Newborn Screening Program Frequently Asked Questions

The DSHS Newborn Screening Program consists of testing, follow-up, and clinical care coordination. All babies born in Texas are required to have two rounds of screening tests for certain inheritable and other disorders. Through the Newborn Screening Program, infants who have an abnormal screen at birth or shortly after birth are identified. An abnormal laboratory result triggers follow up and clinical care coordination to make sure the baby receives confirmatory testing and treatment if needed. Early treatment can help prevent serious complications such as growth problems, developmental delays, deafness or blindness, intellectual disability, seizures, or even early death.

The screening of large numbers of newborns in Texas was made possible and more affordable with the discovery of the filter paper method for testing blood spots, including the introduction of automated laboratory equipment. Texas added screening for the following genetic and heritable disorders in:

1963 – Phenylketonuria (PKU)
1978 – Galactosemia (GALT)
1980 – Congenital Hypothyroidism (CH)
1983 – Hemoglobinopathies (Hb)
1989 – Congenital Adrenal Hyperplasia (CAH)
1999 – Newborn hearing screening implemented (point-of-service screen)

In 2006, with the development of Tandem Mass Spectrometry (MS/MS), DSHS began testing for a panel of metabolic disorders recommended by the American Academy of Medical Genetics. Following the addition of MS/MS, these additional disorders were added in:

2007 – Biotinodase (BIOT)
2009 – Cystic Fibrosis (CF)
2012 – Severe Combined Immune Deficiency Syndrome (SCID)
2014 – Critical Congenital Heart Disease (CCHD) implemented (point-of-service screen)
2015 – Secondary Conditions of the Recommended Uniform Screening Panel
2019 – X-Linked Adrenoleukodystrophy (X-ALD)
2021 – Spinal Muscular Atrophy (SMA)

A very small amount of blood is taken from the baby’s heel 24 to 48 hours after birth or before leaving the birthing facility. A second sample is taken one to two weeks later, usually at the baby's first check-up. The sample is put on a piece of absorbent paper, dried and sent to the DSHS Public Health Laboratory in Austin for screening tests.

Texas screens newborns for 57 conditions which includes 31 core conditions and 24 secondary conditions. Blood is tested for 55 of those conditions. The two other conditions relate to a newborn’s hearing and screening for critical congenital heart disease.

Blood samples are sent to the DSHS Public Health Laboratory in Austin. The blood spots are screened for disorders that can affect a baby's amino acids, endocrine system, fatty acid oxidation, hemoglobin, organic acids, and other disorders. Point-of-service tests screen a newborn’s hearing and for critical congenital heart disease (CCHD) before going home from the birthing facility. The hearing screen checks if the baby may be deaf or hard of hearing. The CCHD screen checks for possible heart defects.

Most children born with these disorders are from families with no known history of disease and appear healthy at birth. Parents who have had healthy children do not expect any problems with birth defects. Because every baby is tested soon after birth, any child who may have a disorder is identified early and can get immediate care.

If screening tests are abnormal for any disorder, DSHS NBS clinical care coordination follow-up staff contact the health care provider to quickly report the abnormal results. Clinical care coordination staff members work with the infant's health care provider and parents to coordinate recommended follow-up screens or confirmatory testing.

Approximately 400,000 babies are born each year in Texas. The DSHS public health laboratory receives approximately 800,000 specimens and CCC staff provides follow-up on approximately 20,000 abnormal screens. Approximately 900 infants are diagnosed core disorders annually.

There is no cure for these conditions. Early treatment may prevent or control the serious effects.

Parents can only refuse to have their child screened if the screening conflicts with a parent’s religious tenets or practices (see Texas Health & Safety Code Sec. 33.012). In order to refuse, a parent must sign a form stating he/she has a religious objection to newborn screening. Points to consider before refusing newborn screening:

There are important medical benefits of newborn screening.

Symptoms of a newborn screening disorder can appear much later, after a child’s health has already been injured by the disease.

The screen is mandated by law.

The only legal reason to refuse newborn screening is if it conflicts with your religious tenets or practices.

If parents have concerns, they should talk to their baby’s physician or contact the NBS Program Staff by phone at (888) 963-7111, ext. 7333 or email newbornscreeninglab@dshs.texas.gov

Newborn screening of the blood spot consists of a series of tests to look for 53 diseases that can cause a baby to get really sick or die if they are not identified and treated early. The diseases can cause growth problems, mental or physical delays, deafness, blindness, seizures, and early death. Most babies with these conditions look perfectly normal when they are born, and problems may not appear for several weeks or months. About 1 child out of every 500 screened has one of these newborn screening conditions.

The statute’s only reference to allowing the parent, guardian, or managing conservator the right to object to screening is if it conflicts with their religious tenets or practices.

The health care provider or facility sending the specimen to the laboratory buys the specimen collection kit for private pay patients. How these patients are billed is determined by the commercial insurance carrier. Texas Department of State Health Services (DSHS) provides specimen collection kits at no cost to those covered by Medicaid and receives reimbursement from Medicaid.