All babies in Scotland are eligible for blood spot screening under the auspices of the Newborn Blood Spot Screening Programme (currently up to an upper age limit of six months, from the 20th March 2017 this will change to up to one year of age).
From the 20th March 2017 the following guidance should be used
Newborn Bloodspot Sampling Guidelines 2017 v1.0
Some babies who require specialist neonatal care have additional screening requirements, this is determined by gestation at birth and/or whether their clinical management includes transfusion of blood products.
- Babies admitted to neonatal units are likely to have multiple blood samples taken. Blood spot screening should be coordinated with other tests when possible. On admission/prior to blood transfusion, babies less than 96 hours of age should have a single circle blood spot sample taken for routine SCD screening. This should be on a separate blood spot card marked ‘Pre-transfusion’.
- The pre-transfusion sample should be despatched to the newborn screening laboratory together with the routine day 4-5 day (96-120 hours) sample if the baby has received a blood transfusion in the interim. The pre-transfusion sample can be discarded appropriately if the baby has not received a blood transfusion. If the baby is transferred to another unit before the day 5 sample has been taken, ensure the pre-transfusion sample accompanies the baby.
- The routine blood spot sample (four spots) should be taken between 96-120 hours of life (4-5 completed days) for all babies. For the purpose of screening, day of birth is day 0. *In exceptional circumstances the sample can be taken between day 5 and day 8. If taking the sample on day 4 the babies age in hours at the time of sampling should be recorded in the comments section of the card
- When a baby has had a blood transfusion, either intrauterine or in the newborn period, an interval of at least three clear days is required between the transfusion and the routine blood spot sample for CF, CHT and the IMDs, however, in the event of multiple blood transfusions, even if it has not been three clear days since the last transfusion, a routine blood spot sample should be sent by day 8 at the latest regardless. In this scenario, a repeat sample will be needed at least three clear days after the last transfusion.
- The date of the last blood transfusion before the blood spot must be recorded on the blood spot card and on discharge/transfer notifications. Inform parents of any outstanding screening tests, and record this in the PCHR and maternity/professional record.
CHT sampling
- Babies born at less than 32 weeks (less than or equal to 31 weeks + 6 days) require a second blood spot sample (two spots) to be taken, in addition to the day 5 sample. The explanation to be given to parents is that in babies born at less than 32 weeks of pregnancy, the routine test may not pick up congenital hypothyroidism. It is advised to have another test at either 28 days of age or immediately before the baby is discharged home, whichever comes first. Mark the card ‘CHT preterm’. Write the gestational age on the card.
- If the baby is being discharged home before 28 days of age, write ‘discharged home’ on the repeat sample. Record all blood spot samples taken in baby’s hospital records, on transfer documentation, PCHR and on an auditable IT system.