Newborn tests in the United States

What newborn screening is, and what it is not

Newborn screening happens after your baby is born and tests the baby. It is a different exercise from the prenatal screening offered to you during pregnancy: different samples, different conditions, different timing. A normal prenatal screening result says nothing about what newborn screening will find, which is exactly why both exist.

Every state runs a public health program that screens babies for serious conditions. Shortly after birth a health professional takes a few drops of blood from the baby's heel onto a filter paper card, which is sent to the state's newborn screening laboratory. Two further tests sit alongside the blood spot: a hearing screen and a pulse oximetry check for critical congenital heart disease.

The Recommended Uniform Screening Panel

The RUSP is the national guideline. It is a list of conditions the Secretary of Health and Human Services recommends all newborns be screened for. As of the panel published on 15 December 2025 it contains 40 core conditions and 26 secondary conditions, the latter being disorders that can turn up in the differential diagnosis of a core condition.

The list is not static. On 16 December 2025 the Secretary added Duchenne muscular dystrophy and metachromatic leukodystrophy to the panel, with the reasoning published in two Federal Register notices.

Two core conditions are not blood tests at all, which surprises people:

• Hearing loss — screened by an otoacoustic emissions or auditory brainstem response test.
• Critical congenital heart disease — screened by pulse oximetry, a sensor on the skin measuring blood oxygen.

The rest span metabolic disorders (organic acid, fatty acid oxidation and amino acid conditions), endocrine disorders such as congenital adrenal hyperplasia and primary congenital hypothyroidism, hemoglobin disorders including sickle cell anemia, and a group of other disorders covering cystic fibrosis, severe combined immunodeficiency, spinal muscular atrophy, Pompe disease, the mucopolysaccharidoses and X-linked adrenoleukodystrophy.

Why your state is the real answer

The RUSP is a recommendation, not a mandate. Newborn screening panels are set by states, and HRSA notes that most states screen for the majority of RUSP disorders while newer conditions are still working through adoption. Some states also screen for additional disorders not on the panel.

So the only accurate answer to "what will my baby be screened for" is the one published by your own state program. HRSA maintains a state-by-state directory for exactly this purpose, and it is worth checking before the birth rather than after a result arrives.

Cost is more predictable. Conditions on the RUSP are part of the comprehensive preventive health guidelines HRSA supports under section 2713 of the Public Health Service Act, which means non-grandfathered health plans must cover those screenings without copayment, coinsurance or deductible, for plan years beginning one year after the Secretary adopts the condition. States may separately charge a program fee for the specimen kit.

Hearing: the 1-3-6 benchmarks

CDC sets out three timing benchmarks for early hearing detection and intervention, known as 1-3-6:

• Screening before 1 month of age — best done before leaving the hospital after birth.
• Diagnostic evaluation before 3 months if the baby does not pass.
• Enrollment in early intervention before 6 months if hearing loss is confirmed.

Screening takes a few minutes and is not painful. Two methods are used. Otoacoustic emissions (OAE) places a sensitive microphone in the ear canal to measure the inner ear's response to sound. Auditory brainstem response (ABR) places electrodes on the head and records brain wave activity in response to sound. Neither depends on the baby responding behaviourally, so a sleeping baby can be tested.

Not passing a screen is not a diagnosis. It means a full hearing test by an audiologist is needed, and needed promptly — no later than 3 months of age.

Results, repeats and what to ask

Most babies screen normal and many state programs contact families only when follow-up is needed, so silence usually means a normal result. Do not rely on that assumption: ask your baby's clinician to confirm that results were received and filed, particularly if you changed address or insurance in the first weeks.

Repeat samples are common and are not by themselves a sign that something is wrong. They can be needed because the first sample was collected too early, was too small, or was affected by prematurity, a blood transfusion or intravenous feeding. If you are asked for a second sample, book it immediately — the value of the whole exercise lies in catching treatable conditions in the first days and weeks.

An abnormal screen is not a diagnosis

Screening tests are deliberately tuned to miss as few affected babies as possible, which means they also flag babies who turn out to be unaffected. An out-of-range result triggers diagnostic testing, usually through a specialist center, and the great majority of those babies are healthy. CDC's role here is instructive: it operates the world's only laboratory dedicated to ensuring the quality and accuracy of newborn screening tests, and works with state laboratories on improving methods and checking their testing processes.

If your baby is flagged, ask three things: what the specific condition is, what the confirmatory test will be, and what you should do in the meantime. For some metabolic conditions, feeding instructions given while you wait for confirmation matter more than the confirmation itself.

Questions to ask before you leave the hospital

• Has the blood spot been collected, and on what date and time?
• Has the hearing screen been done, and did the baby pass in both ears?
• Has the pulse oximetry check for critical congenital heart disease been done?
• Which contact details do you hold for me, and are they current?
• Who receives the results, and how do I confirm they arrived?

Babies born at home or in a birth center, and those discharged very early, are the most likely to slip through. If that is you, confirm with your midwife or pediatric clinician who is responsible for arranging each of the three tests and by when.

Where to get help

HRSA's Maternal and Child Health Bureau is the federal authority for newborn screening policy and publishes the current RUSP table; note that the former Advisory Committee on Heritable Disorders in Newborns and Children was terminated in March 2025 and its pages are archived, so a page found through an old link may be out of date. CDC operates the world's only laboratory dedicated to the quality and accuracy of newborn screening tests and publishes the hearing benchmarks. For what applies to your baby, go to your state newborn screening program through HRSA's state directory.