Newborn Screening in the NICU

As I told you a few weeks ago, newborn screening saves lives. My experience with newborn screening has been slightly different than most, because Sophia was a NICU baby.

Pulse Oximetry Testing:

Because Sophia arrived nearly 5 weeks early, she had to be evaluated in the nursery for 5 hours after birth. In the nursery, she was hooked up to a pulse ox machine (non-invasive, quick, and painless) and it showed a concerning low blood oxygen level. She was immediately hooked up to oxygen and transferred to the Level 3 NICU floor for care where they concluded that her respiratory center was a bit underdeveloped.

Sophia with a pulse ox sensor on her hand

While the pulse oximetry test was not used in the typical newborn screening sense – to screen for CHDs – it was a very important tool in measuring how sick my baby was. Sophia looked healthy to the untrained eye and it was rather mind blowing to me that a small pulse ox machine could tell us so much otherwise in just minutes.

Bottom line: Pulse oximetry testing takes minutes but can possibly save you from a whole world of heartache. Advocate for your baby, demand pulse ox screening after your baby is 24 hours old and before leaving the hospital.

Blood Test:

A screening test that is commonly performed on newborn babies is the blood/heel stick test. This test screens for a whole slew of disorders, which can vary by state, and is another quick test that can tell so much.

Sophia had the heel stick test performed 3 times during her hospital stay. The first test results came in and showed abnormal numbers which could indicate Congenital Adrenal Hyperplasia. Again, seemingly healthy baby with abnormal test results. The doctors reassured us that just because the numbers came back to indicate CAH, doesn’t necessarily mean that Sophia has the condition. They repeated the heel stick twice more before Sophia was discharge and luckily everything came back normal.

Bottom line: The blood test (heel stick) screens for disorders that are not necessarily recognizable on the outside. Had Sophia had CAH, we would have never known if it weren’t for the heel stick. It’s a very important screening tool that uses small samples of blood to screen for SO much, as early detection in newborns is key in treating many disorders.

Hearing Test:

The newborn hearing test was performed right at Sophia’s bedside, without even waking her up. There are 2 types of hearing tests used in newborn screening:

  • Otoacoustic emissions (OAE): During an OAE test, a small earphone is placed into a baby’s ear. A sound is emitted, and the otoacoustic emission that the ear produces (like an echo) is measured.
  • Auditory brain stem response (ABR): During an ABR test, headphones are placed over a baby’s ears, and electrodes are placed on the baby’s head. Sounds are played into the earphones, and the electrodes measure the brain’s response.

The ABR test is recommended for preemie / NICU babies as it may detect certain types of hearing loss not found by the OAE test alone.

The hearing test was especially important for Sophia because premature birth is a risk factor for hearing loss. Thankfully, my sweet baby was not even fazed by the 5 minute test and even got a certificate for passing ;)

Bottom line: The newborn hearing screening test is quick and painless. Results are available right away so that if your newborn happens to fail the hearing test, you can be proactive about the next steps to take.


Visit Baby’s First Test for more in-depth information on newborn screening and what to expect in your state. Remember, early detection is key when it comes to treating disorders that are detected via newborn screening. Talk with your doctor, add it to your birth plan, educate and advocate for yourself, and start your baby off on the right foot.

Planning a birth outside of a hospital? It’s up to you to take the initiative to make sure your newborn is screened. Baby Dickey shares her experience with newborn screening after a homebirth.

Get involved:

Talk to the expecting women in your life about newborn screening, Cora’s Story and Baby’s First Test. A simple conversation could save a baby’s life. You can also show your support by “liking”  Baby’s First Test and Cora’s Story on Facebook!

Disclosure: I am a Baby’s First Test Blogger Ambassador and am supported by the Baby’s First Test project. Baby’s First Test is funded through a cooperative agreement with the Health Resource and Service Administration (HRSA), Grant no. U36MC16509, Quality Assessment of the Newborn Screening System.


  1. Thanks for putting this info out there! It helps!

  2. Great info! I think people are quick to decline things just because they have the parental power to do so, when in actuality these precautions are important and put in place to protect our children.

  3. My babies never had a hearing test before, I didn’t even know they did that for newborns. Thanks for the info.

    • Stephanie Hungerford says:

      In some states the hospitals do not have to ask permission to do the hearing or pulse ox test because these test are considered Non-invasive. Meaning no needles or not causing pain and do them and then chart the results. And only tell people if there are problems. It has been several years since I worked in a hospital and did the test. But I know if a mom had a C-section we usually did all of the infant screenings before she came out of surgery so she could spend as much time with the baby as she wanted.

  4. I always wondered how the hearing test was performed. :)

    • Stephanie Hungerford says:

      The hearing test is performed when the baby is almost a sleep. An electrode sensor is stuck on their fore head sometimes they use 2 on the forehead. they also place an electrode on the back of the head. My hospital used the earphones that stick to the ears but some hospitals use little reusable baby headphones that look similar to the large headphone or noise cancelling headphones. They send some specific beep like tones to the babies ears and then read the brain waves to see if the baby heard anything. If the test is abnormal then they refer you to have a second screening test in a couple of weeks. This is not a conclusive test but it screens so a baby that is born hearing impaired can start getting extra therapy right away.

  5. Theresa C. says:

    My state does all of these test.It’s good to know!Thanks for the info because i’m due anyday :)

  6. We had a NICU baby as well and I think people who have typical birth sometimes don’t recognize the value even though there are so many important things that can be learned from the screenings. Thank you for putting it out there!!

  7. I had never even heard of the newborn screenings when I found out the my oldest had failed the hearing test. She failed it three times in hospital and again as an outpatient before we were sure there was some hearing loss. We were immediately referred to an audiologist and by the time she was three weeks old we had confirmed a profound hearing loss in both ears and were able to start taking action. I’m so grateful my state requires the newborn screening. Though the problem was not life-threatening, it could have taken a year to figure out what was going on, instead we knew right from the beginning and have been able to take full advantage of the technology and therapy available to her.

  8. Great information! Thanks for sharing.

  9. Poor baby girl since she had to go through all of these tests after arriving early but thank goodness that these routine procedures are performed so we can make sure our little ones are a-okay right away!

  10. Thanks for sharing this super important information! Glad your baby girl is healthy — she’s beautiful! <3

  11. This is great information. My husband and I hope to start trying for a baby within a year or so.

  12. Laura Love says:

    Thanks for the very well written post. When I gave birth, it was all such a blur that I don’t really remember the tests they did. Thanks for providing this really important information.

  13. natalie s says:

    Thanks for the thourough info! I am due in a few weeks with baby boy #3 and will have to inquire about some of these newborn screening tests.

  14. Thank you for writing about this information, as I really had no knowledge of it before reading your blog. If we have another little one in the future, this will definitely be something I want.

  15. michelle riebeek says:

    Blood testing is the worst!

  16. Kimberly Bauer says:

    After 4 kids I learned more from your post than I ever did from the hospital.

  17. thanks for sharing this!!!

  18. Andrea G. says:

    This is good to keep in mind. We’re expecting our first in March!

  19. I never heard of the pulse oximetry testing before. Thanks for sharing this info.

  20. This is the kind of information that ALL parents (whether first time or not) need to be aware of! Thanks for sharing!!

  21. I didnt even know they did hearing test in the NICU, very interesting!

  22. Very informative. I’m glad you wrote about this. It is something important to know and pass along!

  23. I had twins 3 months ago and even though I watched the hearing test being performed, I had no idea what they did. So cool – thanks for all this great info!

  24. My 2nd daughter also ended up in the NICU (life flighted without me to a nearby, bigger city :( !) because of low pulse ox readings. She was full-term and over 8 lbs…definitely unexpected, but I’m so grateful for these simple tests because of it. Today she is healthy and happy, but it was sure a scary start! I also have a cousin with PKU, which is easily diagnosed with the routine blood test, but can be life-altering w/o proper diet and treatment. Newborn screening really CAN save lives!

  25. Thanks for posting about this! Lots of great info and love the link to look up specific to each state!

  26. great info!

  27. I recently had a baby at a hospital that routinely does pulse oximetry and the ABR hearing tests for all babies. I was so thankful to have these helpful, non-invasive tests done automatically!

  28. Great information, I wondered how they did all those tests, i’m giving birth in 4 weeks but it’s always good to know these things since you never know when you are giving birth and when a baby may need to stay in the NICU. Thanks!

  29. Kristin Bertsch says:

    With two NICU babies (27 wks, now 2 1/2 and 25 wks now 15 mths) we didn’t have an option with the testing either. To be honest, I probably was so overwhelmed with the million other tests they ran, I didn’t even know what these tests were for. So it’s good to hear about them now that things are a tad calmer for us.

  30. Britni Bradford says:

    This is a great write up on these tests. When DD was born, she was just a week early, but she was slow to respond to the hearing test on the right side. I was so thankful to have a lady running it who was patient enough to run it again, and thankfully DD’s hearing was fine. She was just a little groggy – I think it might have been that she was a C-section baby and she was still shaking the groggies off from that. We had 2 heal stick tests, one in the hospital and one that was done 2 days after we left the hospital. The 2nd one was hilarious. The second that the nurse pricked DD’s heal, she had a massive poop-a-gedon (that’s armagedon level poo) all over the baby table. We weren’t allowed to change here there, so we had to run down the hall to the bathroom with a baby COVERED in poo.

  31. Julie Ghrist says:

    I think the pulse ox test is soo important and such an easy screening to avoid a horrible tragedy… I just don’t understand why it is not required everywhere. My husband and I were talking about it and we are not sure if it was done with my son or not but now that I am aware of it I will definitely be sure that with this next baby it will be done.

  32. my daughter had jaundice (our blood types are incompatible.) not a big deal in the scheme of things, but she had all of these tests done. I think it is a great thing for sure. We all want healthy babies!

  33. I am new to your blog, was your daughter a preemie. My last baby girls water broke at 26 weeks and I delivered at 31 weeks. I am currently 31 weeks and enjoying every minute of this new pregnancy

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