Phenylalanine testing...once or twice?

JustBeachyNurse, LPN · Oct 1, 2014

My son and most of my patients were tested once after birth.

Pediatric Critical Care Columnist · Oct 1, 2014

They have to have been fed some form of milk before they can be tested. Neonates who are too sick at birth to be fed will be tested later, but I've never heard of any peds offices testing them at their first visit.

klone, MSN, RN · Oct 1, 2014

Our peds office does the PKU at the first well baby visit.

Elvish, BSN, DNP, RN, NP · Oct 3, 2014

Most kids in our place get one screen once they're over 24 hours old (assuming well-baby here). If parents refuse it in hospital or there is a need to redraw, the peds office can do it.

Reality is overwhelmingly that they get it once.

SilleLu · Oct 4, 2014

Thank you for the responses!

TiffyRN, BSN, PhD · Oct 4, 2014

All the infants in the NICU where I work get two state screens that include PKU; the first at 24-48hrs old and the 2nd at 7-14 days old. My understanding is that the well kids get one in General Nursery & a second one at the Pedi office at 7-14 days old.

Elvish, BSN, DNP, RN, NP · Oct 4, 2014

The only time I've seen multiple ones be drawn on well babies is a) problem with the initial sample, such as insufficient blood on the paper; or b) Mom has a known case of PKU/galactosemia etc. I've only seen the second scenario once in all my years. We did that kid's screen at birth, at 12 hrs, 24 hrs, at discharge, and s/he got a 4th at 7-10 days (honestly can't remember if it was a boy or girl, LOL).

Not meaning to contradict Tiffy above...there may be variations between facilities or regions. Just saying what I've seen.

TiffyRN, BSN, PhD · Oct 4, 2014

Not meaning to contradict Tiffy above...there may be variations between facilities or regions. Just saying what I've seen.

Hey, no problem!! I think it is important to know that there can be a lot of variation from different States. I'll look at the forms tonight, which are written to be read by parents or providers of well babies directing them to do the repeat test at 7-14 days old.

zeus&lincoln · Oct 6, 2014

In our NICU we do it at admission, again at 48-72 hours old, then again at 28 days old and if there is a problem we will repeat again. The first three PKU testings are done on every single baby that comes thru our NiCU regardless of the outcome of the first test. Hope that helps.

TiffyRN, BSN, PhD · Oct 6, 2014

Off the state screen form: "Q: when is my baby tested? A: In Texas, babies have a newborn screening test when they are 1-2 days old. This test is done again at 7-14 days old. The test is done in accordance with Texas law."

Elvish, BSN, DNP, RN, NP · Oct 6, 2014

Off the state screen form: "Q: when is my baby tested? A: In Texas, babies have a newborn screening test when they are 1-2 days old. This test is done again at 7-14 days old. The test is done in accordance with Texas law."

You got me curious, so I looked up my state's requirements.

]A filter paper blood spot sample is required by state law (GS 130A-125) to be submitted to the North Carolina State Laboratory of Public Health for each infant born in North Carolina. The sample is tested for conditions that may cause mental retardation or death, if untreated. To prevent the effects of disease, the sample should be drawn during the infant´s first two to three days of life.

North Carolina State Laboratory Public Health - Newborn Screening

Very interesting to see the variation. It's also interesting to note that states vary on which conditions they test for. NC tests for 25 conditions but others test for more or fewer than that.