Newborn Screening

How Screening Works

Newborn Dried Blood Spot Screening

What is Dried Blood Spot Screening?

All infants born in Tennessee are required to have a newborn screening blood sample collected and submitted to the Tennessee State Laboratory. This screening looks for certain genetic and metabolic conditions that may not be noticeable at birth.

A few drops of blood are collected, usually from the baby’s heel, and placed on a special card called a dried blood spot.

Why Dried Blood Spot Screening is Important

Early diagnosis and treatment can make a critical difference in a child’s health. Early care may help prevent:

• Developmental delays
• Long-term health care needs
• Serious complications
• Death

Understanding Screening Results

Newborn screening is not a diagnostic test. Results can be affected by:

• The baby’s age at the time of collection
• Medical condition or treatments
• The quality or amount of the blood sample
• Other testing variables

Because of this:

• Some conditions may not be detected
• False-positive or false-negative results are possible

If a screening result is out of the normal range, the Tennessee Department of Health works with the baby’s health care provider to:

• Arrange repeat testing
• Confirm results
• Coordinate care with a specialist, if needed

Newborn Hearing Screening

Purpose of Newborn Screening

The Newborn Hearing Screening Program works to ensure that all infants born in Tennessee receive a hearing screening:

• Before hospital discharge, or
• Before one month of age

Early identification of hearing loss is essential for speech, language, and cognitive development.

The 1-3-6 Hearing Screening Plan

Tennessee follows the nationally recognized 1–3–6 plan:

• 1 – All infants are screened for hearing loss before discharge or by 1 month of age
• 3 – Infants who do not pass the screening receive a diagnostic hearing evaluation before 3 months of age
• 6 – Infants diagnosed with hearing loss begin early intervention services no later than 6 months of age
• And – Families of children with hearing loss have access to parent support services

Legal Requirement

Newborn hearing screening is required by:

• Tennessee Code Annotated, Title 68, Chapter 5, Part 9, Sections 901–906
• Rules and Regulations 1200-15-01
• Also known as Claire’s Law (July 2008)

Critical Congenital Heart Disease (CCHD) Screening

What Is CCHD?

Critical congenital heart disease (CCHD) refers to serious heart defects present at birth. Congenital heart disease is the most common type of birth defect and may be detected before or after birth.

How CCHD Screening Works

CCHD screening is done using pulse oximetry, a painless test that measures oxygen levels in the blood. This screening:

• Is recommended nationally by the U.S. Secretary of Health and Human Services
• Is endorsed by:
  • American Heart Association
  • American Academy of Pediatrics
  • American College of Cardiology

Pulse oximetry has been shown to successfully detect some forms of CCHD in newborns.

Why Early Detection Matters

If CCHD is not detected before a baby leaves the hospital, it can lead to:

• Cardiogenic shock
• Severe illness
• Death

Babies diagnosed later may be at higher risk for:

• Neurologic injury
• Developmental delays

Early detection can improve outcomes and reduce illness and death.

Newborn Screening Long-Term Follow-Up (LTFU)

What Is the Long-Term Follow-Up Program?

The Long-Term Follow-Up (LTFU) Program supports children in Tennessee who are identified with conditions through newborn screening and their families.

The program helps connect families to:

• Health care providers
• Early intervention programs
• Social workers
• Support organizations

A list of conditions eligible for Long-Term Follow-Up is available here:
LTFU Conditions (PDF) (2025)

Participation and Consent

Participation in the LTFU program is voluntary. Families may:

• Choose different levels of involvement
• Change their participation at any time

With parent or guardian permission, information about a child’s medical care may be collected. This information helps:

• Track how early diagnosis benefits children over time
• Improve care for children across Tennessee

Consent forms are available in:

• English
• Spanish

Long-Term Follow-Up Contact Information

Conditions Screened Through Newborn Screening

Newborn screening in Tennessee includes testing for a wide range of genetic, metabolic, endocrine, immune, hearing, and heart conditions. The list below provides a complete and detailed overview of conditions included in the screening panel.

Some conditions are grouped by category. Individual conditions within each category are listed alphabetically. This information is provided for informational purposes and is not a diagnosis.

External Links Disclaimer
The following links direct you to third-party websites that are not maintained by the Tennessee Department of Health (TDH). TDH does not control or guarantee the accuracy, relevance, timeliness, or accessibility of information on these external sites and is not responsible for their content or functionality.

Accessing Services

This section explains how newborn screening services are provided in Tennessee and what parents can expect if follow-up care is needed.

Newborn Dried Blood Spot Screening Services

Why Newborn Screening Is Important

Most newborns appear healthy at birth. However, some serious health conditions may not be detected during a routine physical exam. Blood tests are used to screen newborns for these conditions so treatment can begin as early as possible.

A baby may look healthy but still have an inherited condition. Early testing during the first two to three days of life helps prevent serious health problems.

How and Where Your Baby Is Tested

Tennessee law requires that a filter paper blood spot sample be collected for every baby born in the state.

• A small heel prick is used to collect a few drops of blood
• The sample is collected before your baby leaves the hospital
• The blood sample is sent to the Tennessee State Laboratory in Nashville
• Hospitals provide parents with a Newborn Screening Parent Pamphlet (2025) with additional information

Repeat Testing and Follow-Up

In some cases, testing may need to be repeated. This can happen if:

• The sample was not collected correctly
• The baby received a blood transfusion
• The sample was collected before the baby was 24 hours old
• A possible condition was identified

If repeat testing is needed, parents can contact:

• Their baby’s health care provider, or
• Their local health department

Tennessee has a comprehensive genetics program that provides access to:

• Genetic screening
• Diagnostic testing
• Genetic counseling services

These services support individuals and families who have, or may be at risk for, genetic conditions.

Service Referrals for Families

This resource provides information for families about referral services available after a newborn screening result indicates the need for follow-up care. It explains how families may be connected to genetic services, diagnostic testing, and support resources in Tennessee.

Service Referrals Resources for Families (English PDF) (2022)

What Happens to the Extra Blood Sample

Any remaining blood from the screening test is stored at the Department of Health Laboratory for one year.

The stored sample may be used:

• If requested by you or your baby’s doctor
• For quality assurance testing
• To evaluate new screening methods

When samples are used for these purposes, personal information is removed so the sample cannot be linked back to your baby.

The Parent’s Role

After leaving the hospital, you may be contacted by your baby’s doctor or the local health department if follow-up testing is needed.

It is important to:

• Schedule repeat testing promptly
• Follow your provider’s instructions
• Contact your baby’s health care provider with any concerns about screening results

Newborn Hearing Screening Services

Hearing Screening Requirements and Availability

Newborn hearing screening is required by Tennessee Code Annotated, Title 68, Chapter 5, Part 9, Sections 901–906, and Rules and Regulations 1200-15-01, also known as Claire’s Law (July 2008).

Claire’s Law requires:

• Hearing screening before hospital discharge or before one month of age
• Allowable religious exemptions

Where Hearing Screening Services Are Provided

Hearing screening services are available statewide and are provided by:

• All birthing hospitals
• Select birth centers
• Midwives

Screening services may be performed by hospital staff or contracted vendors.

Most insurance plans cover newborn hearing screening. If the screening provider used by your birthing facility is not covered by your insurance, you may choose to have your baby screened at select audiology facilities across Tennessee.

Parents are encouraged to ask their birthing facility or pediatrician:

• Who provides the hearing screening
• Where follow-up services are available

Purpose of Hearing Screening

Newborn hearing screening checks for hearing loss shortly after birth. Identifying hearing loss early helps babies develop speech, language, and communication skills as they grow.

Hearing screenings are completed:

• Before hospital discharge, or
• Between 24 and 48 hours after birth if your baby was not born in a hospital

Types of Hearing Screening Tests

There are two safe and painless hearing screening tests. Both are usually done while your baby is asleep.

• Otoacoustic Emissions (OAE): Measures sounds produced by the inner ear
• Auditory Brainstem Response (ABR): Measures how the hearing nerve responds to sound

Important Information for Parents

• Ask your baby’s medical provider or hospital for hearing screening results
• If your baby does not pass the hearing screen, contact a medical or hearing provider right away to schedule follow-up testing
• The Tennessee Department of Health sends a letter to families whose babies did not pass the initial hearing screening
• If you did not receive a letter, you may contact the Tennessee Department of Health at 615-532-8462

It is important to schedule follow-up testing with a provider who offers the same or a more advanced test than the one used in the hospital.

Finding Hearing Services

If your baby needs follow-up testing:

• Use the Infant Audiology Centers Directory (2025) to find providers who serve infants
• As your baby gets older, a pediatric audiologist may be appropriate
• Use the Pediatric Audiology Centers Directory (2025) for ongoing follow-up

If your baby was not born in a hospital, contact your primary care provider for a referral. The Infant Audiology Centers Directory can help you locate services.

Ongoing Hearing Monitoring

Even if your baby passes the newborn hearing screen, hearing can change over time.

Hearing loss may develop due to:

• Middle ear infections
• Fluid in the middle ear
• Family history of hearing loss
• Illnesses such as meningitis

Some babies may need hearing tested regularly. Contact your baby’s health care provider if you have concerns or questions.

Frequently Asked Questions (FAQs)

This section answers common questions from parents and families about newborn screening in Tennessee. Topics include heart screening, follow-up care, and the Long-Term Follow-Up (LTFU) program. These answers are provided to help you understand what screening results mean and what services may be available for your child.

Critical Congenital Heart Disease (CCHD) FAQs

Tennessee Newborn Screening Long-Term Follow-Up (LTFU) FAQs

Forms & Policies

This section provides required reporting forms and related policies for health care providers involved in newborn screening, hearing screening, and critical congenital heart disease (CCHD) screening in Tennessee.

Accessibility Notice
Accessible versions or alternative formats are available upon request.

For assistance, please contact:

Newborn Screening Program
Email: nbs.health@tn.gov

Visit and Education Requests

Program Visit Requests

Health care providers, hospitals, and birthing facilities may request an educational or program visit from the Tennessee Newborn Screening Program.

• Tennessee Newborn Screening Program Hospital/Facility Visit Request Form (PDF)

Pamphlet Requests

Printed educational pamphlets may be requested for distribution to parents and families.

• Newborn Screening Pamphlet Request Form
  (Use this form to request parent pamphlets in available languages)
  

Refusal Forms

Newborn Screening Refusal

If a parent refuses newborn screening, the following forms and procedures must be used.

• Newborn Screening Refusal Informational Flyer English | Spanish
  
• Newborn Screening Refusal Form (PH-3686) English | Spanish
  

Facilities must review the informational flyer with parents prior to completing the refusal form. Completed refusal forms must be attached to the newborn screening filter card (without blood), following program requirements.

Newborn Dried Blood Spot Screening

For Health Care Providers

The following policies support reporting and compliance related to newborn dried blood spot screening.

• Ophthalmia Neonatorum Information
• Tennessee Department of Health Policy Regarding Newborn Eye Treatment Refusal

Newborn Hearing Screening

Reporting Forms and Best Practice Guidance

The following forms and guidance documents support reporting requirements and recommended clinical practices for newborn hearing screening.

Reporting Forms

• Audiology Reporting Form
• Newborn Hearing Screen Only Form

Best Practice and Clinical Guidance

• Newborn Hearing Screening Best Practice Recommendations (PDF)

• Hospital Hearing Guidelines (PDF)

Critical Congenital Heart Disease (CCHD)

Reporting Forms and Clinical Protocols

The following forms and protocols support reporting and screening for critical congenital heart disease.

Reporting Forms

• CCHD Identified by Pediatric Cardiologist Reporting Form (PDF)

Screening Protocols

• Protocol (Algorithm) for Critical Congenital Heart Disease (CCHD)

Secure Remote Viewer (SRV)

Access to Newborn Screening Results for Health Care Providers

The Tennessee Newborn Screening Program offers a Secure Remote Viewer (SRV) that allows authorized health care providers to view and print newborn screening results online. SRV is a secure, web-based application that provides access to digital copies of patient result reports.

Health care providers must be registered with the Tennessee Department of Health to gain access to the SRV system.

How to Request SRV Access

To request access to the Secure Remote Viewer:

1. Complete the SRV Access Form (PH-3909)
2. Fax the completed form to (615) 532-8555
3. Include a valid email address on the form

Once the form is received:

• You will be notified by email with your username and password
• For security reasons, the email will not include a link to the SRV website
• After receiving your credentials, log in through the State of Tennessee Newborn Screening Program Results Website to access SRV

SRV Forms and User Guidance

• SRV Access Form (PH-3909)
  (Fax to: 615-532-8555)
• Secure Remote Viewer (SRV) User Guide
  

Data, Dashboards & Laboratory Updates

This section provides access to newborn screening dashboards, laboratory information, system portals, program announcements, and operational resources for health care providers and partners in Tennessee.

Program Announcements

The following announcements provide important updates related to newborn screening testing, systems, and program operations.

• Removal of Newborn Screening for Nonketotic Hyperglycinemia (NKH)
  (Effective August 1, 2025)
• Action Required: Timeline for Full Transition to the Newborn Screening Secure Remote Viewer (SRV)
  (November 22, 2024)
• Update: Use of the State Newborn Screening Secure Remote Viewer
  (June 26, 2024)
• Newborn Screening Fee Increase – Notice to Tennessee Birthing Hospitals
  (Effective January 1, 2024 | Notice dated November 14, 2023)
• Ordering Newborn Screening Forms and Track-Kit Memorandum
  (October 4, 2023)

Newborn Screening Laboratory

The Tennessee Newborn Screening (NBS) Laboratory tests more than 80,000 specimens each year.
State law (Tennessee Code Annotated, Title 68, Chapter 5, Part 4) requires that all infants born in Tennessee receive screening for certain conditions.

Laboratory testing helps identify infants who may have serious medical conditions. Early detection and treatment can help prevent:

• Growth problems
• Developmental delays
• Deafness or blindness
• Intellectual disabilities
• Seizures
• Sudden or early death

Specimen Collection and Testing

Newborn screening tests require a simple heel-stick blood sample, typically collected when the infant is 24–36 hours old.

If a screening result is outside the expected range:

• Newborn Screening Follow-Up nurses begin follow-up immediately
• The infant’s health care provider is contacted
• Repeat screening, confirmatory testing, and specialist care are coordinated as needed

The Newborn Screening Follow-Up program also provides:

• Parent resources
• Education and training for health care providers

Laboratory Operations

The Newborn Screening Laboratory:

• Receives specimens and performs testing seven days per week

Department hours:

• Monday–Friday: 8:00 a.m. – 4:30 p.m.
• Saturday–Sunday: 7:00 a.m. – 3:30 p.m.

Laboratory Contact Information

For questions related to newborn screening laboratory services, please contact:

• Email: LabNBS.Health@tn.gov
• Main Laboratory Phone: 615-262-6300
• Newborn Screening Laboratory Phone: 615-262-6353

Data Entry and Results Portal

Newborn Screening Data Entry & Results Portal (Secure Remote Viewer)

Natus Secure Remote Viewer (SRV) is the web-based portal used for:

• Remote data entry
• Viewing and downloading newborn screening results

Health care providers may use the portal to enter demographics and access screening results from the Tennessee Department of Health Laboratory Services.

• Newborn Screening Data Entry & Results Portal for Providers

(Access requires registration. See the Forms & Policies tab for SRV access forms and instructions.)

Dashboards

Newborn Dried Blood Spot Screening Dashboard

This dashboard provides summary data on Tennessee’s Newborn Dried Blood Spot Screening Program, including screening volume, timeliness, and follow-up outcomes, to support program monitoring and quality improvement.

Provide feedback on the newborn screening dashboard (REDCap survey).

Newborn Hearing Screening Dashboard

This dashboard presents statewide data on newborn hearing screening in Tennessee, including screening results, follow-up timelines, and early intervention indicators, to help track program performance and outcomes.

Statewide Quality Reports

Below is a list of Statewide Quality Reports that track Tennessee Newborn Screening program performance over time, organized by year and month. These reports provide transparent information about screening activity and quality measures for the newborn dried bloodspot screening program.

Accessibility Notice:
The Tennessee Department of Health is committed to providing access to information. Accessible versions or alternative formats are available upon request. Please contact nbs.health@tn.gov for assistance.

Education & Resources

This section provides educational materials, guidance, and reference resources for parents, families, health care providers, hospitals, and birthing facilities involved in newborn screening in Tennessee.

For Parents and Families

These materials help parents understand newborn screening, what to expect, and how to support their baby’s health.

Educational Pamphlets and Fact Sheets

• Your Baby and Newborn Screening
  (Spanish: Su Bebé y Exámenes en el Recién Nacido)
• Prenatal Classes: Newborn Screening Fact Sheet
  (Spanish: Lo Que Los Padres Deben Saber Sobre Los Exámenes de los Recién Nacidos)
• COVID-19 Information for Parents

Hearing and Early Intervention Resources

• Hearing Resources Comprehensive Guide
• 2021 Tennessee Early Hearing Detection and Intervention (EHDI) Infographic
• EHDI Data Fact Sheet

For Hospitals and Birthing Facilities

Screening Responsibilities

By law, all infants born in Tennessee must have a newborn screening submitted to the Tennessee State Laboratory.

Hospitals and birthing facilities are responsible for:

• Completing the newborn screening collection form fully and accurately
• Submitting a satisfactory newborn screen on all infants prior to discharge, regardless of age
• Distributing the Newborn Screening Parent Pamphlet to parents

Blood Spot Collection Guidance

• Always collect a newborn screening before any blood transfusion, even if the infant is less than 24 hours old
• Collect a repeat filter paper specimen four days after transfusion
• If an infant is transferred to another facility, collect a newborn screen prior to transfer

Infant Over Six Months of Age

Newborn screening laboratory test methods are not suitable for infants older than six months.

If an infant is over six months of age:

• Contact the metabolic center closest to the provider
• Ask which tests are needed and where specimens should be sent

For Primary Providers

Provider Responsibilities

Primary care providers are responsible for:

• Confirming that a newborn screening was completed
• Reviewing and interpreting results, including transfusion and diet status
• Informing parents of screening results

If a specimen is unsatisfactory or abnormal:

• Providers and parents must ensure a repeat specimen is collected
• Screening results are mailed to both the submitter and the listed provider

Follow-Up Process

• Unsatisfactory results: providers and parents receive a letter requesting repeat testing
• Abnormal results: providers and tertiary centers are notified by phone and fax
• Follow-up staff and tertiary centers support confirmatory testing, diagnosis, and treatment
• Cases are followed until a diagnosis is confirmed or ruled out

Important Screening Limitations

Newborn screening is a screening test, not a diagnostic test.

Results may be affected by:

• Baby’s age
• Medical or treatment status
• Specimen quality or quantity
• Other variables

False-positive and false-negative results are possible.
Regardless of screening results, providers should proceed with diagnostic testing if an infant shows clinical signs or symptoms.

Circumstantial Screening Information

If Parents Refuse Newborn Screening

If parents refuse the initial newborn screening blood test:

• Provide the Newborn Screening Refusal Informational Flyer
• Review the information with parents
• Have them complete the Newborn Screening Refusal Form

If an Infant Dies Before Screening

If the initial newborn screening was not collected due to infant death:

• Complete the newborn screening filter card (without blood)
• Mark the card as Expired
• Include required infant and parent information

If you are aware of an infant death and are unsure whether screening was collected:

• Fax the required information to (615) 532-8555

Laboratory & Specimen Handling Resources

For Health Care Providers, Hospitals, and Midwives

The resources below provide additional information related to newborn screening laboratory testing, specimen handling, and shipping requirements.

Laboratory Reference Materials

• List of Screened Disorders and Mailer Explanations
• Newborn Screening Laboratory Brochure
• Unsatisfactory Specimens Explained
• Specimen Timeline

Blood Collection and Shipping

• Access the Tennessee Newborn Screening Program Information Toolkit

Filter Cards and Supplies

To request filter cards:

• Contact the State Laboratory by email or fax
• Include facility name, address, phone number, and contact person

Fax: (615) 262-6455
Email: DCLAB.supply@tn.gov

Courier and Shipping Information

Statewide Courier Service

The statewide courier service:

• Picks up specimens after 5:00 p.m. local time
• Delivers specimens to the laboratory by 7:30 a.m. the next day
• Operates seven days a week

Will-Call/Call-In locations must request pickup by 3:00 p.m. via:

• Email: tdhcustomerservice@gocrosstown.com
• Backup phone: 800-727-5872

Courier Contact Information

• Laboratory Courier Contact: LabNBS.Health@tn.gov
• Direct Crosstown pickup issues to: tdhcustomerservice@gocrosstown.com

Shipping Information

• Shipping Information for Health Departments and Hospitals

For Private Clinics and Midwives

• Shipping Information for Private Clinics and Midwives

Critical Congenital Heart Disease (CCHD) Education for Providers

Pulse oximetry screening for CCHD began January 1, 2013. Screening is recommended alongside other newborn screenings when the infant is at least 24 hours old.

CCHD screening targets specific heart defects, including:

• Hypoplastic left heart syndrome
• Pulmonary atresia
• Tetralogy of Fallot
• Transposition of the great arteries
• Tricuspid atresia
• Truncus arteriosus
• Double-outlet right ventricle (DORV)

• Single ventricle

• Ebstein's anomaly

• Interrupted aortic arch (IAA)
  

CCHD screening is a point-of-care test. Intervention occurs at the hospital or birthing facility if a newborn does not pass the screening. All facilities should maintain written protocols for responding to failed screens.

Genetics Advisory Committee

Overview

The Genetics Advisory Committee was established in 1985 by the Tennessee State Legislature.
The Committee operates under Tennessee Code Annotated § 68-5-503.

Purpose of the Committee

The Genetics Advisory Committee advises the Tennessee Department of Health on newborn screening and genetic services. The Committee’s goal is to improve services for individuals born with genetic conditions in Tennessee.

The Committee:

• Recommends changes to screening protocols
• Advises on follow-up and treatment guidelines
• Helps ensure infants with genetic conditions are identified early
• Supports timely and appropriate care for affected children and families

Committee Membership

The Committee includes health care professionals from across Tennessee with expertise in:

• Genetics
• Endocrinology
• Pulmonology
• Hemoglobinopathy
• Immunology
• Neonatology
• Hematology
• Cardiology

These members bring diverse clinical and public health perspectives to support newborn screening and genetic services statewide.

Membership Requirements

By law, the Committee is composed of:

• One (1) representative from each regional genetics center
• One (1) representative from each regional sickle cell center
• At least two (2) members at large
• The Chief Medical Officer for the State of Tennessee or a designated representative

Additional specialists may be added as needed to provide guidance on new conditions added to the newborn screening panel.
The Committee also includes a parent representative.

Meeting Materials and Recordings

The Genetics Advisory Committee is required by law to meet at least one time each year. In practice, the Committee typically meets three times per year.

Genetics Advisory Committee Agendas

Genetics Advisory Committee Meeting Recordings

Genetics Advisory Committee Sunshine Notices

Additional Resources

This section provides links to clinical centers, family support services, professional organizations, and educational resources related to newborn screening, genetic conditions, hearing loss, and specialty care in Tennessee and nationwide.

Tennessee Genetics Network

Professional and National Organizations

External Links Disclaimer
The following links direct you to third-party websites that are not maintained by the Tennessee Department of Health (TDH). TDH does not control or guarantee the accuracy, relevance, timeliness, or accessibility of information on these external sites and is not responsible for their content or functionality.

American Academy of Pediatrics (AAP) -  Information on newborn screening, diagnosis, and treatment

American College of Medical Genetics (ACMG) - Education and resources for genetic services

Baby's First Test - Information on newborn screening conditions and follow-up

March of Dimes - Information on pregnancy, birth defects, and newborn screening

Hearing and Early Intervention Resources

Additional Resources

• Rules and Regulations for the Tennessee Department of Health Newborn Screening Program
• Newborn Hearing Screening Pamphlets for Families English | Spanish