Newborn health
Newborn screening tests explained: the heel stick, hearing test, and pulse oximetry
June 29, 2026 · 8 min read
In the first day or two after birth, your baby will have a few quick screening tests, and they can feel like a lot when you are tired and meeting your newborn for the first time. The good news is that these tests are routine, mostly painless, and designed to protect your baby. Every US state screens newborns for a panel of rare but serious conditions so they can be caught and treated early, often before any symptoms show up. This guide explains the three main parts (the blood spot heel stick, the hearing screen, and the pulse oximetry heart check), what a positive screen actually means, and what you need to do. This is general education, not medical advice, so call your provider with any concern about your baby.
Why every newborn is screened
Newborn screening exists to find a small number of rare but serious conditions before they cause harm. Many of these conditions look completely normal at birth, and by the time symptoms appear, damage may already be done. Catching them in the first days means treatment can start early, which can change the course of a baby's health and development. The federal Health Resources and Services Administration (HRSA) maintains the Recommended Uniform Screening Panel (RUSP), a list of conditions it recommends states screen for, so there is a shared national standard. Each state then runs its own newborn screening program and decides the details of its panel and follow-up. Arizona, California, Texas, and Pennsylvania each operate a state newborn screening program, as does every other state. So screening is both nationally guided and locally run, and it happens for essentially every baby born in the United States as a normal part of newborn care.
The blood spot, or heel stick
The first part is the blood spot screen, often called the heel stick. A nurse warms your baby's heel, makes a tiny prick, and collects a few drops of blood on a special card. This is usually done about 24 to 48 hours after birth, because some conditions are easier to detect once your baby has had a little time and a few feedings. Your baby may cry for a moment, but it is over quickly, and holding, feeding, or skin-to-skin contact can comfort them. Those few drops are sent to a state lab and screened for a panel of conditions, including certain metabolic, endocrine, and genetic disorders. The list varies a bit by state but commonly includes things like phenylketonuria (PKU), congenital hypothyroidism, sickle cell disease, and cystic fibrosis. Many of these are treatable with diet, medication, or close monitoring when found early, which is exactly why the blood spot is collected so soon after birth.
The hearing screen
The second part is the newborn hearing screen, and it is quick and painless. It is usually done while your baby is resting quietly or sleeping, often right in the hospital before you go home. A technician places small soft earphones or sensors and plays gentle sounds, and the equipment measures how your baby's ears and hearing pathways respond. Your baby does not have to do anything, and nothing about it hurts. Finding a possible hearing difference early matters because hearing is tied to how babies learn language and communicate, and early support can make a meaningful difference. If the screen does not give a clear pass the first time, that is common and does not mean your baby has hearing loss. Fluid or movement during the test can affect the result, so a rescreen or a referral for a fuller hearing evaluation may simply be the next routine step rather than a sign that something is wrong.
The pulse oximetry heart check
The third part screens for critical congenital heart disease (CCHD) using pulse oximetry. A soft sensor is placed on your baby's skin, usually on a hand and a foot, and it measures the oxygen level in the blood without any needle. This is also painless and takes just a few minutes while your baby rests. The screen looks for certain serious heart problems that can be hard to detect by listening alone but that need attention soon after birth. A low or borderline oxygen reading prompts a closer look, which may include repeating the measurement or an evaluation such as an echocardiogram, an ultrasound of the heart. As with the other screens, most babies pass, and a result that needs follow-up does not by itself mean a heart problem is present. It simply tells the care team to check further so that any condition can be identified and managed early.
A positive screen is not a diagnosis
This is the single most important thing to understand, because it can save you a lot of worry. A positive or out-of-range screen is not a diagnosis. Screening tests are designed to be sensitive, which means they are set up to flag babies who might have a condition so that none are missed. Because of that, they will flag some babies who turn out to be perfectly healthy. A positive screen simply means more testing is needed to know for sure, and most follow-up tests turn out fine. Sometimes the lab or your provider will request a repeat blood spot, often because the first sample was collected very early, was a small amount, or needs confirmation, and that repeat is a normal part of the process, not a sign of trouble. If your baby's screen needs follow-up, your provider or the state program will guide you on the next step, and timely follow-up is what makes screening work.
What parents need to do
The reassuring part is that there is very little for you to do. Newborn screening is routine and is built into standard newborn care, and it is usually low cost or no cost to families. In most cases you simply give consent and let the hospital team do the screens before you go home. The one thing that truly matters on your end is staying reachable. Make sure the hospital and your baby's clinic have your correct, current phone number, and a backup number if you have one, so that results and any follow-up requests can actually reach you. If you move or change your number, tell the clinic. Keep your baby's first pediatric visit, since that is where results are reviewed and any next steps are arranged. If you have not heard anything and want to confirm the results came back normal, it is completely reasonable to call your baby's clinic and ask.
How Materna fits in
Materna does not perform newborn screening, send results, or diagnose anything; the hospital, your baby's clinic, and your state's newborn screening program do that work. What Materna does is help you keep track. The Mommy Passport, which is free for patients, paid by providers, and Spanish-first, can hold your notes on which screens were done, any follow-up appointment, and questions you want to ask at the first pediatric visit, in English or Spanish, so nothing slips through the cracks during a sleep-deprived first week. Materna serves families in Arizona, California, Texas, and Pennsylvania. For any worry about your baby, such as poor feeding, trouble breathing, a bluish color, or unusual sleepiness, call your provider right away, and call 911 in an emergency. If you are struggling with your own mood or having thoughts of harming yourself, you can reach the 988 Suicide and Crisis Lifeline. For questions about coverage or costs of any follow-up, contact your state Medicaid agency.
Frequently asked questions
- Does the heel stick hurt my baby?
- Your baby may feel a quick pinch and cry for a moment, but it is brief and the blood spot only needs a few drops. Holding, feeding, or skin-to-skin contact during and after the test helps comfort your baby. It is over quickly, and most babies settle soon after.
- My baby's screen came back positive. Does that mean something is wrong?
- Not necessarily. A positive screen is not a diagnosis; it means more testing is needed, and most follow-up tests turn out fine. Screening is set up to be sensitive so no baby is missed, which is why some healthy babies get flagged. Your provider or the state program will guide you to the next step.
- Why did the clinic ask for a repeat blood spot?
- A repeat blood spot is a normal part of the process and usually not a cause for worry. It is often requested because the first sample was collected very early, was a small amount, or needs confirmation. Following through on the repeat simply helps the lab give a clear answer.
- Do I have to pay for newborn screening?
- Newborn screening is routine and built into standard newborn care, and it is usually low cost or no cost to families. The main thing you need to do is consent and keep your baby's follow-up visit. For specific questions about coverage or costs of follow-up testing, contact your state Medicaid agency.