PKU testing

In 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.

We 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.

In 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.

By 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.

I'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.

: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.

It 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 lady partslly-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.

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.

(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.

see 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.

As a PKU mom (DS is 8 months old :monkeydance: 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.

We 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.