After your baby is born, one of the first orders of business is to make sure they have come through the stressful birthing experience safely.

There are examinations conducted starting at minute one. They are performed at most birthing facilities by a pediatric nurse in the delivery room whose sole job is caring for your baby while another nurse in the room is charged with caring for the mother.

There are more tests to follow in the coming day or so as part of the standard newborn screening. It’s all part of making sure your baby is off to a healthy start and potential health issues are identified, if possible.

The Apgar scale

Starting at the one-minute mark and again at five minutes after birth, the pediatric nurse will give your newborn a score from zero to 10. Each of the five components is rated from zero to two, with two being the best rating.

1. Color: Low blood sugar can make your baby appear more blue than normal.
2. Heart rate: Is the little ticker ticking at a strong and healthy newborn heart rate?
3. Reflexes: Do the baby’s reflexes respond to stimulation?
4. Muscle tone: Has the baby developed the appropriate muscle mass while exercising in the womb?
5. Respiration: Is the baby breathing properly?

The five ratings are combined to create the Apgar score. If your newborn scores less than seven, the Apgar examination will be done every five minutes for 20 minutes.

Low blood sugar in newborns is common immediately after birth. For many, they begin recovering their healthy blood glucose level quickly. And if your baby’s liver isn’t strong enough, yet, to process all the bilirubin in their body, the high bilirubin level can give their skin and eyes a yellow coloring.

The Apgar scale, developed by a doctor in 1952, is used to measure the immediate health status of the newborn. However, it doesn’t predict the future health of the child.

Next step: newborn screening

One or two days after being born, your child will receive a newborn screening tests. This special exam for infants includes a hearing screening, heart screening and genetic screening.

“Our goal is to identify babies with genetic diseases so we can intervene and save these babies from serious health problems and potentially death,” said Robyn Lindenmeyer, director of Women’s and Children’s Health at OSF HealthCare.

Hearing screening

To check for hearing loss, the baby’s nurse places small earphones in your baby’s ears to check how your child responds to sound.

Heart screening

Your baby’s health provider uses a pulse oximeter machine and sensors on the skin to check how much oxygen is in your child’s blood. This screening is used to identify congenital heart defects.

Genetic screening

Also called a newborn metabolic screening, genetic screening can help detect:

• Amino acid disorders, such as classic phenylketonuria (PKU)
• Blood disorders, such as sickle cell disease or sickle cell anemia
• Endocrine disorders, such as primary congenital hyperthyroidism (CH)
• Metabolic disorders
• Other disorders (See a full list of conditions for Illinois or Michigan.)

A genetic screening is usually performed at least 24 hours after a baby is born before they leave the hospital. Babies born at home can usually receive this screening from the midwife who delivered them.

To perform the screening, providers need a small amount of your baby’s blood. This is usually done with a heel stick – the least traumatic way to collect a blood sample from an infant.

The provider will need to collect a few drops of blood onto a special kind of paper. The whole process takes about 10 minutes.

Bilirubin test

Jaundice in newborns is very common. Jaundice is the yellow color seen in the skin of many newborns caused by elevated levels of a chemical in the blood called bilirubin.

Your baby will have their bilirubin level tested at least once, either by skin or blood test, before they go home from the hospital. If your baby has high levels of bilirubin, they may have phototherapy at the hospital. Phototherapy is a safe form of light therapy that encourages the body to release excess bilirubin through urine or stool. In other cases, your baby can be safely treated at home.

Why screenings matter

Screenings have been a standard part of care for a newborn baby since the 1960s, though the capabilities of the testing have greatly improved since then.

“Back in the ‘60s, we tested for one disease. Now, in Illinois, we test for multiple diseases,” Robyn said.

Some conditions can be diagnosed based on a physical exam, but certain genetic conditions may not be obvious to doctors or parents of a newborn child. Some genetic diseases could go undetected for weeks or even months if it wasn’t for genetic screening.

Genetic screening results

The screening is not used alone to diagnose genetic conditions. Instead, it will show one of two results: normal or abnormal.

If the result is normal, this will be shared with your child’s pediatrician, who may bring it up at your first appointment.

An abnormal result means your child needs more testing. If your child receives this screening result, you will likely be referred to a genetic counselor for more information. An abnormal result isn’t enough to diagnose a genetic condition, and it isn’t necessarily cause for alarm.

While an abnormal result increases the chance a child has a genetic disorder, there are other possible reasons for an abnormal newborn screening. It could indicate the child is a carrier of a genetic disease, which means they have a gene that causes the disease but will never develop any symptoms.

The next step is usually blood or urine testing to find more information. Further testing or examinations could follow, depending on the results.

“We try to walk the family through what the concern was on the newborn screening, what follow-up testing we will do. And then we explain either that it’s all normal or how to follow up with our clinic,” Robyn said. “We know it’s really stressful for families who are adjusting to life at home with a newborn, and it can be really confusing. So, we want to make the process as easy as possible.”

Last Updated: March 14, 2023