# Situation: A nurse works in the newborn nursery and the neonatal intensive care unit (NICU) of a government hospital. She is responsible for newborn screening and for the unit's newborn screening records. Under the Newborn Screening Act of 2004 (RA 9288), when should the blood sample be collected from a healthy term newborn who is in the regular nursery?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629456  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A nurse works in the newborn nursery and the neonatal intensive care unit (NICU) of a government hospital. She is responsible for newborn screening and for the unit's newborn screening records.

Under the Newborn Screening Act of 2004 (RA 9288), when should the blood sample be collected from a healthy term newborn who is in the regular nursery?

## 보기

1. Within the first 12 hours of life, before the first bath
2. After 48 hours of life and not later than 3 days after the birth
3. At the 6-week immunization visit at the health center
4. After 24 hours of life and not later than 3 days after birth **✔ 정답**

**정답: 4**

## 해설

RA 9288 requires the newborn screening sample to be collected after 24 hours of life and not later than 3 days after birth. A sample taken earlier than 24 hours can give false-negative results because feeding has not yet raised the metabolic markers, and waiting weeks delays treatment of disorders that cause harm within days. Collecting within the window allows disorders to be treated before they cause harm.

## 심화 해설

Timing of Newborn Screening Collection Under RA 9288

The correct answer is after 24 hours of life and not later than 3 days after birth. This window balances two competing risks: collecting too early can produce false-negative results, while collecting too late delays treatment for disorders that cause irreversible harm within the first days of life.

A sample drawn before 24 hours may miss metabolic markers because the newborn has not yet received enough feeding to elevate those markers into a detectable range. Conditions such as congenital hypothyroidism, phenylketonuria, and galactosemia rely on the accumulation of metabolites or the postnatal TSH surge. If the heel stick is performed too soon, the biochemical abnormalities may not yet be present, and the infant could be incorrectly classified as normal.

The upper limit of 3 days is equally important. Disorders such as congenital adrenal hyperplasia and maple syrup urine disease can deteriorate rapidly. Waiting until a later immunization visit or beyond 72 hours risks missing the critical window for early intervention before clinical decompensation occurs.

The cited study from Belgium examined a related policy shift: moving the earliest allowable collection time from 72 hours to 48 hours of life. The authors evaluated whether earlier sampling still allowed reliable detection of congenital hypothyroidism through thyrotropin measurement. Although the Belgian context differs from the Philippine RA 9288 standard, the underlying concern is the same: the postnatal TSH surge must have occurred and stabilized for the test to be valid. Sampling too early, before the TSH peak is fully expressed, can lead to missed cases. The study's focus on comparing sampling before versus after 72 hours reinforces the principle that a minimum maturation period is needed before blood collection.

| Collection Time | Risk | Clinical Consequence |
| --- | --- | --- |
| Before 24 hours of life | Metabolic markers not yet elevated by feeding; TSH surge incomplete | False-negative result; affected newborn discharged as normal |
| 24 hours to 3 days (RA 9288 window) | Optimal balance of sensitivity and timeliness | Disorders detected early enough for treatment before harm |
| After 3 days or at later visits | Delayed diagnosis | Irreversible neurologic damage, metabolic crisis, or death may occur |

Watch out! Option 1, which mentions 12 hours and the first bath, is incorrect because the sample is not tied to bathing and is too early for reliable results. Key point! The RA 9288 window is after 24 hours and not later than 3 days after birth, regardless of feeding method or discharge status. The Belgian study's shift to 48 hours illustrates that even a modest reduction in minimum collection time requires validation against false-negative risk, supporting the rationale for maintaining the 24-hour lower boundary in the Philippine standard.

## 임상 시나리오

Newborn Screening Collection Timing (RA 9288)Ensuring Accuracy and Timely Intervention
Collect the sample after 24 hours of life and not later than 3 days after birth. This window minimizes false-negative results while allowing early treatment.

Samples drawn before 24 hours may miss metabolic markers because feeding has not yet elevated them into a detectable range, risking a missed diagnosis.

CautionDo not delay collection beyond 72 hours. Disorders such as congenital adrenal hyperplasia can deteriorate rapidly, making prompt screening essential.

## 핵심 개념

- **Newborn Screening Act of 2004 (RA 9288)** — Philippine law mandating newborn screening for certain genetic and metabolic disorders to allow early treatment and prevent disability or death.
- **False-negative result** — A test result that incorrectly indicates a condition is absent. In newborn screening, this can occur if the sample is collected before 24 hours of life when metabolic markers are still low.
- **Congenital Hypothyroidism** — A condition screened for in newborns where the thyroid gland does not produce enough hormone. Detection relies on the postnatal TSH surge, which may not be present before 24 hours of life.
- **Congenital Adrenal Hyperplasia** — A group of genetic disorders affecting the adrenal glands. It can cause rapid deterioration in newborns, making timely screening within the 3-day window critical.
- **Metabolic Markers** — Substances in the blood that indicate a metabolic process. Their levels are influenced by feeding and time after birth, affecting the accuracy of newborn screening tests.

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