Guidance

Screening tests for you and your baby: babies in special care units

Updated 11 August 2025

Applies to England

This information is for parents of babies who are in a special care baby unit, neonatal intensive care unit or paediatric intensive care unit.

We understand this is likely to be a stressful time for you and your family. This information will help you and your healthcare professionals to talk through how newborn screening tests fit into all the other parts of your baby’s care. This information should support, but not replace, discussions you have with healthcare professionals.

It explains some important differences in the way newborn screening tests are carried out for babies in special care baby units. It is important you also read the Screening tests for you and your baby information you received during your pregnancy. This explains all the screening tests offered for newborn babies.

The screening tests described here are recommended by the NHS. This is because results from these tests can help pick up serious conditions and make sure that your baby gets urgent treatment if needed.

Ideally the screening tests should be completed before you take your baby home.

If your baby was born very early, some of the newborn screening tests will need to be delayed. Newborn hearing screening cannot be done if your baby was born at less than 34 weeks of pregnancy. For example, if your baby is born at 28 weeks of pregnancy, they will need to wait 6 weeks after birth for the hearing test.

The newborn physical examination can also be done at this time to make sure the screening tests are more accurate.

Your baby’s healthcare team will be able to answer any questions you might have.

It is your choice whether to have any of the tests described in this information.

1. Eyes, heart, hips and testicles (newborn physical examination)

1.1 The purpose of the screening test

All babies should be offered a newborn physical examination after birth. This includes examination of the eyes, heart, hips and testicles (in boys).

1.2 How the test is different

The newborn physical examination screening tests will not be done until your baby is well enough. If you choose to have this screening test, the examination should take place before your baby goes home.

If a condition or problem is suspected, your baby will be referred for further assessment and tests if appropriate. This may include referral for a hip ultrasound scan, or referral to specialist teams that look at the baby’s heart, eyes or testicles.

If this happens you will be advised about the best times for these additional tests to be done. 

You will be offered an infant physical examination when your baby is 6 to 8 weeks of age, as some conditions can become apparent later. This is usually done by your GP.

2. Blood spot

2.1 The purpose of the screening test

The test is to find out if your baby has any of these rare but serious health conditions:

• sickle cell disease (SCD)
• cystic fibrosis (CF)
• congenital hypothyroidism (CHT)
• inherited metabolic diseases (IMDs):
  • phenylketonuria (PKU)
  • medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
  • maple syrup urine disease (MSUD)
  • isovaleric acidaemia (IVA)
  • glutaric aciduria type 1 (GA1)
  • homocystinuria (pyridoxine unresponsive) (HCU)

Early treatment can improve your baby’s health. It can prevent severe disability or even death. If you or a family member already has one of these conditions, please tell your baby’s healthcare team straight away.

2.2 Why screening is different for babies in special care units

The blood spot sample is usually taken when a baby is 5 days old. However, the timing is different when a baby is ill and in a special care baby unit.

2.3 How the test is different

The blood spot sample needs to be taken as soon as possible after your baby is born to screen for SCD. This is in case your baby needs a blood transfusion. The test for SCD would be inaccurate if a sample for screening is taken after a transfusion.

Another blood spot sample to screen for the other conditions will then be taken when your baby is 5 days old. If your baby has a transfusion, this test is delayed until they are 8 days old.

If your baby is born before 32 weeks of pregnancy, another sample should be taken to test for CHT. This should happen when your baby is 28 days old or when you take your baby home, whichever comes first.

2.4 Getting my results

If one of the conditions screened for is suspected, you will be contacted by a specialist clinical team. This is to explain the results and offer your baby further testing. Some of these further tests need to be undertaken quickly. You should not ignore any attempts to contact you from the specialist team.

If none of the conditions screened for are suspected, you should receive the results by letter or from your health visitor within 6 weeks.

3. Hearing loss

3.1 The purpose of the screening test

To find babies who have a permanent hearing loss so that support and advice can be offered right from the start.

3.2 Why screening is different for babies in special care units

1 to 2 babies in every 1,000 are born with a permanent hearing loss in one or both ears. This number increases to about 1 in every 100 babies who have spent at least 48 hours in a special care unit.

Newborn hearing screening cannot be done if the baby is born at less than 34 weeks of pregnancy. The screening test should be done when treatment is complete, and your baby is well enough.

Your baby’s healthcare team will let you know the best time for your baby’s test to take place.

3.3 How the test is different

If your baby has been in a special care baby unit for more than 48 hours, they will need to have 2 types of hearing screening tests.

These are an AOAE (automated otoacoustic emission) test and an AABR (automated auditory brainstem response) test.

About 9 in every 100 babies cared for in a special care baby unit for more than 48 hours do not show a clear response to the screening tests.

If the screening test results do not show a clear response from one or both of your baby’s ears, an audiology appointment will be made with a hearing specialist.

Your baby should be seen by a hearing specialist within 4 weeks of the screening test. If your baby was born before 40 weeks of pregnancy, your baby will need to wait a bit longer for this appointment. It is very important you bring your baby to the audiology appointment in case your baby has a hearing loss.

Some babies need to be referred directly to a hearing specialist in audiology without a screening test. For example, when they have an infection which may cause a hearing loss, or they have had a programmable shunt fitted.

Finding out about hearing loss early gives babies a better chance of developing language, speech and communication skills. It helps make sure their families receive the support they need.

Screening does not pick up all types of hearing loss, so it is important to check your child’s hearing as they grow up. The checklist in your baby’s personal child health record (‘red book’) tells you how to do this. If you have any concerns about your child’s hearing tell your health visitor or GP.

Please check with the healthcare team caring for your baby if you are unsure or have any questions.

4. Infectious diseases

4.1 The purpose of the screening test

During pregnancy, we offer and recommend women a blood test to screen for hepatitis B, HIV (human immunodeficiency virus), and syphilis.

If you received a positive screening result for hepatitis B, HIV or syphilis in pregnancy, your baby will need follow up care after birth. Your healthcare team will discuss this with you. 

4.2 Follow-on care for babies born to women living with hepatitis B

All babies born to women living with hepatitis B will need 6 separate doses of hepatitis B vaccination from birth. This is needed to protect your baby against long lasting (chronic) hepatitis B infection. The vaccination is a small injection in the thigh.

It is very important your baby has all 6 recommended hepatitis B vaccinations at the right time.

Vaccinations should take place:

• within 24 hours of birth (including immunoglobin if needed)
• at 4 weeks of age
• at 8, 12 and 16 weeks of age (part of routine childhood immunisation schedule)
• at 18 months of age

Very premature babies (born before 28 weeks) may need their breathing monitored for 2 to 3 days after their first vaccination.

Your baby may also need hepatitis B immunoglobulin. This is an antibody that fight infection and offer additional protection. This is given as soon as possible after birth (within the first 24 hours).

Your baby will also need to have a blood test between 12 and 18 months of age to check if the infection was avoided. This will be offered and carried out by your GP.

4.3 Babies born to women living with HIV

If you are living with HIV, treatment and specialist healthcare can greatly reduce the chance of it being passed on to your baby.

It is usually advised to avoid breastfeeding. However, this can be supported if you are receiving good HIV treatment. You should discuss this with your healthcare team.

4.4 Babies born to women who have been treated for syphilis

If you had treatment for syphilis during your pregnancy, your baby will need an examination and blood tests after birth. They may need antibiotics. Your baby will need a follow up appointment at 3 months of age to make sure that they have no signs of infection.

5. More information

Details of organisations that can provide support for parents when their baby needs special care are available on NHS.UK.

The NHS Screening Programmes use personal information from your NHS records to invite you for screening at the right time. NHS England also uses your information to ensure you receive high quality care and to improve the screening programmes. Find out more about how your information is used and protected, and your options.