Heel prick test...

[ann_of_loxley]

To test for things like sickle cell and PKU, etc...

I remember reading that it should not be done right after the birth - it would be inconclusive then and pointless. The best window of opportunity is the 5-8 day period to test for these things.

So...why exactly should it not be done right after the birth?

Thanks

[alegna]

The results aren't useful until baby has been eating for awhile.

-Angela

[Kiddoson]

Originally Posted by alegna

The results aren't useful until baby has been eating for awhile.

-Angela

:
we did ours about 9 days old. mainly cause i couldn't drive til then. can do it 2 days after milk comes in.

[nashvillemidwife]

It's mostly a test for metabolic diseases which aren't going to show up until the baby's system has metabolized something.

[sapphire_chan]

There's a higher chance of false positives--except with the hypothyroid test where there's a good chance of a false negative. If you get the test done at 36 hours odds are you'll have to get another anyway.

[Kiddoson]

Originally Posted by sapphire_chan

There's a higher chance of false positives--except with the hypothyroid test where there's a good chance of a false negative. If you get the test done at 36 hours odds are you'll have to get another anyway.

Sad that my DD was never tested again after the initial prick. she had the vit K so it was hell getting the blood out, she screamed the poor thing. If there had a prob they wouldn't have known since the test was done too soon. They would have done the same to DS had I not said no and brought him back later. DS was born in PA and we live in MD, apparently MD does many more tests that PA. We didn't go again, just stuck with whatever PA did. :

[nashvillemidwife]

Originally Posted by sapphire_chan

If you get the test done at 36 hours odds are you'll have to get another anyway.

This must vary according to each lab's procedures. I always do mine between 24-48 hours as per our state law and have never had to repeat any.

[mwherbs]

I suggest reading on metabolic screening -- for example they test for cystic fibrosis here and the test is actually a state of the art test and is not really a screening test but is diagnostic - but they go through the moves of the other test because it is what has been accepted(maybe even legally defined) in our state.
in the past the PKU test was the Guthrie Test, now PKU can be detected in infants under 24 hrs and with less false positives using the newer testing methods--

the newer testing is MS/MS , tandem mass spectrometry

[sapphire_chan]

I've also read that for a bit more money they can even use cord blood for the test, anyone know about that?

[nashvillemidwife]

They can use cord blood for the tests that aren't for metabolic disorders. The problem is that the newborn screening is for a whole panel of disorders (in most states between 30-40 different diseases), some of which can be done early and some that need to wait until the baby has eaten.

A lot of people say that the tests aren't reliable on breastfed babies until the milk comes in, but the test values take into account whether or not the baby is breastfed and uses different values for range of normal. Perhaps some labs don't do this and they are seeing more inaccurate results. We don't see that here.

[hapersmion]

Originally Posted by nashvillemidwife

This must vary according to each lab's procedures. I always do mine between 24-48 hours as per our state law and have never had to repeat any.

Tennessee laws say 24-48 hours? Weird. I was planning for the next baby to have it done around five days old, like last time. Is that for all midwives in TN, or just for midwives who are licensed with a certain group?

[nashvillemidwife]

That's for all babies. Care provider or place of birth is irrelevant.

[nashvillemidwife]

Specifically, for babies born in the hospital:

Every chief administrative officer of a hospital and the attending physician in each instance shall be responsible for submitting a specimen of blood to the State of Tennessee Laboratory, State Department of Health, in a manner as directed by the Department. This sample shall be collected before newborn infants are discharged from the nursery, regardless of age.

Every chief administrative officer of a hospital and the attending physician shall direct every parent, guardian, or custodian to bring the infant, if the infant was initially screened before twenty-four (24) hours of age, back to the hospital or to a physician or the nearest local health department to be re-screened within twenty-four to forty-eight (24-48) hours after birth.

For home or birth center babies:

Any health care provider(s) of delivery services in a non-hospital setting shall be responsible for submitting a specimen of blood to the State of Tennessee Laboratory, or directing every parent, guardian, or custodian to bring the infant, between twenty-four to forty-eight (24-48) hours of age, to a hospital, physician or local health department to be screened for Biotinidase Deficiency, Congenital Adrenal Hyperplasia (CAH), Congenital Hypothyroidism, Galactosemia, Hemoglobinopathies, Homocystinuria, Maple Syrup Urine Disease (MSUD), Medium-Chain Acyl CoA Dehydrogenase (MCAD) Deficiency, Phenylketonuria (PKU), and other metabolic/genetic tests as designated by the Department of Health.

For UC babies:

Any parent, guardian, or custodian residing in Tennessee, of an infant born in Tennessee, outside a Tennessee health care facility and without the assistance of a health care provider, shall between twenty-four to forty-eight (24-48) hours of the birth of said infant present said infant to a physician or local health department for testing for the purpose of detecting Biotinidase Deficiency, Congenital Adrenal Hyperplasia (CAH), Congenital Hypothyroidism, Galactosemia, Hemoglobinopathies, Homocystinuria, Maple Syrup Urine Disease (MSUD), Medium-Chain Acyl CoA Dehydrogenase (MCAD) Deficiency , Phenylketonuria (PKU), and other metabolic/genetic tests as designated by the Department of Health.

[hapersmion]

Originally Posted by nashvillemidwife

That's for all babies. Care provider or place of birth is irrelevant.

Interesting. They never said anything to me about it when I showed up for the test at 5 days.

[nashvillemidwife]

A lot of midwives do wait, but I think it's irresponsible not to at least tell parents and give them the option of having it done sooner. While uncommon, these are diseases that are very serious yet easily treatable when caught early. Simply knowing a few days sooner that their diet should be modified can save a baby from permanent damage or even death. If I was caring for a baby that suffered because I didn't offer testing at the appropriate time, I would have sad parents and my own conscience to deal with in addition to the state.

[ZoeyZoo]

Originally Posted by sapphire_chan

I've also read that for a bit more money they can even use cord blood for the test, anyone know about that?

I used cord blood for mine. The cord blood is accurate for the genetic tests (like sickle cell) but not for most of the metabolic tests. Some metabolic tests can be accurate depending on the equipment the lab uses since some of the metabolic tests look for matter that is passed through and processed by the placenta as well as BM. Several of the metabolic tests (like PKU) can also be tested for from urine after 2 weeks (a great excuse to practice EC). It didn't cost me anymore $ than the heel prick.

I went through a private lab though since most states store the blood samples for "research".

[hapersmion]

Originally Posted by nashvillemidwife

A lot of midwives do wait, but I think it's irresponsible not to at least tell parents and give them the option of having it done sooner. While uncommon, these are diseases that are very serious yet easily treatable when caught early. Simply knowing a few days sooner that their diet should be modified can save a baby from permanent damage or even death. If I was caring for a baby that suffered because I didn't offer testing at the appropriate time, I would have sad parents and my own conscience to deal with in addition to the state.

I certainly agree that informed consent is good. I was informed about the health part - the midwife would have done the test at two days old if we had stayed that long. I was unaware of the legal aspects, though, thanks for the info.

Looks like I'll have to look into all this (cord blood testing too) more deeply for the next time.

[nashvillemidwife]

Well, unless you UC, the legal aspect if the responsibility of the midwife. The law says she's either supposed to take the sample or refer you to the ped or health dept within 24-48 hours.

You can't do cord blood testing for the newborn screening in TN.

[hapersmion]

Ah, I see. She did her part, then - I had access to hospitals and midwives once I got back home.

Hmm, oh well about the cord blood then. We usually donate it anyway, no reason to add more confusion.

[nashvillemidwife]

Of course you had access, but did she tell instruct to take the baby to the hospital, health department, or doctor between 24-48 hours after the birth? Just curious, it doesn't matter to me. But by law that's what she was supposed to do.