CE/CME

Newborn Screening

Welcome to the training on Newborn Screening provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).

Credit Hours: 1.00 CE

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Goal

The goal of this module is to equip Texas Health Steps providers and other interested health care professionals to participate in the state’s newborn screening program—and once screening is performed—to correctly interpret and act upon the results, educate parents and provide appropriate follow-up and referral when necessary.

Target Audience

Texas Health Steps providers and other interested health care professionals.

Specific Learning Objectives

After completing the activities of this module, you will be able to:

  1. Summarize the timeframe for conducting newborn screening and the broad categories of health disorders they cover.
  2. Specify procedures that ensure satisfactory collection and handling of newborn dried blood spot specimens to avoid delay in receiving results. 
  3. Employ the state’s ACT and FACT information sheets about each screened disorder that are available for health care professionals and for parents or caregivers.
  4. Evaluate how to communicate with parents about positive newborn screening results, follow-up testing and available services.

Note: The term “parents” in this module includes guardians and caregivers.

All data presented in the module reflect the most recent year for available data.

Please note this module expires on 7/6/2025.

This module was released on 7/6/2022.

Featured

American Academy of Pediatrics. (2017). Newborn Screening Expands: Recommendations for Pediatricians and Medical Homes—Implications for the System.

American College of Obstetricians and Gynecologists, Committee on Genetics. (2019). Committee Opinion No. 778: Newborn Screening and the Role of the Obstetrician-Gynecologist.

Baby’s First Test. (2018). Newborn Screening 101.

Clinical and Laboratory Standards Institute (CLSI). Dried Blood Spot Specimen Collection for Newborn Screening, 7th ed. CLSI standard NBS01. Clinical and Laboratory Standards Institute; 2021.

Botkin, J. R., Rothwell, E., Anderson, R. A., Goldenberg, A., Kuppermann, M., Dolan, S. M., Rose, N. C., & Stark, L. (2014). What Parents Want to Know about the Storage and Use of Residual Newborn Bloodspots. American Journal of Medical Genetics, Part A, 164(11): 2739–2744.

Botkin, J. R., Rothwell, E., Anderson, R., Stark, L. A., & Mitchell, J. (2014). Public attitudes regarding the use of electronic health information and residual clinical tissues for research. Journal of Community Genetics, 5(3):205-13.

Botkin, J. R., Rothwell, E., Anderson, R. A., Rose, N. C., Dolan, S. M., Kuppermann, M., Stark, L. A., Goldenberg, A., & Wong, B. (2016). Prenatal Education of Parents About Newborn Screening and Residual Dried Blood Spots: A Randomized Clinical Trial. JAMA Pediatrics, 170(6):543-9.

DeLuca, J. M. (2017). Public Attitudes Toward Expanded Newborn Screening. Journal of Pediatric Nursing, 38:e19-e23.

Stevens, B., Yamada, J., Campbell-Yeo, M., Gibbins, S., Harrison, D., Dionne, K., . . . Riahi, S. (2018). The minimally effective dose of sucrose for procedural pain relief in neonates: a randomized controlled trial. BMC Pediatrics, 18(1):85.

Texas Administrative Code 25.1.37D, Rule 37.56. Responsibilities of the Physician (or Other Person Attending a Newborn, if No Physician is Present) and Collection of First and Second Specimen.

Texas Department of State Health Services. (2021). 10 Things Parents Want to Know About Newborn Screening. Available in English and Spanish.

Texas Department of State Health Services. (2022). Newborn Screening Laboratory.

Texas Department of State Health Services. (2021). Newborn Screening Program.

Texas Department of State Health Services. (2021). What Parents Want to Know About Newborn Screening. Available in English and Spanish.

Medical Definitions

The medical definitions provided in this module were adapted or obtained from American Family Physician, Children’s Hospital of Philadelphia, Medline Plus, Merriam Webster and the U.S. National Library of Medicine.

Continuing Medical Education

The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians. 

The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.00 contact hour(s) of Continuing Nursing Education.

Social Workers

The Texas Department of State Health Services, Continuing Education Service, the continuing education provider, ensures that the education provided is directly related to the practice of social work; and that the individuals presenting the information have the necessary experience and knowledge in the topics presented. The Texas Department of State Health Services, Continuing Education Service has awarded 1.00 hours of credit.

Certificate of Attendance

The Texas Department of State Health Services, Continuing Education Service has designated 1.00 hour(s) for attendance.

General Disclosure

One of the requirements of continuing education is disclosure of the following information to the learner:

  1. Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
    • Create a Texas Health Steps account.
    • Complete on-line registration process.
    • Thoroughly read the content of the module.
    • Complete the on-line examination.
    • Complete the evaluation.
  2. Commercial Support.
    The THSTEPS Web-based Continuing Education Series has received no commercial support.
  3. Disclosure of Relevant Financial Relationships.
    The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose.
  4. Non-Endorsement Statement.
    Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center.
  5. Off-Label Use.
    Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).

The following are policies and definitions of terms related to continuing education disclosure:

The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.

All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.

Glossary of Terms

Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.

Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.

Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).

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Health-Care Providers

American Academy of Pediatrics. (2017). Newborn Screening Expands: Recommendations for Pediatricians and Medical Homes—Implications for the System.

American College of Obstetricians and Gynecologists. FAQs: Newborn Screening Tests provides brief, plain language answers to frequently asked questions that parents ask about newborn screening tests.

American College of Obstetricians and Gynecologists. Newborn Screening and the Role of the Obstetrician-Gynecologist. Committee Opinion, Number 778, May 2019.

Baby’s First Test, a federally funded national newborn screening clearinghouse.

March of Dimes. Newborn Screening Tests for Your Baby.

Parent Companion First Five Years, a bilingual website focusing on young children with disabilities. It was created to comfort, inspire and connect parents to helpful disability resources.

Save Babies Through Screening Foundation.

Texas Administrative Code 25.1.37D, Rule 37.56. Responsibilities of the Physician (or Other Person Attending a Newborn, if No Physician is Present) and Collection of First and Second Specimen.

Texas Administrative Code 25.1.37D, Rule 37.58. Follow-up, Reporting, and Record Keeping on Abnormal Screening Results and Confirmed Cases.

Texas Department of State Health Services. Critical Congenital Heart Disease web page. Reporting confirmed CCHD cases is mandatory in Texas.

Texas Department of State Health Services. Critical Congenital Heart Disease FAQ web page.

Texas Department of State Health Services. Newborn Hearing Screening Additional Information.

Texas Department of State Health Services. Newborn Hearing Screening Frequently Asked Questions.

Texas Department of State Health Services. Newborn Screening. About Us.

Texas Department of State Health Services. Newborn Screening Educational Materials page offers downloadable literature such as “These Tests Could Save Your Baby’s Life” (in English and Spanish) for parents, and “Save Your Babies!” for primary care providers.

Texas Department of State Health Services. Newborn Screening. Screened Disorders.

Texas Department of State Health Services. Texas Newborn Screening Laboratory website and contact information.

Texas Department of State Health Services. Texas Newborn Screening Web Application provides immediate access to newborn screening result reports. To obtain authorization to access the system, complete and submit a Facility Security Agreement for each facility and a Web User Access Agreement form for each user. Forms are available on the Remote Data Systems web page.

Texas Department of State Health Services. Newborn Screening Facility Report Card.

Texas Department of State Health Services. Meeting National Recommendations for Timely Collection and Submission of Newborn Screening (NBS) Specimens.

Texas Department of State Health Services. Newborn Screening – Healthcare Provider Resources  web page provides examples of an unsatisfactory report, a Normal report and an Abnormal Report.

Texas Department of State Health Services. NBS Unsatisfactory Specimen Examples web page provides links to examples of unsatisfactory blood spots that you can examine and download along with Tips to Avoid various collection problems.

Texas Department of State Health Services. Newborn Screening – Specimen Collection Requirements web page provides a link to the Newborn Screening Laboratory’s newsletter Spotfocus, which provides quality improvement tips.

Texas Department of State Health Services. Newborn Screening – Specimen Collection Requirements web page provides the DSHS Order Form for Newborn Screening Supplies.

Texas Department of State Health Services. Newborn Screening Remote Data Services Forms.

Texas Department of State Health Services. Newborn Screening Unsatisfactory Specimen Examples web page provides links to examples of unsatisfactory blood spots that you can examine and download along with Tips to Avoid various problems.

Texas Department of State Health Services. Order Form for Newborn Screening Supplies. Do not share or exchange kits with other facilities, because DSHS associates all kits with the facility that ordered them. For additional information about the specimen collection kits, contact DSHS Laboratory Supply at 512-776-7661 from 7:30 a.m. to 4:30 p.m. Central Time, Monday through Friday, or fax 512-776-7672.

Texas Department of State Health Services. “Parental Decision Form for Storage and Use of Newborn Screening Blood Spot Cards” allows parents and guardians to opt in or opt out of long-term storage of their baby’s blood spots and possible public health research outside of DSHS. The form is available in English, Spanish and Vietnamese.

Texas Department of State Health Services. Texas Early Hearing Detection and Intervention (TEHDI) Program.

Texas Department of State Health Services. Texas Pulse Oximetry Project (TXPOP) CCHD Toolkit.

Texas Department of State Health Services. Weight Conversion Chart – Pounds and Ounces to Grams.

Texas Department of State Health Services. Informational ACT Sheets for core and secondary conditions are available for health-care providers.

Texas Department of State Health Services. FACT Sheets (many available in English and Spanish) to give parents, guardians and caregivers so they can read more about their child’s newborn health condition. Visit the FACT sheets for core and secondary conditions screened through blood spots in Texas.

Texas Department of State Health Services. 10 Things Parents Want to Know About Newborn Screening. Available in English and Spanish.

Texas Department of State Health Services. Form to Refuse the Newborn Screening Blood Test may be used by parents who wish to decline newborn screening because it conflicts with their religious tenets or practices. Available in English and Spanish.

Texas Department of State Health Services. Newborn Screening Clinical Care Coordination Publications Order Form web page provides links to numerous pamphlets, including the following helpful items.

  • Newborn Screening Tests: For Your Baby’s Health (available in English, Spanish and Vietnamese).
  • These Tests Could Save your Baby’s Life (available in English, Spanish and Vietnamese).
  • What Parents Want to Know About Newborn Screening (available in English, Spanish and Vietnamese).

Texas Department of State Health Services. Newborn Screening - Healthcare Provider Resources page contains annotated examples of confidential laboratory reports for Normal and Abnormal screenings, as well as an example of Unsatisfactory Specimens report in the section titled Result Reports and Remote Data Systems. See the fourth bullet item, Result Report Examples, to download an example of each report.

Texas Department of State Health Services. Newborn Screening Advisory Committee.

Texas Department of State Health Services. Newborn Screening Benefits Program web page provides more information about the benefits program and a link to download the Contractor Manual.

Texas Department of State Health Services. Resources for health-care providers:

  • Electronic notification (email ListServ). Sign up online or call 800-252-8023, ext. 2600. Benefits:
    • Receive “URGENT” notifications
    • Link to material for more extensive information
    • Forward information to other relevant staff.
    • Subscribe and Unsubscribe capability
    • Contact information is NOT shared with any third party
    • All links on the service are secured through the DSHS website
  • DSHS Newborn Screening websites:

Texas Health and Human Services Commission. Case Management for Children and Pregnant Women web page provides information on case management, becoming a provider and a case management potential provider tutorial. You will also find contact information for the program, a list of Health Service Regional Office contacts, a list of providers by region, forms and many other resources.

Texas Health and Human Services Commission. Children’s Health Insurance Program (CHIP) website describes low-cost or free health coverage for children who qualify in Texas.

Texas Health and Human Services Commission. Children with Special Health Care Needs Program website provides information in English and Spanish about services to children with extraordinary medical needs, disabilities and chronic health disorders.

Texas Health and Human Services Commission. Early Childhood Intervention (ECI) Services web page provides a video and information about the statewide program for families with children ages birth through 35 months who have developmental delays, disabilities or certain medical diagnoses that may impact development. You will also find links to the Physician Referral and Orders for Early Childhood Intervention form and a search tool to find your local ECI program. A link is also provided to the ECI Qualifying Diagnosis Search page.

Texas Health Steps, Anticipatory Guidance Provider Guide.

Texas Medicaid & Healthcare Partnership. Newborns Comprehensive Care Program (CCP).

U.S. Department of Health and Human Services, Health Resources and Services Administration, Advisory Committee on Heritable Disorders in Newborns and Children (ACHDNC). Provides advice, recommendations and technical information about aspects of heritable disorders and newborn and childhood screening to the U.S. Secretary of Health and Human Services.

U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. National Newborn Screening and Global Resource Center.

Videos:

Texas Newborn Screening Blood Specimen Collection, a 5-minute video produced by the Texas Department of State Health Services and the Texas Health and Human Services Commission that details how to correctly collect and prepare samples for a newborn screening.

Texas Newborn Screening Collection Kit Submission, a 5-minute video produced by the Texas Department of State Health Services and the Texas Health and Human Services Commission that explains how to handle specimens after they are collected and best practices to meet the 24-hour submission deadline.

Texas Newborn Screening Collection Kit Completion, a 6-minute video produced by the Texas Department of State Health Services and the Texas Health and Human Services Commission that details how to complete the newborn screening bloodspot collection.

March of Dimes: A Parent’s Guide to Newborn Screening video. (English)

March of Dimes: A Parent’s Guide to Newborn Screening video. (Spanish)

Texas Newborn Screening Follow-Up. This 4-minute video produced by the Texas Department of State Health Services and the Texas Health and Human Services Commission explains steps taken by Newborn Screening follow-up staff after an out-of-range screening result. The video provides tips for timely intervention and shows how you can help achieve prompt clinical care coordination for babies with out-of-range screening results.