Screening tests

Shortly after your little one is born and over the next several months, a doctor, nurse, or midwife will perform a series of tests to make sure they’re in good health.

The Apgar score

A baby’s Apgar score is assessed within the first few minutes of life. It evaluates five health markers: colour, heart rate, reflexes, muscle tone, and breathing.

The Apgar score gives you a sense of how your baby is adapting to life outside the uterus. However, it doesn’t predict your child’s future physical or neurological development.

Newborn physical exam

Shortly after birth, a medical practitioner will clear mucus out of your newborn’s mouth and nose using a bulb syringe or suction tube if needed.

They will also assess your newborn’s overall health and check for birth defects and injuries that may have occurred during birth (e.g., an injury caused by forceps).

During the first few hours, they will also take your baby’s temperature, weigh them, and measure their height and head circumference.

Within 24 hours, and when your baby’s condition is stable, your little one will undergo a complete physical examination. Their reflexes will be checked, notably their sucking reflex, to see if they’re able to feed.

Newborn blood spot screening

Before you head home with the newest member of your family (between 24 and 48 hours after birth), medical staff will ask for your consent to perform a blood spot screening test. This test is offered under the Quebec Neonatal Blood Screening Program and is free and available to all newborns across the province.

If you agree to the test, your baby’s heel will be pricked to draw a few drops of blood. The blood sample will be collected on a card and sent to the screening program lab, where all samples from across the province are analyzed.

Blood spot screening is performed to detect rare but serious diseases that could have serious consequences on a child’s life.

Oftentimes, these diseases are not apparent at birth. The earlier they’re detected, the sooner treatment can begin, ideally before the first signs and symptoms appear.

The blood screening program tests for four different types of diseases:

• diseases affecting hormonal functioning (e.g., congenital hypothyroidism)
• diseases affecting the circulatory system (e.g., sickle cell anemia)
• diseases affecting metabolism (e.g., phenylketonuria, tyrosinemia, fatty acid oxidation disorders)
• cystic fibrosis

You will only be informed of the results if they are positive or at the upper limit of the normal range (i.e., borderline). A borderline result means that the results are unclear. This can be due to a number of reasons (e.g., the sample is too small or contaminated). If this is the case, program staff will contact you to request a second sample and provide more details on how to proceed.

Bilirubin testing

Hospitals generally screen for jaundice shortly after birth so that they can intervene rapidly, if needed, to prevent certain rare but permanent consequences.

In some cases, parents return home quite soon after the birth of their child. In these circumstances, the Canadian Paediatric Society recommends that a bilirubin test be performed between three and five days after birth. This screening can be done at a CLSC, or sometimes at home by a perinatal nurse. Your health care team will advise you before you leave the hospital or birthing centre.

Eye exam

During your baby’s first physical examination at the hospital, their eyes will be checked for signs of disease. A follow-up exam may be done by your family doctor or by a nurse when your child is goes in for their vaccinations.

According to the Association des optométristes du Québec, babies that are premature or have a family history of vision problems should undergo a a more thorough eye exam with an optometrist or ophthalmologist.

The Association also stresses the importance of first-year eye exams for all children to screen for vision problems and eye diseases. Your child will have their skin and external eye structure examined, as well as their conjunctiva, cornea, iris, and pupils. A red reflex test will also be done to assess your child’s reaction to light.

Hearing test

Hearing tests can now be performed in hospitals thanks to the Quebec Newborn Hearing Screening Program. If you give consent, this test will be done in the hours following delivery, before you go home.

If hearing tests aren’t available at your hospital, you can get your child screened elsewhere before they’re 1 month old. Depending on the results, you may be referred to an audiologist. If you feel your baby is having trouble hearing, talk to their doctor.

Urine screening

After leaving the hospital or birthing centre, you’ll receive a testing kit with everything you need to collect a sample of your baby’s urine when they’re 21 days old. Your health care team will give you all the details on what do.

The Quebec Neonatal Urine Screening Program isn’t mandatory, but it’s free. It allows for the early detection and treatment of certain hereditary diseases that affect metabolism. The program screens for a number of illnesses, including diseases affecting the metabolism of amino acids and organic acids.

To learn more about urine screening, see our fact sheet on urine sampling at 21 days to test for hereditary diseases (in French only).

Other tests and exams

Depending on your baby’s health and risk factors, other tests or exams might be necessary. For example, if your baby weighs less than 2.5 kg at birth, a blood test for iron-deficiency anemia may be done.

Additionally, if family members are carriers of a hereditary disease or if the mother contracted a contagious disease during pregnancy, your baby may need to undergo further tests. If you have any questions or concerns about additional testing, you can always contact your health care team.

Things to keep in mind

• Your health care team will assess your baby’s overall health as soon as they’re born by performing a series of tests.
• These tests make it possible to detect health problems early so your child can receive prompt treatment. You’ll be asked for your consent first.
• Some tests are performed in the weeks or months after birth.

Scientific review: Paméla Farman, M.Sc., nurse clinician and lecturer at the Université Laval faculty of nursing Research and copywriting:The Naître et grandir team Updated: February 2023

Photo: BSIP/Astier