Newborn Screening in Maryland: What That Tiny Heel Stick Is Really For
Somewhere in the blur of the first day or two after birth, a nurse pricked your baby's heel and collected a few drops of blood on a card. Most parents barely register it. That small test is one of the most important things that happens to your newborn.
September is National Newborn Screening Awareness Month, so here is what that test is actually looking for.
More than 60 conditions
Maryland began newborn bloodspot screening in 1965 with a single condition, phenylketonuria (PKU). The program has grown since then, and the Maryland Department of Health now screens newborns for more than 60 conditions.
Most of these are rare. Most are also treatable — but only if they are caught early. That is the entire point of screening: these conditions are found before a baby looks sick, because by the time symptoms appear, permanent harm may already have been done.
Why Maryland does two screens, not one
This surprises a lot of parents. Maryland uses a two-screen system:
The first screen is collected once your baby has had about 24 hours of feeding — usually the day of hospital discharge. A sample taken before 24 hours is not valid for several conditions on the panel.
The second screen is collected after your baby is 7 days old, ideally between 10 days and two weeks. This one often happens right here in our office at an early well visit.
The second screen is not a formality. Roughly 10% of congenital hypothyroidism cases in Maryland are identified on that second sample, and it can also pick up milder forms of other conditions that were not yet detectable in the first days of life. If we ask you to come in for it, please come.
The other newborn screens
Bloodspot screening is one of three. Before discharge, your baby also had:
A hearing screen. Hearing loss caught in the first months, rather than at age 2, changes a child's language development substantially.
A pulse oximetry screen for critical congenital heart disease. A painless sensor on the hand and foot measures oxygen levels and can flag serious heart defects that are not obvious on exam.
What if we get a call about the results?
First: do not panic. An out-of-range screening result is not a diagnosis. Screening is deliberately designed to be sensitive, which means it flags babies who need a closer look — and most of those babies turn out to be fine.
What it does mean is that your baby needs repeat or confirmatory testing quickly. We will call you, explain what was flagged, and tell you exactly what happens next. Please follow through the same week.
One thing you can do right now
Make sure we have your current phone number and address. Every year, results come back needing follow-up and the family cannot be reached because a phone was disconnected or a family moved. If anything has changed, call the office or send us a message through the portal.
Maryland does allow parents to decline newborn bloodspot screening in writing. We do not recommend it. These are a few drops of blood that catch conditions which are silent at birth and serious later, and there is no other way to find them in time.
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