In the hours after your baby is born, your little one’s care team will run a series of screenings to detect any problems or underlying health issues. The hospital experience can feel like a complete whirlwind with so many doctors, nurses and specialists examining and testing your baby (and you!).
Here are the standard newborn tests and screenings you can expect at Women & Babies Hospital, as well as other hospitals in Pennsylvania. As your baby is going through each of these tests, it’s completely ok—and encouraged—to ask baby’s providers and care team questions. It can be a lot to take in!
Apgar Test
This test is routinely given immediately after your little one is born, and is a quick way to assess their physical condition. The Apgar test is given at one minute after birth, again at five minutes after birth and, if necessary, again at 10 minutes after birth.
The Apgar test measures:
- Heart rate
- Respiration (assessed by how strong and regular baby’s cry is)
- Muscle tone (assessed by how active baby is)
- Reflex response (assessed by baby’s reaction a bulb syringe or similar device inserted into their nose)
- Color (of baby’s body, hands and feet)
Each of these factors are scored on a scale of 0-2, with a total score of 10 being the highest possible rating. “Normal” Apgar scores are between 7-10, whereas a score of 4-6 may mean your baby needs medical intervention or careful monitoring. A score of less than 4 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 your baby needs medical attention (such as oxygen), it does not necessarily signify a long-term problem. If your little one’s score improves at the five-minute assessment, this is a great sign that your little one is doing well.
Hearing Screening
Hearing screening is a way to ensure all babies who are born deaf or hard of hearing (roughly 1-3 in 1,000 babies in the U.S.) are identified quickly after birth. You may wonder—how in the world does a hearing test work for a newborn? There’s a very cool way to test, called the Automated Auditory Brainstem Response, or AABR. This test measures how baby’s hearing nerve and brain respond to sound. A set of headphones are placed over baby’s ears, and painless electrodes are placed on baby’s head. Clicks or soft sounds are played into baby’s ears, and the electrodes measure the hearing nerve and brain’s response to the sounds. The screening typically takes five to 10 minutes, and is usually given when baby is asleep or resting quietly.
Each newborn will be screened prior to being discharged from the hospital. If the screening indicates a problem, your care team may schedule another test at one month of age, or refer you to outpatient testing with a hearing specialist.
Bilirubin Screening
Once your baby is 24 to 36 hours post-delivery, a bilirubin screening will be performed in order to assess if your baby has 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 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 typically 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.
Dried Blood Spot Screen
This test (sometimes known as the “heel stick” test) is performed by pricking your newborn’s heel (we know, it’s hard to think about!) 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.
Results for this screening are typically available in about seven to10 days, and will be given to your little one’s provider. 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.
Critical Congenital Heart Defect Screening
While newborn heart disease isn’t very common, it can be difficult to detect. After 24 hours of age, all newborns are screened for heart disease at Women & Babies Hospital in order to identify any heart conditions before outward signs or symptoms appear. This screening is very simple and painless for baby. An oxygen monitor, often known as pulse oximeter, will be wrapped around your baby’s foot and hand, and will provide a reading.
Typically babies who have an oxygen saturation level greater than, or equal to, 95% in the right hand or foot, with less than, or equal to, a 3% difference between the hand and foot are considered to “pass” the screening. If your baby does not pass the screening, your provider will request a consultation with a specialist to discuss next steps and any further testing.
These screenings can seem like a lot of hurdles for your little one to clear. But they’re all quick, fairly painless, and a great way to ensure that any potential health problems are identified as soon as possible. Your baby is in great hands, mama.