Baby health

Newborn screening in Canada: What to expect

From Apgar to the heel prick test, everything you need to know about your newborn's procedures.

Newborn screening in Canada: What to expect

Photo: iStockphoto

The hours and days after your newborn arrives will bring many firsts, including her first medical test. Knowing exactly what’s being done—and why—will help bring you peace of mind.

The specific procedures performed will depend on which province or territory you live in. But, generally, immediately following your baby’s birth, your doctor or midwife will conduct the Apgar test to assess her overall health. She’ll be scored on five factors by doing a visual assessment of skin colour, listening to her heart and lungs, and checking reflexes and muscle tone. Within the first hour, your little one will also receive a vitamin K injection in her thigh, which assists in blood clotting (something your infant needs a little help with early on). She’s also given an antibiotic eye ointment that prevents her from potentially contracting an eye infection from gonorrhea or chlamydia when passing through the birth canal.

The next step is the newborn screening test, which looks for a variety of disorders, including cystic fibrosis and severe combined immunodeficiency, and is usually done between 24 and 72 hours after birth by a doctor, midwife or nurse using a heel lancet, a medical tool that makes a tiny incision less that two millimetres deep in your baby’s heel. A small amount of blood is collected and then sent to a provincial screening centre for analysis. “Sometimes the newborn will be taken into another room to avoid alarming the parents,” says Canadian Midwives Association president Joanna Nemrava. “But I’ve seen babies who are being breastfed during the test who don’t even cry.”

Lauren Higgins, a genetic counsellor at Newborn Screening Ontario (NSO), stresses the importance of the newborn screening test. “Even if a baby looks healthy at birth, she may be at risk for serious health problems if she has a disease that’s not detected and treated early.” She explains that the number of diseases tested for differs between provinces and territories. For example, in Ontario it’s 30 diseases; Alberta tests for 17. It’s important to understand that a positive result only indicates that there’s a greater probability of your baby having one of the conditions and further diagnostic testing is needed. It doesn’t necessarily mean your child has the disease.

Babies in Ontario are now screened for congenital heart problems 24 to 48 hours after birth using a probe that wraps around a baby's finger, hand or lower limb to detect oxygen levels in the blood. About 12 in every 1,000 babies are born with congenital heart disease.

In some provinces like British Columbia or Ontario, your infant will be screened for hearing impairment prior to being discharged from the hospital. A specialist plays very soft sounds into the ear through headphones or a small earpiece to measure the inner ear’s response. Parents in provinces that don’t offer the test, or those discharged from the hospital prior to it being administered, should take their child into a hearing clinic for testing within two weeks of birth, as hearing impairment can go unnoticed for years.


Before the home birth of her second child, Madeleine Picard told her midwife not to give the antibiotic eye ointment or vitamin K injection to her son. “We wanted to let nature do its thing,” says Picard. She was well within her rights. Most provinces assume implied consent—that the parents want the tests and treatments unless they’re specifically refused. This means there are no consent forms to sign. Nemrava says that while routine procedures are done with the best interests of the child in mind, you have the right to be fully informed and make your own decisions.

Find out which procedures are done in your specific hospital by asking your doctor, or, if you’re having a home birth, consult your midwife, so you can decide if what’s offered makes sense for your baby. These are the first direct medical treatments your child will receive; it’s best to be informed.

Did you know? The Apgar test, which determines whether a newborn needs immediate medical attention, is done twice: one minute after birth, then again five minutes later. The average score is 7 out of 10. The acronym stands for: Appearance, Pulse, Grimace, Activity, Respiration

A version of this article appeared in our November 2014 issue with the headline "Testing 1,2,3," p. 50.

Read more:
What prenatal testing can tell you
Why your baby's gut bacteria is so important

This article was originally published on Oct 20, 2014

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