What are the screening procedures?

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 babys blood sample. The other part is for important information for the lab performing the screen, such as the babys 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 babys primary care provider for the follow-up results. During the blood test, which is sometimes called a heel stick, the babys heel will be pricked to collect a small sample of blood. 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.

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 babys 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 brains 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 babys head to detect the brains response to the sounds. If the babys brain does not respond consistently to the sounds, there may be a hearing problem.

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 babys 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 babys newborn screening result is out of the normal range from their babys 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 babys primary healthcare provider immediately to learn the cause of the out -ofrange 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 states 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 or doula 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 babys 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 hospitals protocol, speak with your obstetrician or the babys 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 infants 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 childs 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) worldwide will have newborn screening provided through a contract with Perkim Elmer. The standardized panel offered by the Department of Defense for MTFs enrolled in the contract screens for 29 disorders as primary targets and detects an additional 24 disorders as secondary targets. This specifially covers all of the conditions on the Recommended Uniform Screening Panel. For military babies born outside of MTF's, 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 babys 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.