# Situation: A public health nurse makes home visits to mothers and newborns in a farming barangay during the first weeks after birth. A baby was born at home with a midwife at 4:00 p.m. The nurse visits at 11:00 a.m. the next day, when the baby is 19 hours old and feeding well. The parents agree to newborn screening. When should the nurse collect the blood sample?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627158  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: A public health nurse makes home visits to mothers and newborns in a farming barangay during the first weeks after birth.

A baby was born at home with a midwife at 4:00 p.m. The nurse visits at 11:00 a.m. the next day, when the baby is 19 hours old and feeding well. The parents agree to newborn screening. When should the nurse collect the blood sample?

## 보기

1. At the 6-week visit, with the first pentavalent dose
2. After 24 hours of age and within 3 days of birth **✔ 정답**
3. Now, so that the sample is not missed
4. At 7 days of age, when feeding is well established

**정답: 2**

## 해설

Under the Newborn Screening Act (RA 9288), the sample is collected after 24 hours of life and not later than 3 days (up to 7 days only for babies in intensive care). A sample taken before 24 hours can give false results, and a late sample delays detection and treatment.

## 심화 해설

The timing window for newborn screening
Under the Newborn Screening Act of 2004 (RA 9288), the newborn screening blood sample is collected after 24 hours of life and not later than 3 days from birth. The upper limit extends to 7 days only for babies in intensive care. This baby is 19 hours old at the time of the visit, so it is too early to collect the sample now. The nurse should arrange for the sample to be collected after the baby reaches 24 hours of age and within 3 days of birth. Collecting too early can give false results, and collecting too late delays detection.

Why the 24-hour lower limit
Several of the screened disorders are detected by substances that build up only after the baby has been feeding and its own metabolism has taken over from the mother's. For example, in phenylketonuria the amino acid phenylalanine rises after protein feeding begins, and in congenital hypothyroidism the normal surge of thyroid-stimulating hormone just after birth can make an early sample look abnormal. A sample taken before 24 hours may therefore miss a true case or flag a normal baby. Waiting until after 24 hours gives a more reliable result.

| Situation | When to collect |
| --- | --- |
| Healthy newborn | After 24 hours of life, not later than 3 days |
| Baby in intensive care | Up to 7 days of age |
| This baby at 19 hours | Too early now; collect after 24 hours, by day 3 |

Why the upper limit matters
Disorders such as congenital hypothyroidism and galactosemia cause irreversible damage, including intellectual disability or death, if treatment is delayed. Collecting the sample by day 3 allows results to come back and treatment to begin in the first weeks of life. Waiting until the 6-week visit with the first pentavalent dose would delay detection well past the period when treatment prevents harm. Waiting until day 7 applies a limit meant only for babies in intensive care. Watch out! An option to take the sample "now, so it is not missed" sounds safe but uses a sample that is too early to be reliable.

Exam takeaway
Remember the newborn screening window as after 24 hours and not later than 3 days. For a home birth, the nurse plans a return visit or arranges for the midwife or a newborn screening facility to collect the heel-prick sample on day 2 or day 3. She explains the purpose to the parents, records their consent, and tells them how they will receive the results and what happens if a recall for confirmatory testing is needed.

## 임상 시나리오

Newborn Screening TimingCollecting the sample under RA 9288
Collect the newborn screening sample after 24 hours of life and not later than 3 days. Babies in intensive care may be screened up to 7 days.

At 19 hours, this baby is too young; an early sample can give false results.

Arrange collection on day 2 or day 3, explain the purpose, and tell parents how results and recalls are handled.

CautionDo not delay screening to the 6-week visit; late detection can cause irreversible harm.

## 핵심 개념

- **Newborn screening** — A blood test of newborns to detect treatable congenital disorders before symptoms appear.
- **RA 9288** — The Newborn Screening Act of 2004, which institutionalized newborn screening in the Philippines.
- **Heel-prick sample** — A few drops of blood from the baby's heel, blotted on filter paper for screening.
- **Congenital hypothyroidism** — A thyroid hormone deficiency present at birth that causes intellectual disability if untreated.

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