Heel Prick Blood Sampling Research Articles

Thyroid hormone status of newborns in relation to in utero exposure to PCBs and hydroxylated PCB metabolites

The associations between in utero exposure to polychlorinated biphenyls (PCBs) or hydroxylated PCB metabolites (OH-PCBs), and free thyroxin (fT4) or thyroid-stimulating hormone (TSH) status in the newborn were investigated as a pilot study of a large-scale epidemiologic study on in utero PCB or OH-PCB exposure and thyroid function of the newborns. Umbilical cord tissue was used as the media for the biological monitoring of PCBs/OH-PCBs exposure in utero. For the measurement of fT4 and TSH, a heel-prick blood sample spotted on filter paper, which is called Guthrie card, is collected from each neonate at day 4–6 postpartum for this study when the mass screening sampling was performed. We showed that the concentration of total OH-PCBs and one of the OH-PCB congeners (OH-PCB 187) was related significantly to higher fT4 level of newborns. On the other hand, the concentration of total PCBs and PCB congeners (PCB 118, 138, 153, and 180) showed no relationship with fT4 and TSH level of the newborns. The results obtained in this pilot study indicated the possibility that in utero OH-PCBs exposure affects thyroid hormone status of newborns.

Delayed cord clamping and haemoglobin levels in infancy: a randomised controlled trial in term babies

This study was carried out to assess whether delaying umbilical cord clamping is effective in improving the haematological status of term infants living in a malaria-endemic area, and whether this is associated with complications in infants and mothers. We randomly assigned women delivering term babies in Mpongwe Mission Hospital, Zambia, to delayed cord clamping (DCC, n = 46) or immediate cord clamping (controls, n = 45) and followed their infants on a bi-monthly basis until the age of 6 months. We compared the haemoglobin (Hb) change from cord values and the proportion of anaemic infants. Secondary outcomes related to infant and maternal safety. Throughout the observation period infant Hb levels in both groups declined, but more rapidly in controls than in the DCC group [difference in Hb change from baseline at 4 months 1.1 g/dl, 95% confidence interval (CI) 0.2; 2.1]. By 6 months, this difference had disappeared (0.0 g/dl, 95% CI -0.9; 0.8). The odds ratio for iron deficiency anaemia in the DCC group at 4 months was 0.3 (95% CI 0.1; 1.0), but no differences were found between the groups at 6 months. No adverse events were seen in infants and mothers. Our findings indicate that DCC could help improve the haematological status of term infants living in a malaria-endemic region at 4 months of age. However, the beneficial haematological effect disappeared by 6 months. This simple, free and safe delivery procedure might offer a strategy to reduce early infant anaemia risk, when other interventions are not yet feasible.

What influence does experience play in heel prick blood sampling?

The objective of this study was to investigate the role of ‘experience’ in performing the heel prick test. Babies ( n = 340) were randomly allocated to be tested with either the Tenderfoot or Genie Lancet heel prick device. Testing was conducted by nine midwives ( n = 4, experienced, more than 20 years qualified) who performed the heel prick procedure routinely and rotational midwives ( n = 5, less experienced, 4–8 years qualified) who only performed the heel prick procedure when working in the community. Test technique outcomes investigated included (1) cleaning of heel, (2) babies position, (3) feeding at test, (4) use of soothing words. Other test outcomes (1) quality of the blood sample, (2) number of heel pricks required to take sample, (3) blood flow, (4) presence of bruising (5) time taken to collect sample, (6) time squeezing the heel and (7) time baby cried were also studied. The experienced midwives were more likely to hold the baby during testing but less likely to clean the infants heel prior to the incision. The experienced midwives collected a better quality sample, in less time and required fewer heel pricks than the less experienced midwifery group.

A Scottish study of heel-prick blood sampling in newborn babies

to conduct a randomised-controlled trial to investigate the effectiveness of two heel-prick devices (Tenderfoot and Genie Lancet) used in the newborn-baby screening test. a randomised-controlled trial. the homes of 340 healthy term newborn babies discharged from the maternity unit of Stirling Royal Infirmary, Scotland. Data were collected between April and November 2003. babies were randomly allocated to be tested with either the Tenderfoot or Genie Lancet heel-prick device. primary study outcomes include (1) quality of the blood sample; (2) time taken to collect the sample; (3) number of heel pricks required to take the sample; (4) whether squeezing of heel was required; (5) pain expressed by the baby; and (6) presence of bruising. A potential intervening variable was the experience of the midwife. on all outcomes, the Tenderfoot device was more effective than the Genie Lancet. Experienced midwives were more efficient in sample collection. this study shows that the Tenderfoot device saves significant time for midwifery staff, improves baby care and reduces the need for more than one heel prick at each test, making it superior to the Genie Lancet device. there is a case to be made for midwives to be issued with the Tenderfoot device for neonatal screening.

Effect of foremilk and hindmilk on simple procedural pain in newborns

Infants are exposed to painful stimuli during routine medical care in the first few days of life. The aim of the present study was to compare the effect of foremilk; hindmilk, which has been known to have more fat content than foremilk; and sterile water in reducing pain in newborns undergoing minor painful procedures. Sixty-two healthy term infants requiring a heel prick blood sample for screening tests were randomly allocated to receive 2 mL of foremilk, hindmilk or sterile water. Median crying time, duration of the first cry, percent change in heart rate, maximum heart rate and neonatal facial coding system scores were recorded to assess the infants' response to pain. Statistically significant differences between the three groups were not found in terms of crying time, duration of the first cry, percent change in heart rate or maximum heart rate (P = 0.19, P = 0.08, P = 0.22 and P = 0.91, respectively). When the mean pain scores of the groups were compared at 0, 1, 2 and 3 min, there was no statistically significant difference between the three groups (P = 0.58, P = 0.55, P = 0.58 and P = 0.84 for 0, 1, 2 and 3 min, respectively). Although hindmilk has a minor superiority in terms of crying time, duration of the first cry and percent change in heart rate, it does not reach statistical significance. It is concluded that neither foremilk nor hindmilk is superior in relieving pain when compared to placebo.

In vivo spectroscopy of jaundiced newborn skin reveals more than a bilirubin index

The aims of this study were to improve the algorithms for calculating a transcutaneous bilirubin index (TcB), to follow the bilirubin concentrations during phototherapy and to evaluate possible changes in skin optical parameters such as pigmentation and erythema during phototherapy. Reflectance measurements were performed on 51 jaundiced newborns, of which 10 were subjected to phototherapy. The measurements were collected with a diode array spectrophotometer with an integrating sphere accessory, and a TcB was calculated from the measured spectra using algorithms based on diffusion theory. The newborns' birthweights were > or = 2000 g and their gestational age was > or = 35.5 wk. They had no substantial illnesses, and no newborns were submitted to the study until their second day. Heel prick blood samples were analysed for total serum bilirubin (Sbr) by the diazo reaction method. Phototherapy equipment was either an overhead lamp or lightbed. Measurements from the forehead gave the best correlation between TcB and Sbr (r = 0.81, p < 0.05). However, during phototherapy no significant correlation between TcB and Sbr was observed. A correlation (r = 0.45, p < 0.05) was found between phototherapy and melanin index obtained from the patients' back. Reflectance spectroscopy is useful in assessing bilirubin concentrations before phototherapy, and can also reveal changes in skin parameters such as pigmentation occurring as a result of phototherapy.

Screening for phenylketonuria and congenital hypothyroidism in 5.8 million neonates in China

To summarize neonatal screening for phenylketonuria (PKU) and congenital hypothyroidism (CH) in China, to further clarify incidence of the two kinds of diseases in newly-born babies, and to explore issues in neonatal screening and their solutions. Neonatal screening for PKU and CH was conducted by 39 neonatal screening centers all over the country, sponsored by the Group of Neonatal Screening, Chinese Society of Child Health Care, Chinese Preventive Medical Association and the Center for Neonatal Screening Quality Control Laboratory, National Center for Clinical Laboratories (NCCL). In each infant a heel prick blood sample was collected at 72 hours postnatal onto standard filter paper. PKU was screened by bacterial inhibition assay and fluorometric method, and CH was screened by TSH measurement by time-resolved fluorescence immunoassay (TRFIA), fluorescence enzyme immunoassay (FEIA) and enzyme immunoassay (EIA). From 1985 to 2001 in China, totally of 5 817 280 newborns were screened for PKU, 522 cases of PKU detected with an incidence of 1:11 144, and 5 524 019 newborns were screened for CH, 1 836 cases of CH detected with an incidence of 1:3 009. Annual average number of newborns screened for congenital genetic diseases was increased by 45.5% in recent six years. Neonatal screening was developed quickly in China in recent years, especially in some developed cities, such as Shanghai with a coverage of 98.3% in 2001. But, its coverage was about only 10% in China as a whole. In development of neonatal screening, it is necessary to attach more importance to quality of screening and increasing coverage of screening, as well as gradual development of new screening techniques for other neonatal preventable diseases, in addition to PKU and CH, and their application, and improvement of level of child health care in China.

Does topical amethocaine gel reduce pain from heel prick blood sampling in premature infants? A randomized double-blind cross-over controlled study

Heel prick blood sampling is the most common painful invasive procedure performed on neonates. Currently, there are no effective ways to provide pain relief from this painful procedure. To assess the efficacy of the topical anesthetic amethocaine 4% gel (Ametop, Smith & Nephew Inc, St Laurent) in reducing the pain of heel prick blood sampling in neonates. A randomized, double-blind, placebo controlled, crossover trial was conducted. Neonates between 33 to 37 weeks' gestational age in their first seven days of life were eligible. Heel prick blood sampling was performed on each participant twice. Each infant was randomly assigned to receive either amethocaine 4% gel or placebo to the heel for the first prick, and then received the alternative agent for the second prick. Prick pain was assessed using both Premature Infant Pain Profile (PIPP) and Neonatal Infant Pain Scale (NIPS). Squeeze pain was assessed by NIPS. Ten babies were recruited. There were no significant differences in the average PIPP and NIPS scores between the treatment and placebo groups for both prick and squeeze pains from heel prick blood sampling. For prick pain, linear-regression showed significant correlation between the PIPP and NIPS scores. No adverse reactions were observed after application of either the active or placebo agents. Topical amethocaine 4% gel is not shown to reduce prick and squeeze pains significantly from heel prick blood sampling in neonates between 33 to 37 weeks' gestational age. Further studies are needed to find ways to provide effective pain relief from this common procedure.

Comparison of sucrose, expressed breast milk, and breast-feeding on the neonatal response to heel prick

Newborns endure many heel pricks and other uncomfortable procedures during their first hospital stay. The aim of this study was to investigate the effectiveness of breast-feeding in reducing pain in newborns undergoing heel prick tests. One hundred thirty healthy term infants requiring a heel prick blood sampling for the Guthrie test were studied. Infants were randomly allocated to 1 of the following treatment groups: group 1, 25% sucrose (n = 35); group 2, breast milk (n = 33); group 3, sterile water (n = 34); and group 4, breast-feeding (n = 28). The median values of crying and recovery time and percent change in heart rate at 1, 2, and 3 minutes were recorded. A behavioral pain scale was applied according to the infant body coding system. The median crying time was 36, 62, 52, and 51 seconds in groups 1, 2, 3, and 4, respectively (P =.002). Similarly, there was a significant overall difference among groups for the duration of recovery time (P =.006) and the percent change in heart rate at 1 (P =.03), 2 (P =.01), and 3 (P =.009) minutes favoring the sucrose group. But when we compared the groups, the significance remained for the sucrose versus breast milk (P =.007) and water (P =.001) groups for the recovery time and sucrose versus all other groups for the percent change in heart rate at 3 minutes. The infant body coding system showed that babies in the sucrose group had significantly lower scores followed by the breast-fed and breast milk groups (P =.0001). Our study revealed that 25% sucrose is superior to breast-feeding in pain relief, which is reflected mainly in crying time and behavioral variables. The behavioral effects of breast-feeding did not provide any additional benefit. © 2001 by the American Pain Society

Association between composition of the diet and haemoglobin and ferritin levels in 18-month-old children.

To investigate the associations between composition of the diet at 18 months of age and ferritin and haemoglobin levels. Cross-sectional study. A total of 796 children taking part in the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC). Food and nutrient intakes and haemoglobin and ferritin levels at 18 months. Diet was assessed by a 3-day unweighed food record. A heel-prick capillary blood sample was taken for measurement of ferritin and haemoglobin. Ferritin levels were negatively associated with the amount of cows' milk consumed (r = -0.2462, P < 0.001) and calcium intake (equivalent to a 4-5% drop in ferritin levels for a 100 mg increase in energy-adjusted calcium intake). Haemoglobin levels were positively associated with energy-adjusted vitamin C intake and were higher in children who ate any fruit (P = 0.024) or any vegetables (P = 0.030). The associations between nutrient intakes and ferritin and haemoglobin levels remained on adjustment for socio-demographic factors. The prevalence of low haemoglobin levels was higher in those children who consumed no meat or poultry (28.8% vs 19.0% overall, P = 0.044). Higher levels of milk and dairy product consumption are associated with lower ferritin levels in children of this age, and over-reliance on these foods should be avoided. Fruit and vegetable consumption should be encouraged, and the inclusion of a little meat or fish in the diet of small children is advisable.

Topical amethocaine gel for pain relief of heel prick blood sampling: a randomised double blind controlled trial

BACKGROUNDHeel prick blood sampling is a commonly performed and painful procedure in the newborn infant. Use of a topical local anaesthetic does not relieve this pain. A 4% w/w amethocaine...

Investigation of Seroprevalence of Respiratory Virus Infections in an Infant Population with a Multiantigen Fluorescence Immunoassay Using Heel-Prick Blood Samples Collected on Filter Paper

Respiratory viruses are an extremely common cause of childhood morbidity. However, the current seroprevalence of viruses in infant populations is difficult to establish because invasive venipuncture may be technically and ethically unacceptable. This prospective study aimed to establish the seroprevalence of respiratory viruses in an infant population by use of a novel multiantigen fluorescence immunoassay against common respiratory viruses, using heel-prick blood samples collected on filter paper. Mothers and babies were recruited in the immediate peripartum period in the Royal Maternity Hospital, Belfast. Cord blood samples at birth and heel-prick filter paper blood samples at 7 mo were collected for measurement of virus-specific IgG to respiratory syncytial virus, influenza A virus, adenovirus, and parainfluenza virus type 1, type 2, and type 3 by indirect immunofluorescence using a multiviral assay developed for this purpose. Of 386 mothers approached, 325 (84%) permitted follow-up at 7 mo, and of these, 256 (79%) agreed to the heel prick. From 234 paired samples, 125 infections were documented. Adenovirus infections were commonest, 53 (22.6%), followed by respiratory syncytial virus, 32 (13.7%); influenza A virus, 22 (9.4%); parainfluenza virus type 3, 14 (6%); parainfluenza virus type 1, 2 (0.85%); and parainfluenza virus type 2, 2 (0.85%). These results demonstrate the seroprevalence of a range of respiratory viruses in an infant population, using a novel multiviral immunoassay. The filter paper collection of blood samples and multiantigen assay format has implications for easy, widespread viral serodiagnosis in both seroepidemiology studies and in the diagnosis of pediatric viral illnesses. Filter paper permits recovery of respiratory virus-specific IgG and can be used as a simple and acceptable epidemiologic and diagnostic tool.

Failure to thrive: the earliest feature of cystic fibrosis in infants diagnosed by neonatal screening.

The benefits of early treatment of nutritional and respiratory problems in the CF infant and of genetic counselling for the parents are widely recognized. However, clinical diagnosis of CF is often delayed despite early onset of symptoms and the usefulness of neonatal population screening as a preventive measure is still under debate. This study analyses the clinical history of CF patients diagnosed exclusively on the basis of positive neonatal screening tests with the aim of identifying the earliest markers of the disease. We studied 103 CF infants born in north-east Italy, diagnosed following neonatal screening: assay of immunoreactive trypsin (IRT) from a heel-prick blood sample followed by a measurement of meconium lactase in cases with raised IRT. Diagnosis was confirmed by sweat test at an average age of 39 days. Eighty-one patients (79%) had symptoms strongly suggestive of CF at diagnosis, and signs and/or symptoms of pancreatic insufficiency were present in 16 of the remaining 22 cases. The most frequent symptom was growth failure (69% of infants) and of these, 44% weighed the same as at birth or less. Pancreatic insufficiency was confirmed by the low level of faecal chymotrypsin found in 85% of cases. IRT was elevated in all cases. CF had not been suspected in any symptomatic infant, although most of the infants had been monitored by a paediatrician. In conclusion, most infants with CF diagnosed by neonatal screening are already symptomatic in the first six weeks of life and the most frequent symptom is failure to thrive; pancreatic insufficiency was already present in most cases. In areas without CF neonatal screening programs, the disease should be excluded by differential diagnosis in all cases with growth failure notwithstanding adequate caloric intake in the first months of life. The high sensitivity, low cost and simple execution of IRT and fecal chymotrypsin tests make them an ideal first step in suspect cases before proceeding to the sweat test, often performed late because of limited availability.

Exposure to invasive procedures in neonatal intensive care unit admissions.

The nature and numbers of invasive procedures were studied in 54 consecutive infants admitted to a neonatal intensive care unit. Over 3000 procedures were recorded, 74% in infants below 31 weeks of gestation. One infant (23 weeks' gestation, birth weight 560 g) underwent 488 procedures. Heel prick blood sampling was the most common procedure (56%), followed by endotracheal suction (26%) and intravenous cannula insertion (8%). Invasive procedures which would cause pain or distress to a child are frequently performed on infants admitted to the neonatal intensive care unit. A reduction in the number of procedures, modifying them, or providing adequate analgesia could relieve some of this pain and distress.

Serological Response to Ureaplasma urealyticum in the Neonate

A serovar-specific antibody response to Ureaplasma urealyticum was observed in stillborns, neonates, and mothers by means of the modified metabolic inhibition test. Elevated levels of ureaplasma antibody were found in cases of stillbirth and neonatal respiratory disease. There was a higher risk of mortality among neonates with respiratory disease who had elevated levels of ureaplasma antibody. IgG and IgM serovar-specific antibody responses to U. urealyticum serovars were confirmed by the immunoperoxidase and immunofluorescence assays. In contrast to ELISA-based assays that use soluble membrane proteins as antigen, these three assays use whole intact cells. These observations suggest that the serovar-specific antibody response may be associated with the ureaplasma extramembranous carbohydrate (lypoglycan) coat, which comes off during centrifugation. With the immunoperoxidase assay, a heel-prick blood sample (20 microL) can be screened for 16 IgM or IgG + IgM + IgA (combined) responses in 4 hours. The predictive value of IgM antibody for U. urealyticum infection and other mycoplasma infections and for the risk of stillbirth and development of chronic lung disease should now be assessed.

Increased speed and sensitivity, and reduced sample size of a micro-radioallergosorbent test (MRAST)

Performance of the radioallergosorbent test (RAST) in small volumes (MRAST) increases the efficiency with which both IgE antibody and 125I-anti-IgE bind. The rate at which antibody binds is increased up to 290-fold so that the assay can be completed in 60 min with comparable sensitivity to RAST. The increased speed of binding is achieved by the use of small incubation volumes which does not affect the rate at which bound antibody is dissociated. The resulting change in the equilibrium in favour of antibody binding yields a 10-fold increase in sensitivity which makes it possible to use as little as 5 μl of sample compared with 50 μl which is normal for RAST. MRAST can be used to measure IgE antibody in heel prick blood samples taken from babies, in rat sera and in other situations where the sample is in short supply.

The development of mammary secretory immunity in the human newborn.

Milk protein concentrations were determined either by radioimmunoassay (IgA and IgG) or single radial immunodiffusion (IgM, lactoferrin, albumin and lysozyme) in single or serial samples of neonatal milk (witch's milk) obtained from 33 healthy newborns (seven of whom were light for dates), four ill newborns following major surgery and four newborns suffering from one of a variety of infections. In addition, paired neonatal milk and heel prick blood samples were collected from seven newborns, and paired neonatal milk and maternal milk samples were collected from a further seven neonates and their respective mothers. The concentrations of secretory IgA (11S IgA) in neonatal milk, although 300-fold lower than the corresponding IgA concentrations in maternal milk, when compared with neonatal serum IgA concentrations, were consistent with local synthesis of IgA occurring in the neonatal mammary gland. Among the milk protein studies, on 11S IgA concentrations increased significantly after birth in neonatal milk, the rise being unrelated to the gestational age of the newborn. As an entero-mammary circulation of IgA precursor lymphocytes exists in adults, it is suggested that the entry of foreign antigens into the neonatal gut after birth may be an important factor influencing the development of neonatal secretory immunity.