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Your Baby’s Screening Screening Procedures

There are nearly 4 million babies born in the United States each year. While most babies are born healthy, some infants are born with serious but treatable medical conditions. These conditions can be present in any family, even those without a family history of them. Newborn screening helps health professionals to identify and treat these conditions before they make a baby sick. 

What are the screening procedures?

There are three parts to newborn screening: the blood test (or heel stick); the hearing screen; and pulse oximetry

Blood Test: 

First, a physician, nurse, midwife, or other trained member of the hospital staff will fill out a newborn screening card. One part of this card is the filter paper to collect the baby’s blood sample. The other part is for important information for the lab performing the screen, such as the baby’s name, sex, weight, date/time of birth, date/time of heel stick collection, and date/time of first feeding. It will also include the contact information of the parents and the baby’s primary care provider for the follow-up results.

During the blood test, which is sometimes called a heel stick, the baby’s heel will be pricked to collect a small sample of blood. Parents are welcome to be a part of this process by holding their baby while the heel stick is performed. Studies show that when mothers or health professionals comfort babies during this process, the babies are less likely to cry. The health professional will put drops of blood onto the filter paper card to create several “dried blood spots.” The newborn screening card is then sent to the state laboratory for analysis.

Families can make requests for additional screening, also known as supplemental screening. Additional screening refers to extra testing that can be performed after participating in your state’s newborn screening program. This is sometimes done if there is family history of certain conditions or other health concerns. While each state screens for many conditions, there are more conditions that can be detected at birth. We recommend discussing additional screening and any concerns you might have with a health care professional. Make sure to ask what conditions are covered in your state and what information additional screening could provide. It is also important to contact your insurance company to determine their policy regarding additional screening coverage, since state programs do not pay for additional screening or the follow-up treatment. For more information about additional screening, click here.

Hearing Screen:

Two different tests can be used to screen for hearing loss in babies. Both tests are quick (5-10 minutes), safe and comfortable with no activity required from your child. In fact, these tests are often performed while a baby is asleep. One or both tests may be used.

  1. Otoacoustic Emissions (OAE) Test: This test is used to determine if certain parts of the baby’s ear respond to sound. During the test, a miniature earphone and microphone are placed in the ear and sounds are played. When a baby has normal hearing, an echo is reflected back into the ear canal, which can be measured by the microphone. If no echo is detected, it can indicate hearing loss.
  2. Auditory Brain Stem Response (ABR) Test: This test is used to evaluate the auditory brain stem (the part of the nerve that carries sound from the ear to the brain) and the brain’s response to sound. During this test, miniature earphones are placed in the ear and sounds are played. Band-Aid-like electrodes are placed along the baby’s head to detect the brain’s response to the sounds. If the baby’s brain does not respond consistently to the sounds, there may be a hearing problem.
To find contact information for your state's Early Hearing Detection and Intervention (EHDI) program, click here.

Pulse Oximetry Testing:

Pulse oximetry, or pulse ox, is a non-invasive test that measures how much oxygen is in the blood.  Infants with heart problems may have low blood oxygen levels, and therefore, the pulse ox test can help identify babies that may have Critical Congenital Heart Disease (CCHD).  The test is done using a machine called a pulse oximeter, using a painless sensor placed on the baby’s skin. The pulse ox test only takes a couple of minutes and is performed after the baby is 24 hours old and before he or she leaves the newborn nursery.

Why are all babies screened at birth?

Most babies are born healthy. However, some infants have a serious medical condition even though they look and act like all newborns. These babies generally come from families with no previous history of a condition. Newborn screening allows health professionals to identify and treat certain conditions before they make a baby sick. Most babies with these conditions who are identified at birth and treated early are able to grow up healthy with normal development.

Do parents have to ask for screening?

No – it is normal hospital procedure to screen every baby regardless of whether the parent asks for it and whether the parents have health insurance. The screening test is normally included in the forms for standard medical procedures that the newborn may need after birth. Parents sign this form upon arrival at the hospital for the birth of their baby. All states require screening to be performed on newborns, but most will allow parents to refuse for religious purposes. Any decision to decline or refuse testing should first be discussed with a health professional, since newborn screening is designed to protect the health of the baby.

When does the screen happen? 

The blood test is generally performed when a baby is 24 to 48 hours old. This timing is important because certain conditions may go undetected if the blood sample is drawn before 24 hours of age. If the blood is drawn after 48 hours of age, there could be a life-threatening delay in providing care to an infant that has the condition. Some states require babies to undergo a second newborn screen when they are two weeks old. This precaution ensures that parents and health professionals have the most accurate results.

Ideally, the newborn hearing screen should be performed before the baby leaves the hospital.

How will parents find out the results?

Parents will learn if their baby’s newborn screening result is out of the normal range from their baby’s health care provider and/or the state newborn screening program. An abnormal newborn screen result does not necessarily mean your baby is ill.  It may occur because the blood sample was collected too soon after birth, not enough blood was obtained, or your infant did not have enough breast or bottle feedings prior to the testing. However, sometimes an out-of-range result indicates a serious, but treatable, health problem. It is important for parents to follow up with the baby’s primary healthcare provider immediately to learn the cause of the out-of-range result.

How are screening costs covered?

Newborn screening test costs vary by state because individual states finance their newborn screening programs in different ways. Most states collect a fee for screening, but health insurance or other programs often cover all or part of it. Babies will receive newborn screening regardless of health insurance status. For more information regarding the cost of newborn screening in your state, contact your state’s newborn screening coordinator. Find the contact info for your state coordinator by searching for your state here.

Newborn Screening and Home Births 

Even babies who are not born in a hospital are required to have newborn screening. If a home birth is planned, the licensed midwife may be qualified to complete the newborn screening blood test and hearing screen. If newborn screening cannot be completed in the home, parents should bring the infant to a hospital or clinic for the newborn screening blood test within a few days of birth. A hearing screen should also be scheduled with the baby’s health care provider at no later than one month of age.

Newborn Screening for Preterm, Low Birth Weight, NICU or Sick Newborns

Babies born preterm, sick or with a low birth weight often have certain medical problems that require special treatments. These treatments or procedures can affect the newborn screening results. These infants may require a special process for newborn screening. For example, many preterm, sick or low birth weight infants require more than one blood draw throughout their hospital stay to ensure accurate testing. To find out more about your hospital’s protocol, speak with your obstetrician or the baby’s doctor.

Newborn Screening and Adoption

For international adoptions, some adoption agencies may be able to arrange overseas newborn screening during the pre-adoption period with the consent of the infant’s legal guardian. For children adopted from the United States, most states recommend that contact information for the adoptive parents, adoption agency, or lawyer be included on the newborn screening card, rather than that of the birth mother. This will allow timely follow-up with the child’s caregivers in the event of an abnormal test result.

Adopted children who are born at home, in independent clinics or in other countries may not have had newborn screening, or their results may be unavailable. If results cannot be confirmed during the initial medical assessment of an adopted infant, screening should be done promptly. Clinical testing may be more appropriate than newborn screening for adopted children older than one year of age and for children whose medical history suggests they have a health condition.

Newborn Screening for Military Families

Babies born at Military Treatment Facilities (MTF's) will have newborn screening provided through the state they were born in.  This applies to all branches of the military (Army, Navy, Air Force). For babies born in MTFs outside of the continental United States, the MTF will send the sample to a preselected state program on the mainland for testing. Military babies born outside of MTF's will get the screening used by the hospital they are born in. For information on state programs, please visit the state page of where the baby will be born to learn about that state's panel.

Additional Questions

If you have additional questions regarding the newborn screening process, please speak with your baby’s health care provider. For specific information regarding newborn screening in your state, visit the Conditions Screened by State page or contact your state newborn screening coordinator.

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Last Reviewed - 08/20/2019

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