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Neonatal Specimen Collection Instructions

  • Newborns with high hematocrits may require a larger sample volume of whole blood.
  • Order of draw for microtainers: EDTA (Lavender), Lithium Heparin (Green), SST-Serum Separator Gel (Gold).
  • Invert tubes gently 8-10 times immediately after drawing blood.
  • TESTS IN RED CAN BE ORDERED STAT
Test name

TAT*

  • Stat
  • Routine
Container type

Minimum sample volume
Whole blood

Collection instructions

ABG- Arterial Blood Gases 15 mins Heparin syringe 0.3 mL
  1. Mix well
  2. Send on ice
ACTH
(Adrenocorticotrophic hormone)
PLASMA
7 days Lavender microtainer 1 mL
  1. Pre chill tubes
  2. Mix gently after drawing
  3. Send to lab on ice
ACYL-CARNITINES
Also request free and total carnitine with this order
7 days Green or Gold microtainer 0.6 mL
  1. On ice
  2. Send to lab ASAP
ALBUMIN 2 hrs Green or Gold microtainer 0.4 mL
ALDOSTERONE 10 days Green or Gold microtainer 2 tubes
0.5 mL
Indicate all drugs administered in last 2 weeks
ALP
(Alkaline Phosphatase)
2 hrs Green or Gold microtainer 0.4 mL
AFP
(Alpha Fetoprotein)
Same day
Mon-Fri
Gold microtainer 0.5 mL
ALPHA 1 ANTI-TRYPSIN 7 days Green or Gold microtainer 0.5 mL
ALPHA 1 ANTI-TRYPSIN PHENOTYPE 7 days Gold microtainer 0.5 mL
ALT (Alanine Aminotransferase) 2 hrs Green or Gold microtainer 0.4 mL
AMIKACIN
  • Trough
  • Peak
1 day Green or Gold microtainer 0.5 mL Trough: 0-30 min
Before next dose
Peak: 30-60 min after IV completed
AMINO ACIDS
  • BLOOD
    (Quantitative)
5 days Green microtainer 0.4 mL Send to lab immediately
AMINO ACIDS
  • URINE
    Quantitative
    (Order urine screen unless diagnosis is known)
7 days Sterile
Urine container no preservative
5 mL Keep sample cool
For quantitation, provide tentative diagnosis
AMINO ACIDS
  • CSF
4 days LAP kit. Sterile conical screw top tube. 0.5 mL Bloody specimen inappropriate for analysis
AMMONIA -BLOOD 1 hr
2 hrs
Lavender microtainer 0.4 mL Send on ice immediately and
Indicate time drawn
AMYLASE 4 hrs Green or Gold microtainer 0.4 mL
ANDROSTENEDIONE 14 days Gold microtainer 1 mL
ANTI CARDIOLIPIN 7 days 2 Gold microtainers 1 mL
Anti-Xa (AXA) 2 hrs BLUE COAG “MiniCollect” tube
(3.2% sodium citrate)

0.9mL of blood to 0.1-mL 3.2% sodium citrate.

1 MiniCollect if AXA ordered only

2 citrated MiniCollect tubes if ordered with full Coag panel – PT/PTT, D-Dimer, and Fibrinogen

  1. Dose times: 06:00 and 18:00. Take blood 4 hours after medication is given.
  2. Add exactly 0.9 mL blood to liquid in each tube.
  3. Invert gently and thoroughly 4-6 times immediately after collecting.
  4. Send to lab ASAP.
  5. Indicate the type of heparin (Enoxaparin)
APT 2 days Sterile urine container 10 mL
  • Gastric Aspirate
  • Stool
  • Vomitus
Sample must be pink or red. Colorimetric reaction with brown end-point. Any red-brown or black sample will not be accepted.
AST (Aspartate Aminotransferase) 2 hrs Green or Gold microtainer 0.4 mL
BETA HYDROXY BUTYRATE 7 days Gold microtainer preferred
Green microtainer acceptable
0.5 mL
Can be combined with Free Fatty Acids – 0.6 mL both
Send immediately on ice
BILIRUBIN
  • TOTAL
    (Microbilirubin or MBR)
  • SERUM
2 hrs Green or Gold microtainer 0.4 mL
BILIRUBIN
DIRECT – (Bilirubin Conjugated)
2 hrs Green or Gold microtainer 0.4 mL Protect from light.
BLOOD CULTURE
For infants < 24 hrs old
Refer to SCI-5.7.15.2.14 (HL) BACTEC® PEDS PLUS
BOTTLE (Pink top and label)
1 - 3 mL of blood per bottle. Do not refrigerate. Deliver A.S.A.P. to the lab.

BLOOD CULTURE
For infants ≥ 24 hours old

NOTE: Weekdays, 2200 hours to 0500 hours AND Weekends and Holidays, 2000 hours to 0500 hours: Collect neonatal blood cultures in a BACTEC PEDS PLUS bottle, not isolator tube.

Refer to SCI-5.7.15.2.14 (HL)

STAT

“Isolator 1.5 tube”
+
(yellow top with pink label)
WAMPOLE ISOLATOR 1.5 1.5 mL of blood is optimum for culture If M. furfur suspected, please indicate. Mix well. Do not refrigerate.
Deliver to lab immediately.
BUN (UREA) 2 hrs Green or Gold microtainer 0.4 mL
Capillary Blood Gases (CBG) 20 mins Heparin coated capillary (0.14 mL) Or full cap tube
  1. Mix well.
  2. Insert metal mixing flea and cap ends.
  3. Send immediately on ice
CALCIUM (Total) 2 hrs Green or Gold microtainer 0.4 mL Can be ordered as Ca/Alb/Phos/Mg panel
CARBOXY HEMOGLOBIN (COHB)
- BLOOD
20 mins Heparin syringe 0.25 mL

Send on ice.

CARNITINE
Free and total
7 days

Gold microtainer preferred.
Green acceptable.
Also, performed on urine.

0.5mL serum or plasma

Send on ice.
CSF CELL COUNT 1 hr CSF collection tube 0.05 mL Send to lab ASAP.
If delay anticipated, keep specimen at room temperature.
If multiple tubes of CSF are collected, the first tube shall not be used for microbiological examination.
Indicate the order collected on the tube. Send tube 3 for cell count.
CSF DIFFERENTIAL 2 hrs CSF collection tube 0.10 mL (cell count also performed)

See CSF Cell Count

CSF GLUCOSE 1 hr CSF collection tube 0.4 mL (Glucose and Protein)

See CSF Cell Count

Send tube 1 for glucose.

CSF PROTEIN 1 hr CSF collection tube 0.4 mL (Glucose and Protein)

See CSF Cell Count

CHOLESTEROL 4 hrs  Green or Gold microtainer 0.4 mL
CHROMOSOMES
(KARYOTYPE)
7-12 days

Sodium Heparin vacutainer or Sodium Heparin syringe

1-3 mL A HSC or Mt. Sinai chromosome requisition must be filled out.
Send to the lab at room temp.
Do not take sample on the weekend or late Friday.
COCAINE-URINE 24 hrs Sterile urine container 2 mL A HSC toxicology form must be filled out.
See Biochemistry section of SCI.
COCAINE – HAIR 10 days Sterile urine container 5 mg

A HSC toxicology form must be filled out. Done only if urine screen is negative
See Biochemistry Section of SCI

CBC (Complete Blood Count) and DIFFERENTIAL (DIFF) CBC =30mins
DIFF = 1 hour
Lavender microtainer

0.3 mL whole blood

Gently invert 10 times immediately after collecting to prevent formation of clots

CORD BLOOD

  • Blood Bank
    (Routine)
Same day Pink top vacutainer 6 mL draw 3 mL

SIGNED, completely filled-in pink requisition MUST accompany FULLY labelled sample

CORD BLOOD
  • HEMOGLOBIN
30 mins Lavender microtainer 0.30 mL Gently invert 10 times immediately after collecting to prevent formation of clots
CORD GASES
  • Arterial
  • Venous
15 mins Balanced Heparin syringe 0.3 mL syringe
  1. Indicate if arterial or venus cord
  2. Mix well
  3. Send on ice immediately
CORTISOL Same day Gold microtainer 0.5 mL 150 uL
CREATININE 1 hr Green or Gold microtainer 0.4 mL
CK (Creatine Kinase) 2 hrs Green or Gold microtainer 0.4 mL
CRP 2 hrs Green or Gold microtainer 0.4 mL
Dehydroepiandroster-one sulphate (DHEAS) 7 days Green microtainer 0.5 mL
D-DIMER 1 hr BLUE COAG
“MiniCollect” tube
(3.2% sodium citrate)

1 MiniCollect for
D-Dimer only.

2 citrated MiniCollect tubes if ordered with full Coag panel – PT/PTT, D-Dimer, and Fibrinogen

Add exactly 0.9 mL blood to liquid in each tube
  • Invert gently and thoroughly 4-6 times immediately after collecting
  • Send to lab ASAP.
7 – DEHYDRO CHOLESTEROL 20 days Green or Gold microtainer 0.7 mL Send to the lab protected from light
DIHYDRO-TESTOSTERONE (DHT) 20 days Gold microtainer 2.0 mL
DIGOXIN 4 hrs Green or Gold microtainer 0.3 mL
DILANTIN (Phenytoin) 4 hrs Green or Gold microtainer 0.5 mL
DIRECT ANTIGLOBULIN TEST (DAT) Same day Lavender microtainer ≥ 0.5 mL SIGNED, completely filled-in pink requisition MUST accompany FULLY labelled sample
ELECTROLYTES (NA, K+, CL) 1 hr Green or Gold microtainer 0.4 mL
ELECTROLYTES (URINE) 1 hr Sterile urine container 0.4 mL
FACTOR ASSAYS – COAG BLUE COAG “MiniCollect” tube
(3.2% sodium citrate)

2 citrated MiniCollect tubes

NOTE: Not to be combined with full coagulation panel
May need 2nd tube if more than 4 factors ordered

  1. Add exactly 0.9 mL blood to liquid in each tube.
  2. Invert gently and thoroughly 4-6 times immediately after collecting
  3. Send to lab ASAP.
FECAL OCCULT BLOOD 2 hrs Sterile bottle 0.5 mL
  1. Send in sterile bottle.
  2. Label as “STAT” and notify lab that a sample is being sent 
FERRITIN 4 hrs
(M-F)
Green or Gold Microtainer 0.5 mL
FIBRINOGEN 1 hr BLUE COAG “MiniCollect” tube
(3.2% sodium citrate)

1 MiniCollect for repeat fibrinogen only.

2 citrated MiniCollect tubes if ordered with full Coag panel – PT/PTT, D-Dimer, and Fibrinogen

  1. Add exactly 0.9 mL blood to liquid in each tube.
  2. Invert gently and thoroughly 4-6 times immediately after collecting
  3. Send to lab ASAP.
FREE T3 4 hrs
(M-F)
Green or Gold Microtainer 0.8 mL with TSH for full thyroid panel
FREE T4 4 hrs
(M-F)
Green or Gold Microtainer 0.8 mL with TSH for full thyroid panel
FREE FATTY ACIDS Weekly

Gold microtainer preferred.
Green microtainer acceptable

0.6 mL – Can be combined with Beta Hydroxy-butyrate (0.6 mL for both). FASTING Sample preferred
FOLLICLE STIMULATING HORMONE (FSH) 4 hrs
(M-F)
Green or Gold microtainer 0.4 mL
G-6-P-D SCREEN
(Glucose-6-phosphate dehydrogenase)
Batch test. Performed Tues and Thurs Lavender microtainer 0.5 mL

Gently invert 10 times immediately after collecting to prevent clot formation

CBC & Retic must be ordered with each G6PD Screen request.
Send separate tube for CBC and Retic.

G-6-P-D ASSAY
(Glucose-6-phosphate dehydrogenase)
5 days Lavender microtainer 0.25 mL G-6-P-D screen results must be indeterminate or deficient.
GALACTOSEMIA SCREEN Done on Fridays Heparin syringe 0.4 mL use a 3 mL syringe Send on ice immediately to lab.
Test invalid if baby has been transfused.
GAMMA GT (GT)
(Gamma-glutamyl transpeptidase)
4 hrs Green or Gold microtainer 0.4 mL
GENTAMICIN
  • Trough
  • Peak
  • Random
2 hrs
4 hrs
Gold microtainer 0.5 mL Trough: 0-30 min before next dose
Peak: 30- 60 min after IV completed
Indicate time on label
GLUCOSE - BLOOD 1 hr Green or Gold microtainer 0.4 mL
GLUCOSE - CSF 1 hr CSF collection tube 0.4 mL (Glucose and Protein) Send to lab ASAP.
If delay anticipated, keep specimen at room temperature.
If multiple tubes of CSF are collected, the first tube shall not be used for microbiological examination. Indicate the order collected on the tube.
Send tube 1 for glucose.
GROUP & SCREEN
  • Blood Bank

STAT= 45 mins
Routine = Same Day

Lavender microtainer ≥ 0.5 mL SIGNED, completely filled-in pink requisition MUST accompany
FULLY labelled sample
GROWTH HORMONE (GH) 7 days Gold microtainer 1.0 mL
HAPTOGLOBIN 4 hrs
(M-F)
Gold microtainer 0.5 mL
HEMOGLOBIN ELECTROPHORESIS 3 working days Lavender microtainer 0.5 mL Gently invert 10 times immediately after collecting to prevent clot formation
17 – HYDROXY PROGESTERONE 2 weeks Gold microtainer 0.8 mL
HOMOCYSTEINE (TOTAL) - PLASMA 7 days Lavender microtainer 0.5 mL Send on ice.
Human Herpes Virus Type 6 by PCR (HHV 6A, 6B, 7) 2 days  Lavender microtainer Need 1 mL Sent to Hospital for Sick Children
Same as Roseola infantum, Exanthem subitum
Check off VZV group PCR on Sick Kid’s requisition
Human Immunodeficiency Virus (HIV 1 and 2) 6 days Lavender microtainer Need 2 mL of plasma Sent to Hospital for Sick Children.
Refer to infant sample sheet
Human Immunodeficiency Virus by DNA PCR 1-2 weeks lavender microtainer Need 2 mL of plasma Sent to Hospital for Sick Children.
Refer to infant sample sheet
INSULIN 4 hrs
(M-F)
Green or Gold microtainer 1.0 mL Send on ICE
INSULIN LIKE GROWTH FACTOR 7 days Serum 1 mL Send to lab on ice IMMEDIATELY
IONIZED CALCIUM 20 mins Heparin syringe 0.3 mL Send IMMEDIATELY to LAB (Preferred sample type)
KARYOTYPE See Chromosome studies
KETONES Green or Gold microtainer 0.4 mL
LACTATE 20 Mins
2 hrs
Heparin syringe
Green microtainer

0.3 mL

Send to lab on ice IMMEDIATELY
LEUITINIZING HORMONE - LH 4 hrs
(M-F)
Green or Gold microtainer 0.4 mL
LIVER PANEL
(Includes ALP, AST, ALT, and TBIL)
4 hrs Green or Gold microtainer 0.6 mL
MAGNESIUM 2 hrs
4 hrs
Green or Gold microtainer 0.4 mL
0.6 mL for panel with Ca/Phos/Mg/Alb
METABOLIC SCREEN
  • URINE
    (Includes Amino Acid screen, DNPH, NITROPRUSSIDE)
10 days Random urine
Sterile Urine container
3-5 mL
MET-HAEMOGLOBIN 20 mins Heparin syringe ,CBG tube, or heparinized microtainer Send to lab on ice immediately.
MUCOPOLY-SACCHARIDES
(SCREEN)
7-10 days Random urine 10 mL Refrigerate if sample not completed in one collection
NEONATAL ETT (Endotracheal Tube) C&S: Positive- 1 to 2 days unless otherwise indicated
Negative: 2-4 days
Sterile screw cap container If the specimen is large enough to get into the container (ie a large amount of secretions), use that. If there is a smaller amount that is stuck in the suction catheter, suction up just enough sterile saline to get the specimen into the container

NEONATAL MECONIUM TOXICOLOGY

Consider consulting with team before using them on full-term infants

Meconium can identify drugs taken within the last 20 wks of pregnancy

Varies

White plastic container (provided)

The kits provide popsicle sticks and plastic sheets to line the diapers with so the stool does not become absorbed into the diaper and is easier to collect. It is not advised to use the plastic sheets in the preterm population as it may lead to diaper dermatitis

3g (1 teaspoon)
can be collected over a period of 5-7 days until 3g (~ 1 teaspoon) of volume has been reached.

Stop collecting once stool becomes transitional. Send what has been collected as they may be able to test, but for fewer substances.

Can be kept at room temperature (if collecting specimen over several days)

IF also testing alcohol specimen MUST be refrigerated if collecting over several days. Send specimen to the lab on ice.

Stability limitations: 2 weeks room temp, 3 months refrigerated, 1 year frozen

NEONATAL HAIR TOXICOLOGY
Hair can identify drugs taken within last 90 days of pregnancy
Varies White paper envelope (provided) 100mg of hair is needed to run a panel test
(The diameter of a #2 pencil)

USDTL is a forensic lab and can accurately test hair, but the amount required is significant.

Discuss the feasibility of sending hair for testing with the team before attempting to collect a sample.

USDTL can run 1 test on 50 mg of hair (MUST indicate on form which drug you are looking for)

Stability limitations: no stability limitations available

NEONATAL SCREEN Varies Newborn Screening Card

Follow SCI-5.7.16.0 Neonatal Screening-Blood Collection on Filter Paper(HL)

NEUROTRANSMITTER METABOLITES 14 days from receipt of sample Call lab for special collection containers (total of 5 special containers) 3.5 mL of CSF Call lab for special collection containers. Each set consists of 5 numbered tubes in a small plastic bag. Tube #3 contains antioxidants necessary to protect the sample from oxidation. One set of tubes is required per patient.
CSF should be collected directly from the tap needle: Collect from the first drop into the containers in the order indicated. Fill each tube to the marked line (0.5 ml in tubes 1, 2, & 5 – 1.0 ml in tubes 3 & 4).
Label each tube without covering up the tube number. Place the tubes into a biohazard plastic bag, place on ice, and send to lab immediately.
OLIGOSACCHARIDES (SCREEN) 7-10 days Random urine 1 mL Refrigerate if sample not completed in one collection
ORGANIC ACIDS (qualitative) 5 days Random urine 2 mL Refrigerate if sample not completed in one collection
OSMOLALITY
  • Blood
1 hr
2 hrs
Green or Gold microtainer 0.4 mL
OSMOLALITY
  • Urine

1 hr
2 hrs

Sterile Urine container 0.3 mL
PCR – CSF for Streptococcus pneumoniae and Neisseria meningitidis Mon – Friday same day CSF sterile container CSF collected by LP in sterile screw cap container. Minimum volume is 0.2 mL. Consult with lab before requesting test. Approval by the microbiologist is required. Store in 4ºC refrigerator for up to 48 hours; if >48 hrs, store at -20ºC
PCR-VIROLOGY Testing-CSF Varies CSF sterile container 0.25 mL of CSF

For Neonates and children ≤ 12 yrs only with a diagnosis of HSV encephalitis. Request Herpes Simplex Group (CMV, EBV, HHV8). Requires approval by a Medical Microbiologist.

Indicate virus test required
PHENOBARBITAL 1-2 days Green or Gold microtainer 0.4 mL

Indicate pre, post dose or random. Biochemist approval required.

HSC send out

PHENYTOIN 
(Dilantin)

4 hrs Green or Gold microtainer 0.5 mL Indicate pre, post dose or random

PHOSPHATE 
(Inorganic)

4 hrs Green or Gold microtainer 0.4 mL 0.6mL for panel with Ca/ Phos/Mg/Alb
PTH, (Intact)
(PARATHYROID HORMONE)
4 hrs Lavender microtainer 1.5 mL Note time of draw
PT/PTT 1 hr BLUE COAG “MiniCollect” tube
(3.2% sodium citrate)

1 full MiniCollect tube

NOTE:
2 citrated MiniCollect tubes for full Coag panel – PT/PTT,
D-Dimer, and Fibrinogen

1. Add exactly 0.9 mL blood to liquid in tube.
2. Invert gently and thoroughly 4-6 times
3. Send to lab ASAP.
PYRUVATE 3 days Lithium heparin syringe 0.4 mL –
  • Lactate and pyruvate done on same sample

On ice to lab immediately
(Must reach lab within 30 min of collection)

PYRUVATE KINASE 3 days EDTA (lavender tube) 2 ml Lavendar top tube (Must reach lab within 30 min of collection)
Sample must not be clotted.
PROTEIN - CSF 1 hr CSF collection tube 0.4 mL (Glucose and Protein) See CSF Glucose
RENIN 3 weeks Lavender microtainer 3 mL – 3 tubes Send to lab on ice.
RETICULOCYTE COUNT 30 mins Lavender microtainer 0.30 mL whole blood

Invert gently and thoroughly 4-6 times immediately after collecting

CBC must be ordered with each request for Retic
SIROLIMUS 3 days
Mon.– Thurs.
Lavender microtainer 0.5 mL Trough sample 0-30 min before next dose
TAY-SACHS (Hexosaminidase) 7-12 days Heparin syringe 1.3 mL

A HSC Molecular Genetics requisition must be filled out.

Monday to Friday (8-4)

Send to the lab at room temp.

TESTOSTERONE

  • Total
4 hrs
(M-F)
Gold microtainer 1 mL
Thyroid function
(FT3, FT4 and TSH
4 hrs
(M-F)
Green or Gold Microtainer 0.8 mL
TOBRAMYCIN
  • Trough
  • Peak
  • Random
4 hrs Green or Gold Microtainer 0.4 mL Indicate
  • Trough
  • Peak
  • Random on label
TORCH SCREEN –serology for Toxoplasmosis, Rubella, Cytomegalovirus, Herpes Simplex 7-10 days Gold microtainer 1-2 mL Follow PHL requisition instructions.
Parvovirus not part of TORCH panel.
TRANSFERRIN 7 days Gold microtainer 0.6 mL
TRANSFERRIN ISOELECTRIC FOCUSING FOR CDG Varies 3 Gold microtainers

2 mL (1.2 mL minimum).

TRIGLYCERIDES 4 hrs Green or Gold microtainer 0.4 mL
TROPONIN 1 hr Green microtainer 0.8 mL
UREA (BUN) 1 hr Green or Gold microtainer 0.4 mL
URINALYSIS 2 hrs Sterile Urine container 2 mL urine
URINE DRUG SCREEN Same day Sterile Urine container 5 mL urine A HSC Toxicology form must be filled out
URINE SUCCINYL ACETONE Same Day (sent by lab M to F) Sterile Urine container 3 mL urine
VANCOMYCIN
  • Trough
  • Peak
  • Random
4 hrs Green or Gold microtainer 0.5 mL

Indicate pre, post dose or random on label

VIRUS ISOLATION Varies according to specimen type. Refer to SCI-5.7.15.2.10.
VITAMIN D;25 OH 7 days Gold microtainer 0.5 mL

 

CRITICAL BLOOD WORK FOR HYPOGLYCEMIA
ACTH 7 days Lavender microtainer 0.5 mL
  1. Pre chill tubes
  2. Mix gently after drawing
  3. Send to lab on ice
  4. Collect on non-heparinized syringe
CORTISOL SD Gold microtainer 0.6 mL
BLOOD GAS, LACTATE, SERUM GLUCOSE 7 days CAP TUBE 0.125 mL Send on ice
BETA HYDROXY-BUTYRATE 7 days Gold microtainer With Free Fatty Acids (FFAS)
FREE FATTY A ACIDS (FFAS) Weekly Gold microtainer preferred,
Green acceptable
0.6 mL –
Can be combined with Beta Hydroxy-butyrate.
FASTING Sample preferred
GROWTH HORMONE 7 days Gold microtainer 0.6 mL Collect on non-heparinized syringe
INSULIN 2 days Green or Gold microtainer 0.6 mL Send on ice
Collect on non-heparinized syringe

 

References

  1. BD Microtainer® Tubes. [package insert]. Oakville (ON): BD; 2006.
  2. Hospital for Sick Children. Molecular microbiology virus requisition. Paediatric Laboratory Medicine. HSC; 2010.