National guidelines on blood sampling for newborn screening
Hassan and Shah(1) do not mention recently published national policies and standards for newborn blood spot screening (formerly known as the Guthrie test) produced by the Department of Health-funded UK Newborn Screening Programme Centre(2). These include clear guidance on best practices for taking blood spot samples and state that it is not essential for the heel to be warmed prior to the heel puncture. A systematic review found that warming the heel had no impact on pain responses or need for repeat samples(3). More research is needed with only two studies of heel warming ever published. In both studies assessment of the outcomes was not blind(4,5).
In our regional survey prior to the publication of the new national guidance, we found 97% of midwives reported warming the heel prior to heel puncture(6). However, as clearly illustrated by Hassan and Shah, hot water in the nappy is a potentially unsafe method of warming the heel. If clinicians feel compelled to warm the heel, heel warmers that provide a safe and consistent temperature are commercially available and should be used.
Interestingly, like the senior midwives referred to in this case report, parents of babies with phneylketonuria, who regularly perform heel pricks, have told us that keeping the baby warm with clothing is helpful.
We would welcome research on the effectiveness of heel warming and of warming the whole baby for obtaining blood samples from newborn infants.
N.B. The UKNSPC is funded by the Department of Health for England. The opinions expressed here are those of the authors.
1. Hassan Z, Shah M. Scald injury from the Guthrie test: should the heel be warmed? Arch. Dis. Child. Fetal Neonatal Ed. 2005;90;533-534.
2. UK Newborn Screening Programme Centre. Newborn blood spot screening in the UK: Health Professional Handbook. 2005;1-52. www.newbornscreening-bloodspot.org.uk.
3. Franck LS, Gilbert R. Reducing pain during blood sampling in infants. In: Barton S (ed.). Clinical Evidence. London: BMJ Publishers, 2003;9; 419-435.
4. Barker DB, Willets B, Cappendijk VC, et al. Capillary blood sampling: should the heel be warmed? Arch.Dis.Child. Fetal Neonatal Ed. 1996:74;F139-140.
5. Janes M, Pinelli J. Comparison of blood sampling using an automated incision device with and without warming the heel. J. Perinatol. 2002;22;154-158
6. Cavanagh CM, Coppinger C, Franck LS. How midwives obtain samples for the newborn blood spot screening: a survey of current practice. Br.J.Midwifery 2005;3;160-164.
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