births a year
 Approximately 800,000 specimens a year
collected
 Follow-up on approximately 15,000 abnormal
screens a year
 Approximately 620 diagnosed cases per year
Program will also identify about 300
secondary target disorders.

15. Sickle Cell Trait
 Newborn Screening Program began notifying
parents of Sickle Cell Trait in December
2007.
 Program will identify approximately 10,000
infants with Sickle Cell Trait per year.
 Significance of Trait may need to be
explained to parent.

16. Things Parents Should Know after
Abnormal Screen
 This is a screen. There are presumptive positives &
false negatives
 The newborn screen is designed to detect babies at
risk before they have signs and symptoms
 Early detection and treatment results in prevention of
irreversible complications
 There is often no family history. Siblings may not
have history of any screened disorders

17. Criteria for screened disorders
 Disorder occurs with significant frequency
 Test are inexpensive and reliable
 Effective treatment/intervention exists
 If untreated, baby may die or develop severe
retardation
 Affected baby may appear normal at birth
 American College of Medical Genetics
guidelines

18. Texas babies are mandated to have
2 newborn screens
 The first screen at 24-48 hours or before
leaving hospital, whichever is first
 The second screen at 1-2 weeks of age
 Premature and low weight babies are
required to have screens in same time frame
 Take first screen before transfusion

19. This tear off sheet goes to parent:
To remind them to get #2 screen
To give to pediatrician

20. D
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Doctor will be able to call into Lab’s
Voice Response System or online data
system to access results of 1st
screen.

21. Forms ask for (in military
time):
• Time of birth
• Time of collection

22. Circle #3 if any previous screen was abnormal.
Enter DSHS Lab # if possible.

23. No additional blood
spots required.

25. MEDICAID vs PAID
 Use Medicaid Collection Card if:
 Mother is on Medicaid
 Medicaid is pending
 Charity
 You do not know if mother is on Medicaid

26. “UNSAT”: THE TOP 5

27. #5
 Do not use Expired Forms
 Check Form Serial #
 Rotate stock
 Order new forms before old forms expire
 Destroy expired MEDICAID forms
 Send expired PAID forms back to DSHS lab for
credit
 WILL NOT BE ABLE TO ACCEPT WRONG
YEAR ON CARD

28. #4
 Avoid Contaminants
 Waste first drop of blood
 Do not touch filter paper
 Dry flat 3-4 hours
 Do not put in plastic bag

29. Common Contaminants
 EDTA
 Do not use purple capped tubes
 Be careful of hand lotion
 Fingerprints will leave amino acids
 Alcohol
 Wipe dry after cleaning

30. #3
 Mail specimen within 24 hours
 Do Not Batch
 Eliminate unnecessary Stops
 If someone is on vacation- assign to someone else

31. #2
 Date of Collection
 Specimen cannot be processed without date of
collection
 Do not punch or cover up barcodes
 Date of Birth/time of birth
 Other Demographic information is Important
Mother’s name, address
good phone # for to call if abnormal
Get MD’s name if possible

32. #1
 Get a good Blood Spot!
 Use proper lancet: approx 2.0mm
 Must soak through to other side of filter paper
 Get a good blood spot before moving onto the
next spot
 Do not scratch or abrade paper
 Call the Lab for questions or problems

34. Newborn Hearing Screening
 Hearing screening program
 Performed at birth facilities
 Follow up by audiologists
 Referred to Early Childhood Intervention
if hearing loss is found
 About 3 babies per 1000 are born with
hearing loss

35. Resources Available for Parents
 Newborn Screening Pamphlets may be
ordered online. Available in English, Spanish
& Vietnamese and are provided free of
charge. Please call or e-mail NBS Program if
other language is needed.
 March of Dimes Video available in English
and Spanish.
 NBS Website.

36. Resources for Providers
 NBS Pamphlets
 Collection and Newborn Screening Program Video
 Collection posters
 NBS Newsletter
 NBS website
 Power Point presentations on Collection
 Online Provider Education
 On-site In-Services

37. http://www.dshs.state.tx.us/newborn/default.shtm

38. THE END