Newborn bloodspot screening (NBS) (formally known as newborn screening testing) commenced in Victoria in 1966, when screening was introduced for Phenylketonuria. Since then, screening has expanded to testing for Congenital Hypothyroidism, Cystic Fibrosis, Phenylketonuria, Congenital Adrenal Hyperplasia (CAH) and over 22 other rare conditions. These rare but serious conditions cannot be seen by just looking at the baby. These tests ensure early detection and treatment of these conditions to save lives.
This guideline provides an outline for medical and nursing staff to perform screening tests for newborn infants at the Royal Children's Hospital.
Definition of Terms
Palliative care for children and young people with life-limiting
conditions is an active and total approach to care, embracing physical,
emotional, social and spiritual elements. It focuses on enhancement of
quality of life for the child and support for the family and includes the
management of distressing symptoms, provision of respite, and care through
death and bereavement.
Packed red blood cells/exchange transfusions, platelets, fresh
frozen plasma, and albumin.
Policy for Blood Transfusion - Fresh Blood
Products policy and procedure.
Extremely Low Birth Weight (ELBW)
Birth weight < 1000 grams.
Very Low Birth Weight (VLBW)
Birth weight < 1500 grams.
Timing of the Test
All newborn infants are screened regardless of gestational age, weight, feeding or health status between 48 and 72 hours of life.
Palliated infants: A sample should still be obtained on palliated infants. This may help to exclude diseases which may have implications for the family in future pregnancies. If the sample is taken after the infant dies, write in red on the screening card that it is a “post-mortem” or “peri-mortem” sample as there is a marked difference in the metabolic profile between a live and a deceased infant.
Blood Sampling Table
** If a blood transfusion was received after first
sample, obtain repeat sample when there is a 3-week gap after receiving blood
product. If collection is delayed due to the infant receiving multiple
transfusions, it is acceptable to delay repeat sample, however, do not delay
repeat collection for too long.
recollection has been missed, collect sample as soon as this is
- Birth weight < 1000 grams: repeat sample no
later than 6 weeks of age
- Birth weight 1000 grams-1500 grams: repeat
sample no later than 4 weeks of age
If in doubt or you have any queries in regards to timing of screening, contact
the Newborn Bloodspot Screening Laboratory: Ext 16272
Responsibility Prior to Collection
Nursing staff on each shift are responsible for
checking that screening is performed or has been performed on infants in their
- Nursing staff need to obtain written informed
consent from a parent/guardian prior to performing the test.
Note: if parent/guardian not available to provide
written consent - writing ‘verbal consent by phone’ is only acceptable with
written explanation as to why no parent/guardian signature obtainable. Written or verbal consent is only
applicable for the first card sample.
For subsequent samples, parents should know it has
been taken, but are not required to
sign each subsequent card.
- Parent information leaflet (Newborn Bloodspot
Screening – for the health of your baby) informs parents about the
screening program and should be given to the parents and discussed prior
to obtaining written consent. An interpreter may also be required if their
language not available on the website.
- The brochure, and the simplified version in 12
other languages is available on the Newborn Bloodspot Screening website.
The information leaflet can also be obtained from VCGS (Victoria Clinical
Genetic Service), 4th Floor East, Royal Children's Hospital.
| Ensure all details are filled out correctly on the newborn bloodspot screening card including:
- Birth hospital and current hospital
- Date and time of birth
- Date and time of sample collection
- Gestation at birth
- Birth/Current weight
- If there has been a transfusion, list the date
- Tick box if baby is receiving TPN nutrition at time of sample
- If the baby is male or female gender
- Relevant clinical/family history –
refers to the metabolic conditions we are testing for and if the baby has
a past medical history of relevant conditions such as; meconium ileus,
severe jaundice or maternal hypothyroidism
- Collector’s name
Occasionally, stored newborn bloodspot screening cards get used for
research. Some examples are the development of new tests or determining normal
levels of a biomarker. This research is de-identified (i.e. no personal details
are released to the researchers) and must be approved by an ethics committee.
Parents can tick the “No Secondary Research Use” box if they do not wish their
child’s card to be available for such research
Refusal of Consent
If parents refuse to have the test the following steps should be followed:
Record date and time of sample taken in:
| Electronic Medical
Flowsheets > Primary Assessment > Newborn Bloodspot Screening (NBS).
| Child Health Record
book (Green book)
|| In the ‘Birth Details’ section. |
- Samples should be
airdried at the bedside for 4 hours
- Samples should then
be placed in a paper envelope and sent immediately after drying directly to VCGS Specimen Reception or to RCH
Specimen Reception (both via the pneumatic tube)
- VCGS Specimen
Reception – pneumatic tube #4 (send
to this station between 0700-1700 only)
- RCH Specimen
Reception – pneumatic tube #2 (send
to this station at all other times)
For more information about what happens after
screening, please refer for the Newborn
Bloodspot Screening Information for Parents brochure.
RCH Newborn Screening Clinical Nurse Consultants
Noelle Giordano, Tabitha Hole, Mia Normoyle
Phone: (03) 9345 6244 or (03) 9345 6062
Newborn Bloodspot Screening Laboratory
Victorian Clinical Genetic Services
Royal Children's Hospital, Parkville 3052
Tel: (03) 8341 6272 Fax: (03) 8341 6339
Newborn Bloodspot Screening Nurse: Email:
Phone: (03) 8341 6460
Newborn Screening Evidence Table
Please remember to
read the disclaimer.
The development of this nursing guideline was coordinated by Lauren Cross, Registered Nurse/Midwife, Butterfly Ward, and approved by the Nursing Clinical Effectiveness Committee. Updated January 2023.