Understanding your baby’s results is an important part of the newborn screening (NBS) process. This section explains what the results from blood spot screening, pulse oximetry screening, and hearing screening mean for you and your baby.
Blood Spot Screening Results
The results of your baby’s newborn blood spot screening become available five to seven days after birth. Three types of results are possible:
- In-range (also called negative, normal, or low risk)
- Out-of-range (also called positive, abnormal, or high risk)
- Borderline (also called inconclusive or medium risk)
In-Range Screening Results
What Does an In-Range Result Mean?
An in-range result means that your baby probably does not have a condition detected by blood spot screening. Babies with in-range results do not need more testing.
Your baby’s health care provider may tell you about in-range results at your baby’s first or second well-child visit. If you do not receive your baby’s results, be sure to ask about them so that you know screening was completed.
Health care providers might also refer to in-range results as “negative,” “normal,” or “low risk.”
Can My Baby Have an In-Range Result and Still Have the Condition?
Yes. Sometimes, when NBS shows that a baby is unlikely to have a condition, the baby in fact has that condition. When screening “misses” a baby with the condition, it is called a false-negative result.
Health care providers usually catch false-negative results when a baby begins having symptoms of the condition. Any baby who starts having health problems (like trouble breathing, slow weight gain, or problems with movement) needs more testing—even if that baby’s blood spot screening results were in-range. Regular checkups are important to make sure your baby is healthy and growing normally.
Whenever you have concerns about your baby’s health, you should contact your baby’s health care provider right away.
Out-of-Range Screening Results
What Does an Out-of-Range Result Mean?
An out-of-range result means that your baby might have the condition detected by the screening test. Babies with out-of-range results need more testing.
Your baby’s health care provider will contact you to tell you about out-of-range results and any next steps you should take. If your baby has an out-of-range result, it is important to follow all of your health care provider’s directions about what to do next.
Usually, the health care provider will help you make an appointment for more testing with a specialist. Your baby may need to see the specialist and have any recommended testing right away to diagnose the condition.
You should follow your health care provider’s recommendations about when and what kind of testing your baby needs. To be safe, your health care provider may also recommend that your baby begin treatment for the condition right away.
Health care providers might also refer to out-of-range results as “positive,” “abnormal,” or “high risk.”
Visit the Connecting With a Specialist section to learn about next steps for babies with out-of-range screening results. Visit the After Diagnosis page to view a list of resources for families whose babies receive a diagnosis after NBS.
Do All Babies With Out-of-Range Results Have the Condition?
No. Sometimes, when NBS shows that a baby might have a condition, further testing reveals that the baby does not have the condition at all. This is called a false-positive result. Health care providers usually determine false-positive cases during follow-up testing.
False-positive results can happen in blood-spot screening for many reasons, like the following:
- A reason other than the screened condition—Newborn screening uses indicators in the blood to check whether your baby might have certain conditions. However, other things that have nothing to do with the NBS conditions (for example, stress) can also affect these indicators. Therefore, an out-of-range result can either mean that your baby has an NBS condition or that something else is affecting the result of the screen.
- A problem with how or when your baby’s blood was screened—Collecting and processing NBS blood samples need to happen in a very precise way. If they do not happen correctly, your baby may receive a false-positive result. This might happen if:
- Your baby’s screening was done outside the recommended time frame
- Your baby’s blood sample was not collected correctly
- The card with your baby’s blood sample got scratched or stained by something other than your baby’s blood
- The blood sample was stored incorrectly
- The information on the screening card was wrong
If your baby has a false-positive result, your baby does not have and will not develop the condition.
Borderline Screening Results
A borderline result means that your baby’s screening results fall somewhere between an in-range and out-of-range result.
Babies with borderline results need more screening or testing. Your baby’s health care provider may collect another blood sample from your baby and repeat the original screening.
Sometimes, the health care provider may do other testing, like drawing blood for laboratory tests, instead of repeating the blood spot screening. It is important to follow your health care provider’s directions about when and what kind of repeat screening or other testing your baby needs.
Health care providers might also refer to borderline results as “inconclusive” or “medium risk.”
Pulse Oximetry Screening Results
Pulse oximetry screening determines if your child has certain forms of critical congenital heart disease (CCHD).
Most parents receive their newborn’s pulse oximetry screening results as soon as the screening is complete. Two types of results are possible:
- Fail (also called nonpassing)
Read further to learn about each type of result.
A pass result means that your baby had in-range blood oxygen levels at the time of screening. Babies with pass results do not need more testing.
However, pulse oximetry screening only detects certain types of heart problems. It does not find all heart problems. Babies who develop any health problems, especially trouble breathing, changes in energy level, or trouble eating, need more testing—even if their pulse oximetry screening results were in-range.
A fail result means that your baby had low oxygen levels at the time of screening. Babies with fail results need more testing to determine why their oxygen levels are low.
Not every baby with a fail result has CCHD. A baby can have low oxygen levels for other reasons, like general breathing problems, infections, or minor heart problems.
To determine if your baby’s low oxygen is due to CCHD, your baby’s health care provider will usually check your baby very carefully and order diagnostic test(s). These test(s) might include an echocardiogram, electrocardiogram, and/or chest X-ray to diagnose CCHD.
Babies with fail results need this extra testing before they go home. If the birth facility cannot perform this testing, your baby should be tested at another facility right away.
Health care providers might also refer to fail results as “nonpassing.”
Visit the Connecting With a Specialist section to learn about next steps for babies who do not pass this type of screening. Visit the After Diagnosis page to view a list of resources for families whose babies receive a diagnosis after NBS.
Hearing Screening Results
Most parents receive their newborn’s hearing screening results as soon as the screening is complete. Two types of results are possible:
- Fail (also called nonpassing or refer)
A pass result means that your baby has typical hearing in both ears at the time of screening.
Most babies with pass results do not need more testing. However, babies who pass newborn hearing screening may still develop hearing loss later in infancy or childhood.
This is more common in babies with certain risk factors, like low birth weight or specific infections. Babies with these risk factors may need extra hearing checks—even if they pass newborn hearing screening. Learn more about risk factors for hearing loss.
Parents should be alert for any signs of hearing problems in their babies and pay attention to infant language development milestones. Language development milestones for babies who can hear include things like:
- Crying to loud sounds
- Quieting to familiar voices
- Cooing or making different voice sounds
- Looking toward voices and sounds
Watching for these milestones can help you detect any issues with your baby’s hearing.
A fail result in one or both ears means that your baby might be deaf or hard of hearing. Babies with fail results need more testing. These babies typically have another hearing screen within two weeks after discharge. Your baby’s health care provider can help you schedule this repeat screen before you leave the birth facility.
Babies with fail results on their repeat hearing screen should see an audiologist, a specialist in hearing problems, as soon as possible. Your baby’s health care provider or the state newborn hearing screening program may help you make arrangements for follow-up testing.
Health care providers might also call fail results “nonpassing” or “refer.”
Visit the Connecting With a Specialist section to learn about next steps for babies who do not pass hearing screening. Visit the After Diagnosis page to view a list of resources for families of babies who are deaf or hard of hearing.
Connecting With a Specialist
If your baby did not pass one of the newborn screens, you should work with your baby’s health care provider to see a specialist for the follow-up testing. Your baby’s health care provider or the state NBS program will help you find the right specialist and schedule an appointment for more testing.
It is important for your baby to see a specialist whenever your health care provider recommends. Doing so is the only way to find out for sure if there is a problem with your baby’s health.
The specialist will help you learn more about your baby’s health and get access to treatment or intervention if needed. This will help make sure that your baby lives as healthy a life as possible.
Specialists your baby might see include health care providers with extra training and knowledge in the following areas:
- Genetics (medical geneticist or genetic counselor)
- Hormones (endocrinologist)
- Heart (cardiologist)
- Breathing (pulmonologist)
- Blood (hematologist)
- Immune system (immunologist)
- Nervous system (neurologist)
- Hearing (audiologist)
After Newborn Screening: Questions to Ask
Many parents have questions about NBS. Following is a list of questions you may want to ask after you receive your baby’s NBS results:
- Where can I get a copy of my baby’s screening results?
- What options do I have for what happens to my baby’s blood sample after screening?
- Does an in-range result mean my baby is healthy?
- Does an out-of-range result mean my baby definitely has a condition?
- Does my baby need any more testing?
- Is additional testing covered by insurance?
- What signs should I watch for in my baby?
- Whom can I contact if I have more questions?