Newborn screening results: the heel prick, hearing screen and heart check
Newborn screening looks for rare developmental, genetic and metabolic conditions so that steps can be taken before symptoms start. Most of these conditions are very rare, but they can be treated if found early. (MedlinePlus, newborn screening) Screening tests do not diagnose illness: they show which babies need more testing. (MedlinePlus, newborn screening)
The three checks in the first days (US)
Newborn screening usually starts with a blood test, followed by a hearing test and possibly other tests. (NICHD, how it is done) Screening for hearing loss and critical congenital heart disease is recommended for all newborns, and many states require it by law. The tests are most often done before leaving the hospital, between 24 hours and 7 days old, and need no preparation. (MedlinePlus, newborn screening)
| Check | How it is done | When |
|---|---|---|
| Heel-prick blood test | A small puncture in the heel and a few drops of blood on a special card, which goes to a lab. (NICHD, how it is done) | First sample usually 24 to 48 hours after birth, ideally before the baby leaves the hospital |
| Hearing screen | Either a tiny earphone and microphone in the ear that listen for an echo (otoacoustic emissions, OAE), or sticky sensors on the head that pick up the brain's response to sounds (auditory brainstem response, ABR). Each takes about 5 to 10 minutes. (NICHD, how it is done) (MedlinePlus, newborn screening) | Usually before the baby leaves the hospital |
| Pulse oximetry heart check | A small soft sensor on the skin measures oxygen in the blood in the hand and foot for a few minutes. Low oxygen can be a sign of a heart problem, including critical congenital heart disease (CCHD). (NICHD, how it is done) (MedlinePlus, newborn screening) | Usually at least 24 hours after birth |
The baby will most likely cry at the heel prick, and MedlinePlus says babies held skin-to-skin or breastfed during it show less distress. The hearing screen and the heart check should not hurt. Risks of the heel prick are pain and possible bruising. (MedlinePlus, newborn screening)
What the RUSP is
The Recommended Uniform Screening Panel (RUSP) is the list of conditions the US Secretary of Health and Human Services recommends that states screen for in their newborn screening programs. Conditions are chosen on evidence of the possible net benefit of screening, whether states are able to screen for them, and whether effective treatment exists. Each state decides which conditions it screens for, but HHS recommends that every newborn be screened for all conditions on the RUSP. (Federal Register, Dec 2025)
- Latest changes: on December 16, 2025, the Secretary accepted HRSA's recommendations to add metachromatic leukodystrophy (MLD) and Duchenne muscular dystrophy (DMD) to the RUSP. (Federal Register, Dec 2025) (Federal Register, DMD) HRSA keeps the current list.
- Insurance: conditions on the RUSP are part of HRSA-supported preventive guidelines for infants and children, so non-grandfathered group health plans and insurers must cover the screening without a copay, coinsurance or deductible, starting with plan years that begin 1 year after a condition is adopted. (Federal Register, Dec 2025)
- Examples of conditions found by the blood test: phenylketonuria (PKU), congenital hypothyroidism, cystic fibrosis, sickle cell disease and other hemoglobin disorders, galactosemia, congenital adrenal hyperplasia, severe combined immunodeficiency (SCID), and disorders of how the body handles amino acids, fatty acids and organic acids. The tests done vary from state to state. (MedlinePlus, newborn screening)
What the results mean
- In range (negative): most parents hear nothing at all, which usually means the tests did not find any of the conditions screened for. Most states contact parents only when a result is out of range. If you have concerns, ask your baby's health care provider. (NICHD, results)
- Out of range (screen positive): your baby's provider or the state health department contacts you, usually within 2 to 3 weeks. This does not mean your baby definitely has the condition, and some results are false positives. Your baby needs more testing right away to confirm or rule out the condition. (NICHD, results) An abnormal result means the child should have more testing. (MedlinePlus, newborn screening)
- A diagnosis comes only from those follow-up tests: screening tests and diagnostic tests are not the same. If you get a call about your baby's results, follow up quickly and follow the instructions you are given. (NICHD, results)
- Hearing screen: with the echo test, no echo means there may be hearing loss; with the brain response test, an inconsistent response means there may be a hearing problem. (NICHD, how it is done) A clear result in both ears means hearing loss is unlikely, but the screen does not find all types, and hearing loss can develop later. (NHS, hearing) See hearing tests by age.
Why a repeat sample is common
Some US states require a second blood test that repeats the first set of screenings when the baby is 10 days to 2 weeks old. For some conditions, the screen is not valid if the blood is taken within 24 hours of birth. (NICHD, how it is done) The NHS says a test sometimes needs to be done again for lots of reasons, and that this does not necessarily mean anything is wrong with your baby. (NHS, blood spot)
How newborn screening works in the NHS
| Check | What it covers | When |
|---|---|---|
| Newborn blood spot test | 10 conditions: cystic fibrosis, sickle cell disease, congenital hypothyroidism and 7 inherited metabolic diseases (PKU, MCADD, MSUD, IVA, GA1, HCU and HT1). Spinal muscular atrophy (SMA) is also tested in some parts of England. (NHS, blood spot) | Usually at 5 days old, often at home; results by 6 weeks |
| Newborn hearing screening | A small soft earpiece plays gentle clicks; results are given straight away. (NHS, hearing) | Usually before 4 weeks old, and up to 3 months |
| Newborn physical examination | A check of the whole body, with a focus on the eyes, heart, hips and, in boys, the testicles. The examiner checks the pulse and listens to the heart. (NHS, physical exam) | Within 72 hours of birth, and again at 6 to 8 weeks |
The NHS blood spot test has three possible results: no signs of any condition (most babies), carrier of a condition, or signs of a condition found. A carrier of cystic fibrosis, sickle cell disease or another red blood cell condition does not have the condition and will usually be healthy, but could pass it on to their own children. If a condition is suspected, a health professional contacts you and your baby is referred to a specialist for more tests. (NHS, blood spot)
Where they differ:
- Which conditions: in the US, HHS recommends the RUSP and each state chooses its own list, (Federal Register, Dec 2025) while the NHS blood spot test covers 10 conditions, with SMA added in some parts of England. (NHS, blood spot)
- Timing of the blood test: the first US sample is usually taken 24 to 48 hours after birth, (NICHD, how it is done) while the NHS usually takes it at 5 days old. (NHS, blood spot)
- The heart check: in the US, pulse oximetry screening for critical congenital heart disease is recommended for all newborns, (MedlinePlus, newborn screening) while the NHS describes a physical examination in which the pulse is checked and the heart is listened to, within 72 hours and again at 6 to 8 weeks. (NHS, physical exam)
- How results reach you: in the US, most states contact parents only about out-of-range results, (NICHD, results) while the NHS sends a result for every baby by 6 weeks, including a letter when no condition is suspected. (NHS, blood spot)
Your doctor decides what your result means for you.
This page does not give treatment advice. If you have a flagged result, see after an abnormal screening result for questions to ask.
Questions people ask
Does no news mean my baby's newborn screen was normal?
Usually. NICHD says most parents hear nothing about the results, which usually means the tests did not find any of the conditions screened for. Most states contact parents only when a result is out of range. If you have concerns, ask your baby's health care provider about the results. (NICHD, results)
Does an out-of-range newborn screen mean my baby has the condition?
No. NICHD says an out-of-range result does not mean the child definitely has the condition, and some results are false positives. It does mean your baby needs more testing right away to confirm or rule out the condition, because screening tests and diagnostic tests are not the same. (NICHD, results) (MedlinePlus, newborn screening)
Why does my baby need a second newborn blood test?
Some US states require a second blood test at 10 days to 2 weeks old. For some conditions the screen is not valid if blood is taken within 24 hours of birth. The NHS says there are lots of reasons a test may need to be repeated, and it does not necessarily mean anything is wrong. (NICHD, how it is done) (NHS, blood spot)
What does it mean if my baby did not pass the hearing screen?
It means the screen did not give a clear result. In the NHS, the screen is repeated or a second, different test is offered, and a baby without a clear result in 1 or both ears is seen at an audiology clinic within 4 weeks. (NHS, hearing)
Are all babies in the US screened for the same conditions?
No. HHS recommends that every newborn be screened for all conditions on the Recommended Uniform Screening Panel, but each state decides which conditions its program screens for. MedlinePlus says the tests done vary from state to state. (Federal Register, Dec 2025) (MedlinePlus, newborn screening)