Recommended newborn screening policy change for the NICU infant

Newborn screening (NBS), the practice by which infants are tested for certain genetic and metabolic conditions by heel prick 3 to 5 days after birth, has been a beneficial and cost-effective public health strategy. Many of the screened conditions present in the first 2 weeks of life and are life threatening. Because of the risk of metabolic acidosis, seizures, coma, neurological devastation, or death, NBS is essential for prompt diagnosis and treatment, including dietary, hormonal, and other interventions. However, due to the fact that aminoglycosides, blood transfusions, nothing by mouth status, and the presence of heparinized solutions all potentially affect the screening results, NBS guidelines in neonatal intensive care units (NICUs) ought to be changed to obviate inaccurate results. These guidelines, originally initiated by nurses at the Johns Hopkins NICU due to the missed diagnosis and death of an infant, include screening the day of birth prior to any interventions, performing the screen at 1 and/or 2 weeks of life, and repeating screening as needed.