PKU testing - page 2
I am alittle confussed after talking to a friend of mine in California. They do their PKU's after 12 hours of age. Many of their patients go home prior to 24 hours and C-sections go home in 2-3 days.... Read More
Feb 25, '07In KY, we always did them after 48 hours (repeating if discharge occured prior to 48 hours) until about a year or so ago. The law changed and allowed PKUs to be done after 24 hours. That's 24 hours from birth, not from first feeding.
Feb 25, '07We do ours after 24 hours of age. If baby is discharged before 24 hours we do the PKU and it is repeated at 5 days of age. The only time we don't do the PKU is if it's a midwife pt, the midwife will do her own PKU at 24-72 hours old.
Feb 26, '07In Delaware, it is preferred to have initial heelstick done after 24 hours. They come back for repeat test in 7-10 days. If they don't have the repeat done, the state hunts them down apparently, so it can be done.
Feb 26, '07We do ours on day of life 2, which would be day of d/c for vag deliveries. In NC, babe has to be at least 24 hrs old. What I don't like is the timing...usually around 4am. Off topic.
Feb 26, '07By state law, our newborn screens can't be done prior to 48 hours. We had a mom who had to bring her baby back for a repeat screen because her baby's screen was done a whole two minutes early.
Exception, NICU does the NBS on almost all baby's on admission or prior to the baby receiving any blood products. They will then do a repeat screen after the baby is 48 hours old.
Feb 26, '07I'm from Quebec, Canada, and we do our PKU at at least 24 hours of age, if the baby was well fed. The standard is between 24 and 48 hours. In my province, if the test is done before 24 hours of age, they call back the parents for another test, and, instead of filling up 5 circles with the baby's heel blood, they fill 10 circles! That's why we never do it before the baby's at least a day.
Feb 27, '07:smilecoffeecup: In Tennessee, we do ours at least 24 hours after birth, but in reading the slip, it states it is to be done after 24 hours of lactose feeding.
Feb 27, '07It frustrates me to no end, but we do our PKU the night following the baby's birth. This can be as soon as 8-12hours because it is not the norm for our vaginally-delivered moms to stay more than 24 hours---most often, it's less.
silly because the PKU is then redrawn and sent by the follow-up pediatrician due to our practices where I am.
I do know the literature I have read states it is best to both have a baby feeding AND over 24 hours old prior to drawing these screens. With early discharges, these babies are rarely even close to 24 hours old. The c-sect babes, different story. They are done usually on the 2nd night they are with us.
I just do not like how it is done where I work. Seems a lot to put babies through----two PKU/screening draws in their first week of life.Last edit by SmilingBluEyes on Feb 27, '07
Feb 28, '07I just do not like how it is done where I work. Seems a lot to put babies through----two PKU/screening draws in their first week of life.
(Quote SBE above)
I agree, Deb. When I worked in Pennsylvania, state law required a PKU to be drawn prior to hospital discharge, regardless of whether the test would be valid in terms of age and feeding status. That meant that even if we were transferring a ciritcally-ill baby to a tertiary care facility, we HAD to do the PKU, since we were technically discharging the baby from our facility. Thankfully, most of these babies had lines, so we weren't sticking them for the blood.
Feb 28, '07see that is our conondrum (however ya spell it)----we MUST draw PKU by law (unless parents sign AMA/refusal) prior to d/c home from the hospital.
Apr 11, '07As a PKU mom (DS is 8 months old with classic PKU) and a nurse, I can tell you that it was a blessing that my son had his Guthrie test done at 48 hours. Even then his phe levels were barely above normal. When I retested a week after birth, he was 5x's higher than what he should be. If we had tested before 24 hours we might have slipped through the cracks. Believe it or not it still happens.
Apr 11, '07We do them after 24 hours. I'm in CA BTW.
Unless babe needs to be transfused in the first 24 hours. Then it needs to be redrawn.
According to an article I read, catabolism is part of newborn physiology so for many tests 24-48 hours is sufficient. Since some IEM's can become syptomatic very quickly and time is essential in reducing morbidity/mortality, I think waiting longer than 48 hours isn't a great idea.
Apr 11, '07Here's what Olds, Sally says in "Maternal-Newborn & Women's Health Care":
The Guthrie blood test for PKU is required for all newborns before discharge. The Guthrie test uses a drop of blood collected from a heel stick and placed on filter paper. It should be done at least 24 hours after the initiation of feedings containing the usual amounts of breast milk or formula so its metabolites begin to build up in the baby with PKU once milk feedings are intiated.
The PKU testing of high-risk newborns should be deferred for at least 48 hours after hyperalimentation is initiated. It is vital that the parents understand the need for the screening procedure, and a follow-up check is necessary to confirm that the test was done.
Early newborn discharge puts infants at risk for delayed or missed diagnosis of PKU and congenital hypothyroidism because of decreased sensitivity of screening prior to 24 hours of age. Newborns should be retested by 2 weeks of age if the first test was done prior to 24 hours of age.
The accuracy of the test for PKU is directly related to the newborn's age. The likelihood of detecting PKU increases as the infant grows older, and the infant must be at least 24 hours old for a valid test. A second test is required in most states, usually between one week and one month of age. to minimize the chance of a positive child going undetected.Last edit by GingerSue on Apr 11, '07 : Reason: spelling