Tales from the hospital newborn rounds with medical students… What do we screen for?

Oh, my life as a physician and medical educator.  I have a new crop of green third-year medical students.  They have just spent two years studying books.  Now, they get to see patients and do what most of them have been dreaming about for years.

I am the “newborn attending physician” this week and am tasked to see new babies at the local hospitals.  The medical students, most of whom are not parents themselves, are bright and eager to learn about babies.  One question that they brought up is…

Which newborn screenings are recommended and why?

1. Congenital heart defects.  To screen for this we measure the oxygen saturation in the newborn’s blood with a probe (that looks like a light on a bandaid) at 24 hours of age.  If this is abnormal, an ultrasound of the heart (an echocardiogram) is done to see if there are structural cardiac problems.
2. Genetic and metabolic disorders.  A heel-stick blood draw is done after 24 hours of age to test the newborn’s ability to break down milk proteins and other genetic abnormalities.  This is done by the State lab and Nevada asks for two “newborn screens”:  one done at 24 hours of age and one at 2 weeks of age.
3. Hearing impairment.  This is done by screening for the auditory brainstem response wherein a hospital technician does a non-invasive test on a hopefully sleeping or calm infant.  (It is done this way as newborns will not raise their hand when a sound is heard.)  Sometimes, the initial screen is abnormal (most commonly due to fluid in the ears) and is repeated a few weeks later.  If still abnormal, then an audiologist is consulted.
4. Hyperbilirubinemia (jaundice).  A transcutaneous bilirubin level is obtained by putting a non-invasive light on the newborn’s upper chest to read how much bilirubin is in the skin.  If this is elevated, then a venous sample is obtained.  If this is high, then the newborn is placed under blue lights called “bili lights.”  This is to help the bilirubin from crossing the blood-brain barrier and causing brain damage.

I hope this helps….