While it's completely natural to wonder about your newborn's health, rest assured that the vast majority of babies arrive healthy and ready to thrive. To help keep it that way, a few simple, routine screenings in those very first days can spot rare hidden conditions — like congenital heart defects or metabolic disorders — before any symptoms ever start.
These quick, inexpensive tests give doctors the chance to step in early with simple treatments, ensuring your little one gets the safest, healthiest start possible.
What kind of tests will my newborn baby get?
The newborn screenings your baby will most likely undergo include:
A rating on the Apgar scale
This simple and essential assessment of your baby’s condition is done between one and five minutes after birth. The Apgar test is a very quick way for your health care team to see if your baby might need a little extra help getting used to life outside the womb.
From understanding Apgar scores to packing the sweetest going-home outfit, track every detail on the free What to Expect app. It's your daily guide through pregnancy and life with your baby.
A congenital heart disease screening
Experts recommend, and some states require, screening tests soon after birth for congenital heart defects. These conditions can be very serious — but happily, with early diagnosis and treatment, your baby can go on to live a normal life.
This screening, using pulse oximetry, is simple and painless. A sensor is placed on your baby’s skin to measure your little one’s pulse and the amount of oxygen in his blood.
If the results of the screening seem questionable, the doctor will request further testing (like an echocardiogram or an ultrasound of the heart) to determine if anything is wrong.
A blood test
A few drops of blood are routinely taken using a single heel stick test usually 24 to 48 hours after birth. This single blood test looks for more than a dozen serious genetic, metabolic, hormonal, and functional disorders, including:
- Phenylketonuria (PKU)
- Hypothyroidism
- Congenital adrenal hyperplasia
- Biotinidase deficiency
- Maple syrup urine disease
- Galactosemia
- Homocystinuria
- Medium-chain acyl-CoA dehydrogenase deficiency
- Sickle cell anemia
Although most of these conditions are very rare, they can be life-threatening if they go undetected and untreated.
A hearing test
Hearing impairment is very rare in the United States, occurring in 2 or 3 out of every 1,000 babies born each year in the United States. But it can affect many aspects of a child’s development, including speech and language — so early diagnosis and treatment are key.
That's why your baby will get a hearing screening before you leave the hospital. There are two types of tests:
- Otoacoustic emissions (OAE) measures baby's response to sound by using a small probe inserted in the ear canal. In babies with normal hearing, a microphone inside the probe records faint noises coming from the baby’s ear in response to a noise produced by the probe. The test can be done while baby is sleeping, is completed within a few minutes, and causes no pain or discomfort.
- Auditory brainstem response (ABR) uses electrodes placed on baby’s scalp to detect activity in the brain stem’s auditory region in response to "clicks" sounded in the newborn's ear. ABR screening requires the infant to be awake and in a quiet state, but it’s also quick and painless.
If your baby doesn’t pass the initial screening, the test will be repeated to avoid false-positive results.
A physical examination and preventive treatments
In addition to conducting the core newborn screening tests during your baby's hospital stay, your health care practitioner will most likely also:
- Weigh baby and measure his length and head circumference
- Count fingers and toes and note if any body parts and features appear abnormal
- Examine baby's internal organs, including kidneys, liver, and spleen, externally by touch
- Check your newborn's reflexes, hip rotation, and umbilical stump
- Record your baby's first pees and poops to rule out any issues
- Administer antibiotic eye ointment to prevent infection, a vitamin K injection, and the first dose of the hepatitis B vaccine
What is the vitamin K shot?
The body needs vitamin K to help form blood clots. Since most babies are born with low levels, they'll get a vitamin K shot within six hours of birth to enhance their blood-clotting ability and prevent a potentially dangerous condition from cropping up.
Will my baby need every test? Can I opt out of newborn screening tests?
Newborn screenings are required by law in every state, but each state has its own regulations.
Check with your practitioner or your local board of health to find out what tests are done in your state, or look them up online at Baby's First Test, a newborn screening education center.
If you have any concerns, talk through them with your health care practitioner at a prenatal visit — don’t wait until delivery day to speak up. Your practitioner can help you weigh your concerns and the benefits of these screenings.
You do have the right to opt out of any test or procedure, but you will need to sign paperwork documenting your decision. In some cases, the hospital might inform the state’s department of child services that you’ve decided to forgo the recommended screening.
Keep in mind that although most of these conditions are very rare, they can be life-threatening if they go undetected and untreated. Testing is inexpensive, and in the very unlikely event that your baby tests positive for any condition, the pediatrician can verify the results and begin treatment immediately, making a huge difference in the prognosis.
Will my baby need more tests than the required screenings?
Certain states require additional newborn screenings in their heel-stick tests, sometimes because of an at-risk population in the area. To check which conditions must be tested for in your state, visit Baby's First Test.
Will my insurance cover all the newborn screening tests?
Under the Affordable Care Act, your insurance is required to cover the following newborn screenings:
- Congenital hypothyroidism
- Sickle cell anemia
- PKU
- Bilirubin concentration
- Hearing
There’s a good chance your insurance will cover all the other blood tests as well as the one for congenital heart defects, so be sure to check.
Can I ask for more newborn screening tests?
If your hospital doesn’t automatically provide the core newborn blood tests recommended by your state, you can arrange to have them done. Talk to your doctor, then check with your insurance to calculate your out-of-pocket costs, if any.
If your state doesn’t require screening for congenital heart disease, ask your baby’s pediatrician if your little one can get tested.
Are all newborn tests safe?
Yes. All newborn tests have a proven track record of protecting babies and were recommended only after extensive research. They’re not only perfectly safe for your little one, they’re highly recommended.
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