Newborn Screening (Nursing)

00:01 We're going to take an opportunity to talk about newborn screening.

00:06 So what is newborn screening exactly? It can identify conditions that can affect a child's long term health and survival.

00:14 And these particular disorders that we screened for, if we have early detection and diagnosis, and we can intervene in these disease process, we can really prevent a lot of death and disability.

00:28 So, what is this going to look like? In America, individual states are responsible for newborn screening.

00:35 So this means that the screening can vary from state to state.

00:39 Now, this is also true in Canada.

00:41 So the screening does vary a little bit from province to province.

00:45 And additionally, European countries also routinely participate in newborn screening.

00:50 And these screening conditions vary from country to country.

00:56 In the US, there's a recommended uniform screening panel.

01:00 And this is published by the federal government.

01:03 These recommendations are taken into account by the states.

01:07 And the states determine which conditions they're going to screen for, based on the ability of the state to actually screen for the disorder.

01:16 So do they have the equipment to do this? And the availability of effective treatments? So it's a state by state decision based on the recommendations of the federal government.

01:28 Now, don't freak out, this is a very busy table, and you do not have to memorize all of these.

01:33 This is just to give you an example of all the different types of things that we can screen for.

01:39 This doesn't mean that every state or country screens for every one of these conditions.

01:44 But these are the conditions that we could potentially screen for.

01:50 So what are some common tests when we're doing newborn screening? There are three main categories.

01:56 We're going to perform hearing tests on these infants.

02:00 We are going to check a pulse oximeter on the right palm and the right foot.

02:04 And this can help rule out some congenital heart defects.

02:08 And we're going to collect a blood specimen.

02:11 And this is a way to rule out a whole host of other conditions, including a lot of the inborn errors of metabolism.

02:19 So how do we submit this blood test for newborn screening? And we'll have to redo this test.

02:24 So make sure that you're in the correct window when you're obtaining this blood test.

02:29 You want to really find the safe areas on the sole of the foot, which are going to be toward the side of the heel and warm that heel up because you want as much blood flow to that heel as you can possibly get.

02:40 Because we're going to need several drops of blood to fill this card.

02:44 Then when you go to collect the blood for the card, you want to wipe away that first drop of blood because sometimes there's some tissue, fluids in there that could really dilute down that drop of blood.

02:58 So we don't want that first drop of blood, you're going to wipe that one away.

03:01 And then you're going to continue to squeeze on that foot to get the additional drops of blood.

03:08 Now once you get a good bead of blood on the foot, you're going to place that foot on the card.

03:15 So you're going to lightly tap that card with the foot and get that blood into the circle.

03:20 And occasionally, you're going to need an additional drop of blood right away to make sure we've got that circle completely filled.

03:28 So you don't want to layer too many drops of blood onto that circle because the lab card really if it's oversaturated or layered with too much blood, we may have to send an additional sample.

03:40 But once you do get those circles filled, then we're going to let that blood card drive for a minimum of three hours before you package it up and send it to the lab that's going to analyze the results.

03:52 So how do we do the hearing test? When we're checking hearing on an infant, one of the ways we can do this with is with otoacoustic emissions.

04:01 So we put the instrument in the infancy ear and you can measure the sound waves bouncing back and forth.

04:06 An additional way that we can do this is auditory brainstem response.

04:11 So we're actually placing electrodes on the infant and we stimulate their brain by using sound waves.

04:19 And those electrodes pick up brain activity.

04:21 So we can tell if the infant actually heard the sound or not.

04:26 So each year millions of babies in the US are routinely screened.

04:32 For certain genetic, endocrine, and metabolic disorders, using a few drops of blood from the newborns heel can really give us a lot of information.

04:41 And eventually they can also be tested for hearing loss and for those critical congenital heart defects prior to discharge from the hospital or the birthing center.

04:53 So the newborn screening really allows for early detection of conditions that could otherwise result in death or a lot of disability for these patients.

05:02 And in many of these disease processes, the earlier we can intervene, the better the outcome is going to be for the patient.

05:11 About 12,500 newborns are diagnosed with one of these core conditions every year.

05:18 So let's use the clinical judgment model just to think about newborn screening.

05:24 We really want to recognize cues first, that is the first step in our clinical judgment model.

05:30 And newborn screening is pretty easy.

05:33 We're going to do that for every infant.

05:36 So it identifies conditions that can affect a child's long term health or survival.

05:41 And this early detection and intervention really can prevent a lot of death and disability.

05:46 So their cue is that an infant is born, and we should definitely be doing newborn screening with them.

05:55 So there's a couple of different screening methods.

05:58 So as we're recognizing those cues, we can perform hearing tests, the pulse ox test, and we can collect blood.

06:06 And this is going to allow us to take any actions and evaluate outcomes as we move along this clinical judgment model.

06:13 So remember, we give you a couple of examples of how you can use this clinical judgment model.

06:18 But remember, you're going to want to move through all of the steps.