Newborn screening in the USA is done at 24–48 hours after birth; hearing and heart checks before discharge, with many states adding a 1–2 week repeat.
Newborn screening runs on a clock. In most hospitals the first steps land in the first two days, with more checks right before going home. The program has three parts that work together — a heel-prick blood spot, a pulse-ox test for critical heart defects, and a hearing screen. You can read plain-language timing details on the CDC newborn screening overview.
When Newborn Screening Is Done In The United States: Typical Windows
Here’s a quick view of when each part usually happens. Exact timing can vary by state and hospital, but the windows below match national guidance from public health groups and pediatrics teams.
| Screen | Usual Timing | Why That Window |
|---|---|---|
| Heel-prick blood spot (dried blood spot) | 24–48 hours after birth, before discharge | Metabolic and endocrine markers stabilize after the first day, which cuts false alarms and misses; labs need a dried card to run many tests. |
| Pulse oximetry for critical congenital heart disease (CCHD) | At ≥24 hours of age or as late as possible before discharge | Oxygen levels read more reliably after the ductus begins to close; screening too early can miss disease or trigger needless repeats. |
| Hearing screen | Before discharge; no later than 1 month of age | Early sound checks point families to a full test if needed; fast referral supports the national 1-3-6 benchmarks. |
Some states ask for a second blood spot card a week or two later to catch a few disorders that show up better after feeding is established. Texas uses this plan statewide: one card at 24–48 hours and a second at 7–14 days. If you live elsewhere, your hospital or pediatric office will tell you the local plan.
First 24–48 Hours: The Heel-Prick Blood Spot
The nurse warms your baby’s foot, cleans the heel, and fills small circles on a special filter paper. That card dries and goes to a state lab. Most programs aim for collection at 24–48 hours because samples drawn too early are harder to read. If a card is too thin or smeared, the lab will ask for another sample. Babies born at home or leaving a birth center early should still have the card collected within the first two days, either in the facility or at a clinic visit.
After 24 Hours: Pulse-Ox Screening For Critical Heart Defects
A soft sensor wraps around the right hand and one foot. The monitor reads oxygen levels and heart rate for a few minutes. Teams run this check at 24 hours or later. If the baby is going home sooner, it’s done right before discharge. If results don’t pass, a doctor might repeat the screen or send the baby for an echocardiogram the same day. The CDC’s CCHD page explains the timing and what happens next.
Before Discharge: Newborn Hearing Screen
Most nurseries do the hearing check while your baby sleeps. The tech places tiny ear tips or soft sensors and plays gentle sounds. Many programs aim to screen before the family leaves the hospital, and all babies should have it by one month of age. If the first check doesn’t pass, a repeat is usually set within two weeks. Ask for the date at discharge. Keep it on your calendar.
Why Timing Matters For Each Part
These windows match how newborns change hour by hour. Metabolism settles after day one, oxygen readings stabilize, and ears clear fluid. A little patience boosts accuracy while keeping care fast if a follow-up is needed.
States That Add A Second Blood Spot Card
Several programs ask families to return for a second card at 7–14 days. That extra card helps find conditions that rise later, such as milder thyroid or adrenal disorders, and backs up early draws if the first card was collected before 24 hours. Texas publishes a clear reminder to collect the second card after 168 hours of life. Your clinic folds this into the two-week newborn visit, so there’s no extra trip.
Early Discharge, Home Birth, Or NICU: Timing Tweaks That Families See
Life doesn’t always fit a neat schedule. Here are common situations and how teams adjust the clock so your baby still gets the right checks at the right time.
| Situation | What Changes | What To Ask |
|---|---|---|
| Discharge before 24 hours | Pulse-ox is done just before going home; the blood spot may be collected early with a plan to repeat or a second card at 7–14 days. | “Will we need a repeat blood spot or a second card? When and where?” |
| Home birth or birth center | The midwife or clinic collects the blood spot within 48 hours and arranges hearing and pulse-ox within the first days. | “Who sends the card to the state lab, and how will we get results?” |
| NICU care with IV nutrition (TPN) | Teams try to draw the blood spot when TPN is paused for a few hours or repeat after TPN stops to avoid false alarms. | “When will you draw after a TPN pause, and will we need a second sample?” |
| Blood transfusion planned | Staff aim to collect the blood spot before transfusion; if not possible, a repeat is scheduled months later to check for masked traits. | “Was a pre-transfusion card sent, and do we need a later repeat?” |
| Hearing screen didn’t pass | A repeat screen is booked within days; babies who still don’t pass go to an audiologist by three months of age. | “What date is our repeat, and what’s the next step if it doesn’t pass?” |
Who Contacts You And When
Hospitals and pediatric offices share normal results during routine visits. If any part flags a concern, the call comes quickly and follow-up is arranged. Blood spot results often arrive within five to seven days after birth. Pulse-ox results are instant. Hearing screens also give a pass or refer right away, with repeats set within two weeks when needed.
How To Make Sure You Hit The Right Windows
- Before you leave, check your discharge papers for the time and date of the blood spot, hearing screen, and pulse-ox.
- Book the first pediatric visit at three to five days of age; that visit pairs well with second-card states.
- Ask staff whether your state uses a second card at 7–14 days and get the order in writing if it does.
- Keep your phone number and address current with the hospital and the pediatric office so follow-up calls reach you fast.
- Bring the newborn screening pamphlet or card number to the first clinic visit; many states print a tracking ID on the form.
These small steps save calls later and keep the schedule clear for you and staff.
What If Your Baby Was Screened Too Early?
It happens. Early discharge or a medical need can shift the first draw earlier than planned. Don’t worry. Programs have built-in safety nets. If the first card was taken before 24 hours, many labs ask for another specimen. States that run two-card systems still want the second card at one to two weeks, even if a repeat was sent sooner. Your pediatrician can see which tests need repeating and will book the follow-up with you.
Consent, Refusal, And Costs
Hospitals present newborn screening as standard care because state law requires it in the United States. Most states still allow a parent to refuse, usually for religious reasons. Staff record that choice if a family declines. Many health plans cover newborn screening as preventive care, and Medicaid or CHIP programs help families who qualify.
Plain-English Timeline You Can Save
Use this simple timeline to plan appointments and keep track of results. If your baby needs NICU care or an early discharge, your team will pencil in the right edits and repeats.
- Birth to 12 hours: Settle in. No routine screening yet.
- 24–48 hours: Blood spot card and pulse-ox, usually before going home.
- Before discharge: Hearing screen; a same-day repeat is common if the first try doesn’t pass.
- 3–5 days: First pediatric visit to review results and schedule any repeats.
- 7–14 days: Second blood spot in two-card states; ask your clinic if this applies.
- By 1 month: Hearing screen completed; call sooner if it’s still pending.
What To Do If You Haven’t Heard Back
If a week passes after birth and you haven’t heard about the blood spot, call your pediatric office and ask if results came in. Call sooner if the hospital told you to expect a repeat. If the hearing screen wasn’t done before discharge, book it now. Add a second blood spot at the week-two visit in two-card states. Fast follow-up helps you avoid extra trips and keeps care moving.