Newborn tests in Ireland: the heel prick and the first checks

Three different checks in the first five days

Every baby born in Ireland is offered three separate things in the first days, and they are easy to run together in your head when you are exhausted. They are the newborn clinical examination within 72 hours, the newborn hearing screening test, and the heel prick between 72 and 120 hours.

None of these is the screening you had during pregnancy. Antenatal screening estimated the chance of certain conditions before your baby arrived; these look at the baby in front of you.

The heel prick test

Newborn bloodspot screening, universally called the heel prick, checks for 11 rare but serious conditions. A few drops of blood are taken from your baby's heel onto a card.

The eleven conditions

• Adenosine Deaminase Deficiency Severe Combined Immunodeficiency (ADA-SCID)
• Classical Galactosaemia
• Congenital hypothyroidism (CHT)
• Cystic fibrosis (CF)
• Glutaric aciduria type 1 (GA1)
• Homocystinuria (HCU)
• Maple syrup urine disease
• Medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
• Phenylketonuria (PKU)
• Severe Combined Immunodeficiency (SCID)
• Spinal muscular atrophy (SMA)

Why the timing is fixed

The sample is taken not earlier than 72 hours and not later than 120 hours after birth, and once feeding is established — usually when your baby is between 3 and 5 days old.

That window is clinical, not administrative. Thyroid stimulating hormone rises immediately after birth and falls back to normal by around the second day of life, so a sample taken too early would produce false positives for congenital hypothyroidism. Taken too late, treatment for the conditions that need it starts later than it should.

Where it happens, and consent

You will be asked for your consent. The test usually takes place in your own home, during your baby's first week. If you are still in hospital more than 72 hours after the birth, it may be done there instead.

Your baby is screened to see if they are at risk of these conditions so that treatment can start as soon as possible. If a result suggests risk, you are referred to a healthcare team. A repeat sample is sometimes needed if results are unclear — that is a sample issue, not a diagnosis, and it does not mean something is wrong.

Getting the result

Contact your public health nurse if you want to find out the result of your baby's test. You will not automatically be told a negative result, so if you want confirmation, ask.

The newborn clinical examination

Your baby should get a full newborn clinical examination within 72 hours of birth, carried out by a doctor or specialist midwife. Its purpose is to spot problems as early as possible so treatment can start.

If your baby was born in hospital it usually happens before you go home. After an HSE home birth, your baby is examined by your GP or at a maternity hospital.

The examination covers:

• eyes — a light is shone into the eyes to detect clouding of the lens, which is cataract
• heart — pulse and oxygen levels are checked
• hips — gentle bends of the legs and hips detect dislocation; further tests may be needed if your baby was breech or your family has a history of childhood hip problems
• testicles — checked to confirm they are in the right place, if your baby was born a boy
• hearing screening — a test for echoes in the inner ear using a soft earpiece

You may also be asked about your pregnancy and birth, any health problems you have, health problems in your family, and any concerns of your own. Those questions are part of the examination, so answer them fully — family history of hip problems in particular changes what happens next.

Newborn hearing screening

Newborn hearing screening checks whether your baby has permanent hearing loss. In hospital it is normally done as part of the newborn clinical examination. If your baby was born at home, your community midwife will refer them for hearing screening rather than it happening automatically.

The test is painless and is usually done while your baby is settled or asleep. It is the earliest opportunity to identify permanent hearing loss, and early identification is what allows support to begin while language is developing.

Daily checks while you are in hospital

Alongside the formal screens, a midwife examines your baby daily during your hospital stay. They will ask about feeding patterns and about wet and dirty nappies, check for jaundice, and look at the umbilical cord area. They will also advise on bathing, nappy changing and starting breastfeeding.

These daily checks are where most real problems in the first days are actually picked up, so mention anything you have noticed, however minor it sounds. Feeding patterns and nappy output in particular are the information the midwife cannot get without you, and they are the earliest reliable signal that feeding is or is not working.

Where to get help

Your public health nurse holds your baby's heel prick result and continues to visit at intervals over the next four years, so they are the right first call once you are home. Your midwife or maternity unit can answer questions about examinations done before discharge. Your GP examines your baby at 2 weeks and both of you at 6 weeks under the Maternity and Infant Care Scheme, and can follow up on anything flagged by the newborn checks. HSE Live can point you to the right service if you are unsure who to contact.