Blood Spot Screening FAQs
What is newborn screening?
Newborn screening is a state public health service that reaches each of the nearly 4 million babies born in the United States each year. It ensures that all babies are screened for certain rare, but serious health conditions at birth. For babies identified with a health condition, early detection allows providers to start treatment before the baby becomes symptomatic and harmful effects happen.
For more information visit Expecting Health.
How is newborn blood spot screening done?
A few drops of blood are taken from your baby’s heel and placed on a newborn screening card. This card is transported to the laboratory for immediate processing. If an out-of-range result is detected, your baby’s health provider will be notified immediately and they will reach out to you with next steps.
My baby looks healthy. Is newborn screening really necessary?
Most infants with conditions identified through newborn screening do not appear to be sick until damage has already occurred. In each of the conditions there is an "invisible" problem in one of the many chemicals that are produced naturally in the baby's body. Special laboratory tests are used to identify these imbalances right away to alert the doctor that additional testing needs to occur.
Does my baby still need newborn screening if I had prenatal screening?
Yes, prenatal screening and newborn screening are different tests done at different times. The screenings work together to find health problems early, so babies can get the care they need as soon as possible.
What is the chance my baby has a condition found by screening?
The conditions identified through screening are rare, but serious and can happen in families with no history of disease. Babies with these conditions may appear to be healthy, but can still have a condition. Early detection, diagnosis and treatment can be life saving!
How are results reported and how will I be notified if my baby needs treatment?
The newborn screening results will be reported to the hospital where your baby was born. Ask your provider for your baby's newborn screening results at the first newborn visit. If your baby's results are abnormal, further testing will be done to confirm or rule out a condition. Your provider must have good contact information to reach you in the case that urgent follow-up is needed.
Your baby needs a repeat newborn screening. What is next?
This does not necessarily mean that your newborn has a condition. Some reasons why repeat screenings are needed include:
- Borderline results - the results were slightly out of range
- Early collection - the specimen was collected before 24 hours of age
- Treatment/Medication Interference - some can interfere with the results
- Quality of the sample - there may have been improper handling of the specimen that caused it to not be testable.
Contact your baby's health care provider as soon as possible to schedule a repeat screening.
Can I refuse newborn blood spot screening?
In North Dakota, newborn screening is mandatory; however, parents/guardians may refuse. If you are considering refusing the screening, please discuss your concerns with your baby's health care provider.
To refuse the screening, the parents/guardians must have read and received written information about newborn screening. A signed refusal form must be sent to the Newborn Screening program. Access the newborn screening refusal form here.
Are prenatal and newborn screening required?
Prenatal screening is optional. Both blood spot and heart screening are required, and hearing screening is highly recommended.
To read the laws in regard to newborn screening visit. Add website
What if my baby is not born in a hospital?
It is very important that babies born outside of hospitals are tested between 24 to 48 hours after birth. Parents should arrange with a doctor, hospital or midwife to have the screening done. Visit the main page to find a birthing facility near you.
My child is playing an NCAA sport, how can I obtain their sickle cell status?
The NCAA requires a physical exam for athletes and this should include a sickle solubility test (SST). The North Dakota Newborn Screening program does not conduct SST through newborn screening. Please contact your health care provider to see if your child has already had sickle cell trait testing or to request a sickle solubility test to obtain your child’s sickle cell trait status.
Hearing Screening FAQs
What is newborn hearing screening?
Newborn hearing screening checks if a baby might have hearing loss. This screening typically happens after 24 hours, or before going home from the hospital. Hearing screening is quick, easy and not painful and is typically done when baby is sleeping.
Why does my baby need newborn hearing screening?
Newborn hearing screening helps find a hearing loss early, so your baby can get support for speech, language, and learning during critical early development.
My baby appears to respond to sound, so is newborn hearing screening still needed?
Yes, children can compensate for a hearing loss. They use visual cues, such as shadows or parental expressions and reactions, or they may feel the breeze caused by the motion of the hands or the vibration of objects being used to “check” sound.
How is infant hearing screening done?
The most common infant hearing screening tests include:
- Otoacoustic Emissions (OAE) Test - a small earphone or probe is placed in the baby's ear to measure the " echo" or response from the cochlea (inner ear). The OAE is automated and no interpretation by the screener is needed.
- Automated Auditory Brainstem Response (AABR) Test - electrodes are placed on the baby's head to measure the brainwave activity in response to sound. The AABR is automated, requiring no interpretation by the screener.
- Auditory Brainstem Response (ABR) Test - small electrodes are placed on the baby's head to measure how the hearing nerve and brain respond to sound played through earphones. The ABR requires an audiologist to interpret the results.
For more details on how infant hearing screening is done visit babyhearing.org.
Do I have to ask for newborn hearing screening?
Although newborn hearing screening is not required in North Dakota, most newborns receive it shortly after birth as a point of care testing. You should still ask your baby's provider for their hearing screening results before leaving the hospital.
What if my baby is not born in a hospital, can they still receive hearing screening?
It is important for babies born outside of a hospital receive hearing screening too. Parents should arrange hearing screening with a health care provider or midwife.
What if my baby doesn't pass the initial hearing screening?
Babies who do not pass their newborn hearing screen are referred to an audiologist for a complete audiology (hearing) evaluation.
Baby Hearing is an additional resource if your baby did not pass their initial hearing screening.
If my baby did not pass their initial hearing screening, does it mean that they have a hearing loss?
No, because your baby did not pass their initial hearing screening, this does not mean that your child has a hearing loss. Babies can fail the newborn hearing screening due to vernix in the ear canal, fluid in the middle ear or because of movement or crying during the test. It is very important to follow-up if your baby does not pass their initial hearing screening.
What are the next steps if my baby is confirmed to be deaf or hard of hearing?
You will have several follow up appointments with an ear specialist and audiologist and may need some additional testing. It is very important to get connected right away to early intervention support.
Baby Hearing has additional information and resources available for families.
Are there family support resources for families of children who are deaf or hard of hearing?
Baby Hearing has a number of resources specific to families who have children who are deaf or hard of hearing.
What is ND Early Hearing, Detection & Intervention (EHDI)?
Every state and territory in the United States has an EHDI program. The EHDI program ensures that newborns receive timely hearing screenings, diagnostic evaluations, and intervention services to address hearing loss and help with family support.
ND EHDI operates at the North Dakota Center for Persons with Disabilities (NDCPD), which is located at Minot Sate University.
What are the 1-3-6 hearing guidelines?
- By 1 month: All babies should have a hearing screening. If the child doesn't pass this screening, they should be referred to an audiologist for further testing.
- By 3 months: Babies who failed their screening should receive a comprehensive hearing evaluation from an audiologist to confirm whether a hearing loss is present.
- By 6 months: Babies with a confirmed hearing loss should start early intervention, which includes medical, hearing, and educational support.
When babies with hearing loss are identified early and are enrolled in intervention services by 6 months of age, they can develop language and learning skills that are equal to the skills of their hearing peers by the time they start kindergarten.
Heart Screening FAQs
Why is screening for CCHD important?
Most babies are born with healthy hearts and have enough oxygen in their blood. A few are born with CCHS. Although babies are checked very carefully by a doctor after they are born, some babies with CCHD may not have symptoms until later. Screening can help find babies with CCHD before they go home from the hospital.
How is screening for CCHD done?
Pulse oximetry is used to screen babies for CCHD. Pulse oximetry is fast, easy and does not hurt. A small sensor is placed on a baby's right hand and one foot to measure the oxygen level in the blood. Your baby's doctor or nurse will discuss low pulse oximetry readings with you. Screening for CCHD is done for well newborns at about 24 hours of age or before discharge. Screening is done while a baby is warm and quiet. If a baby is crying, moving, fussing or cold, then screening will take longer. It may need to be repeated.
What if my baby has a low pulse oximetry reading?
Healthy babies may have a low oxygen reading. Babies with low oxygen levels in their blood may have CCHD. Other conditions like breathing problems or infections may also cause a low blood oxygen level. The doctor will check the baby carefully. An ultrasound of the heart (also called "echocardiogram" and "heart echo") may be done to look for CCHD. The heart echo may need to be done in a different hospital or doctor's office. It is ready by a children's heart doctor (pediatric cardiologist). If the heart echo shows problems, then a baby's medical team will discuss next steps with parents.
What if my baby did not pass the pulse oximetry screening?
It means that the screen detected low oxygen levels in your baby's blood. Low oxygen levels can be a sign of Critical Congenital Heart Disease (CCHD) or other conditions such as breathing problems or infections. More testing is needed to find out why a low oxygen level was detected.
What is the treatment for CCHD?
Babies with CCHD typically need surgery within the first year of life. Each baby with CCHD will require a unique treatment plan developed for his or her particular heart defect.
Do parents have to ask for the screening?
No, pulse oximetry screening is required for all babies. Always be sure to ask your provider about your baby's screening results. The results should be available right away.
What if my baby is not born in a hospital?
It is important for babies born outside of a hospital to receive pulse oximetry screening too. Parents should arrange screening with a health care provider or midwife. Visit the main page to find a birthing facility near you.
What do parents need to know?
Most babies who pass the pulse oximetry screen will not have a CCHD. It is important for parents to know that newborn screening cannot identify every child with a critical heart problem. Warning signs that all parents should watch for are: bluish color to the lips or skin, grunting, fast breathing, poor feeding, and poor weight gain. If you notice any of these signs in your baby, please contact your baby's health care provider right away.
Is there financial assistance to help pay for CCHD screening?
The Special Health Services (SHS) Financial Coverage Program provides coverage for services that promote early diagnosis and treatment to children with special health conditions who meet eligibility criteria.
To see if your family may qualify, please review the Diagnostic and Treatment fact sheet and contact SHS with any questions.
The North Dakota Health and Human Services, Special Health Services Unit, does not assume responsibility for the content obtained from external hyperlinks accessed from this website. Any links to external sources are outside of our domain. Information on external websites does not necessarily reflect the views and opinions of the North Dakota Health and Human Services agency or Special Health Services Unit.