Newborn Tests/ Immunizations

Before you take your baby home from the hospital, a blood sample will be taken from your baby’s foot after 24 hours of age. This is required by Tennessee State Law to test them for rare problems in newborns. Babies with these disorders usually appear completely normal at birth. Without treatment they can become very sick or have mental problems. The good news is that these conditions are very rare and they can be controlled with treatment if detected early. Retesting will be required if you baby is discharged before 24 hours of age. Your doctor or health department will be notified of the

test results and your doctor will discuss what may need to be done with you. Generally, parents are notified of test results only if there is an abnormal result. The most common tests are:

  • Phenylketonuria (PKU)
  • Galactosemia
  • Hyperthyroidism
  • Hemaglobinopathies
  • Congenital Adrenal Hyperplasia


At the Medical Center, all pregnant women are tested for the Hepatitis B virus on advice of the CDC. This virus can infect the mother’s liver and also cause harm to her baby. It is the recommendation of the American Academy of Pediatrics to give Hepatitis B Vaccine (HBV) at birth to all babies to protect them from this virus. This is the recommendation even if the mother has a negative test. This shot is given to newborns in the thigh muscle. Three doses of HBV should be given according to the following schedule:

  • First dose, at birth or by the age of 2 months
  • Second dose, 1-4 months of age at least 1 month after 1st dose
  • Third dose, 6-18 months of age and not sooner

A person can get infected with Hepatitis B in several ways, including:

  • Sharing needles when injecting drugs
  • By having unprotected sex with an infected person
  • Exposure to blood or blood products.
  • During birth, when the virus passes from an infected mother to her baby

Getting HBV is much safer than getting Hepatitis B infection. The risk of HBV causing serious harm is very small. Mild problems after receiving HBV include:

  • Soreness for a few days where the shot was given
  • Mild fever which rarely exceeds 99.4º F

Serious allergic reactions are extremely rare. People who are allergic to yeast used for baking should not have the shot. Ask your doctor for more information on this serious virus as well as the additional immunization schedule important to your baby as he grows.

Tdap Vaccine

A disease that is easily passed from one person to another called pertussis is very dangerous to small babies and children. Many people know it as “whooping cough”. Babies can get this disease from other people and most of the time it is passed from a young mother to her baby. Your doctor may order the Tdap vaccine (tetanus, diphtheria, and pertussis) to be given to you, not the baby, before discharge, in order to help you avoid getting this disease and infecting your baby. He/she will get this same vaccine from their pediatrician when they are about 8 weeks old. The Tdap vaccine is given in your upper arm muscle and can cause muscle stiffness and tenderness, especially with movement. This only lasts a few days but the benefit the shot offers for protection to your baby is very important.

Newborn Hearing Screen

The Medical Center, in agreement with the recommendations of the National Institutes of Health and the American Academy of Pediatrics, and the State of Tennessee Department of Health, performs a hearing screen on every baby born at our hospital prior to discharge.

About one in every 1,000 babies is born with a hearing problem that can cause impaired speech and language development. Fifty percent of babies with hearing loss have no family history and no known risk factor for hearing problems. Early identification and treatment is important to help hearing impaired children reach their maximum potential. Undetected hearing loss can result in delayed language, social, emotional, and academic development. Hearing losses that are identified at birth can be diagnosed and treated before the child reaches six months of age. This gives the hearing impaired child more time to hear the necessary sounds for speech and language development.

A “pass” on the infant hearing screen does not rule out a hearing impairment in infancy or early childhood. A child’s hearing ability and speech-language development should be continuously monitored by parents and caregivers. Infants who are at risk for progressive hearing loss should receive hearing tests twice a year. Factors that place a child at higher risk for hearing loss include a family history of permanent childhood hearing loss, long term ventilator use in the nursery, use of medications that are toxic to the ears, some specific infectious diseases, and syndromes known to be associated with hearing loss.

We test the ability for your baby to hear in two ways:

Otoacoustic emission: a small probe is placed in your baby’s ear which emits several tone pairs. If the ear is functioning normally, the two tone pairs will combine to produce an audible signal that is recorded by the probe. If the infant’s ear produces a distortion signal, a “pass” occurs. The test is performed on each ear twice before your baby is considered to have passed the screen.

Automated auditory brainstem response: this method presents a soft click sound to your baby’s ears through tiny earphones. Stickers are placed on your baby’s forehead, neck, and shoulder which read responses that occur under the skin in response to the sounds. All of our intensive care nursery babies receive an automated auditory brainstem response test.

We will make every effort to obtain a “pass” result on each baby and this may require testing more than once or using both types of tests. If your baby does not get a “pass”, then a “refer” result is given. This means your baby needs further testing before we can determine his or her hearing sensitivity. Something as simple as fluid in the ear or as serious as hearing loss can cause a referral. A diagnostic test is usually required to define hearing sensitivity. It is very important to follow-up with a referral, even if your baby seems to be startling to sounds and has no risk factors for hearing loss.

Genetics Program

Tennessee has a comprehensive genetics program that provides access to genetic screening, diagnostic testing and counseling services for individuals and families who have, or are at risk for, genetic disorders. Two major aspects of the genetics program are

  • Newborn Screening (NBS) for genetic/metabolic disorders; and
  • Newborn Hearing Screening (NHS) for early detection of hearing loss.

These comprehensive screening programs are set up as a public health service for the citizens of Tennessee.

NBS allows for early diagnosis of metabolic disorders followed by appropriate medical treatment. Early diagnosis and treatment can make the difference between a child leading a relatively normal life or having more significant developmental delays, long-term healthcare needs or even death.

NHS allows for early diagnosis of hearing loss and appropriate follow up services. Early detection gives parents the most effect opportunity to take action to help prevent the complications of inability to communicate, trouble reading, difficulty learning and isolation.

Click here for more information on medical genetics and newborn screening from the Genetics Center.