Newborn screenings after childbirth

In the hours after birth, your baby’s care team will run a series of screenings to detect any problems or underlying health issues.

“In Pennsylvania, your newborn will be screened for 61 different health conditions,” said Penn Medicine's Amy Latyak, BSN, RN, CCE, CBC, childbirth education program coordinator at Chester County Hospital. “This might sound like a lot, but many of these conditions are evaluated using a single blood test.”

Latyak explained the standard newborn tests and screenings you can expect at Penn Medicine, as well as other hospitals in Pennsylvania.

Apgar test

The Apgar test is routinely given one minute after birth, again at five minutes, and, if necessary, at 10 minutes after birth. It is a quick way to assess a baby’s physical condition.

The Apgar test measures:

• Heart rate
• Respiration (assessed by the strength and regularity of a baby’s cry)
• Muscle tone (assessed by activity level)
• Reflex response (assessed by a baby’s reaction when a bulb syringe or similar device inserted into their nose)
• Color (of a baby’s body, hands and feet)

Each of these factors are scored on a scale of zero to two, with a total score of 10 being the highest possible rating. “Normal” Apgar scores are between seven and 10. A score of four to six may mean your baby needs medical intervention or careful monitoring. A score of less than four means your baby requires intensive medical attention and will be taken to the neonatal intensive care unit (NICU) for special care.

It’s important to note that while a low score on the first test at one minute may indicate a need for medical attention (such as oxygen), it does not necessarily indicate a long-term problem. If your baby’s score improves at the five-minute assessment, this is a great sign that they are doing well.

Hearing screening

A hearing screening is a way to ensure all babies who are born deaf or hard of hearing (roughly one to three in 1,000 babies in the U.S.) are identified quickly after birth.

During the screening, an audiologist will do some special tests to check how well the baby can hear. The tests are done shortly after birth and don’t hurt at all. Often, they can even be done while your baby is sleeping.

There are two different kinds of hearing screenings: the otoacoustic emissions (OAE) test and the auditory brainstem response (ABR) test. An OAE measures the inner ear’s ability to respond to sound, while an ABR measures the brain’s response to sound. Both tests are non-invasive and painless, and can be done quickly and easily by a trained health-care professional.

If the results are abnormal, further testing can determine if there is hearing loss, what type, how much, and the kind of intervention may be needed.

“Finding hearing loss early makes a big difference in how well a child can learn to communicate,” said Latyak. “Plus, it means your doctors can provide you with the right support, options, and resources to learn more about your baby’s communication needs and support their development.”

Pulse oximetry test

Another kind of screening your infant will experience while still at the hospital is a pulse oximetry. A pulse oximeter will measure how much oxygen is in your baby’s blood. This screening is important because low levels of oxygen can indicate a heart defect like congenital heart disease.

Testing for heart defects is key in catching and treating them early. Approximately one percent of all babies are born with a congenital heart defect, and an estimated 120 deaths are prevented each year because of newborn pulse oximetry screening.

A pulse oximeter works by placing a small sensor on your baby’s foot and hand. The sensor will measure your baby’s heart rate and blood oxygen levels for about five minutes.

Blood test

This blood test (sometimes known as the “heel stick” test) is performed by pricking a newborn’s heel and placing a few drops of blood on a special filter paper to be sent to a laboratory for testing. There are 10 mandated disorders that must be screened for in Pennsylvania, as well as a multitude of supplemental disorders.

“This blood test will check for disorders such as phenylketonuria (PKU), hypothyroidism, and sickle cell disease, among other hormonal, metabolic, and hemoglobin concerns. Early detection means early treatment — and better outcomes for your baby’s health.” said Latyak.

Results for this screening are made available to your baby’s provider typically within a few days. While many of the disorders in this screening are rare, they can cause serious health problems if not diagnosed and treated quickly. If any results are abnormal, your baby’s doctor will contact you to discuss next steps or additional testing.

Bilirubin screening

Once your baby is 24 to 36 hours post-delivery, a bilirubin screening will be performed to assess for jaundice. As your baby’s body breaks down and eliminates red blood cells from their body, it produces a colorful pigment known as bilirubin. When bilirubin levels are too high, baby’s skin and eyes might take on a yellow tone, indicating jaundice—a condition that occurs in more than half of all newborns.

To test for bilirubin, your newborn’s care team may prick your baby’s heel to test a small amount of blood, or will use a simple light test on baby’s forehead to monitor their bilirubin levels.

While most cases of jaundice are mild and will resolve on their own, some may require treatment. Jaundice is typically treated using phototherapy, or exposure to a special type of fluorescent light in order to bring bilirubin levels down. This process is usually done by placing baby in an enclosed crib with a light, or using a special blanket with lights inside of it that will be absorbed by the skin. Frequent feedings every two to three hours can also help to reduce jaundice levels in newborns.

Understanding newborn screenings

“It’s okay if the idea of newborn screening makes you a little nervous. You may be worried about being apart from your baby or what the results might be,” said Latyak. "But just know that screening is a great way to give you peace of mind, knowing your baby's health is being monitored and addressed from day one."