Newborn Screening

Newborn screening is a public health program designed to screen infants shortly after birth for conditions that are treatable, but not clinically evident in the newborn period. Newborn screening started in 1963 when Dr. Robert Guthrie pioneered the first screening for phenylketonuria, commonly known as PKU.  The Tennessee Newborn screening program started in 1968 screening for PKU and now screens for certain conditions using a dried blood spot, for critical congenital heart disease (CCHD) using pulse oximetry and for congenital hearing loss via hearing screening.

Tennessee Code Annotated Title 68, Chapter 5, Part 4 requires that all infants born in the State of Tennessee receive screening for certain conditions.  A dried blood spot (DBS) is submitted to the Tennessee State Laboratory. If tests are abnormal, the Department of Health follows up with the baby’s doctor to initiate re-testing, confirmation and treatment from a specialist if necessary. Early diagnosis and treatment can make the difference between a child leading a relatively normal life or having more significant developmental delays; long-term health care needs, or even death.

In 2008 Tennessee Code Annotated Title 68, Chapter 5, Part 9 (Claire’s Law) hearing screening became required. The newborn hearing screening program is responsible for assuring all infants born in Tennessee received a hearing screening before discharge or prior to one month of age. Significant hearing loss is one of the most common major abnormalities present at birth, and, if undetected, will cause problems with speech, language, and cognitive development.  Evidence demonstrates that when infants with hearing loss are identified in the first few months of life and receive appropriate intervention services, 80% are able to maintain age-appropriate language and speech development in the first five years of life. If hearing impaired children are not identified early, it is difficult, if not impossible, for many of them to acquire the basic language, social, and cognitive skills that provide the foundation for later schooling and success in life. 

The 1-3-6 plan for newborn hearing program works to assure that:
1 - All infants will be screened for hearing loss prior to discharge or before 1 month of age.
3 - All infants who do not pass the screening will have a diagnostic audiological evaluation before 3 months of age.
6 - All infants identified with hearing loss will receive appropriate early intervention services no later than 6 months of age.


In 2013 Tennessee Code Annotated Title 68, Chapter 5, Part 5 directed the state to develop a screening program for newborns using pulse oximetry to identify Critical Congenital Heart Disease. Congenital heart disease is the most common birth defect and may be detected during either the prenatal or postnatal period. Failing to detect CCHD while in the nursery may lead to serious events such as cardiogenic shock or death. Survivors who present late are at greater risk for neurologic injury and subsequent developmental delay. Early detection of CCHD can potentially improve the prognosis and decrease the mortality and morbidity rate of affected infants. Pulse oximetry has been investigated and proven to be successful in detecting some forms of CCHD in the newborn nursery.