Newborn Screening Program Frequently Asked Questions

The Texas Newborn Screening Program is an essential public health program that includes:

• Laboratory bloodspot testing for more than 50 disorders
• Point-of-care screenings for 2 more conditions
• Follow-up, case management, and outreach for infants with out-of-range test results

Newborn Screening is required by law for any baby born in Texas (Health and Safety Code, Chapter 33) and identifies babies that may have a specific disorder or medical condition. Early treatment of these disorders can help prevent serious complications or even 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 seven to 14 days 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 law (Health and Safety Code, Chapter 33) requires that all newborns are screened for certain genetic disorders or medical conditions recommended by the Advisory Committee on Heritable Disorders in Newborns and Children (ACHDNC) on the Recommended Uniform Screening Panel (RUSP). Currently for Texas, this includes screening for 31 core conditions, 24 secondary conditions* and point-of-care screens. A list of the conditions on the Texas Newborn Screening Panel can be found here (pdf).

*Note Although the primary mission of NBS is to identify newborns at highest risk for the core conditions, secondary conditions may also be detected during screening for core conditions.  Additional testing may be needed to determine whether it is the core condition or a secondary condition. 

Most children born with these problems appear healthy at birth and are from healthy families. Parents who already have healthy children, or who are "silent carriers" of a genetic condition, do not expect any problems. Because every baby is tested soon after birth, children who may have one or more of these disorders can be identified early and get early care. This can make a tremendous difference in health outcomes for the child.

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.

Most of these conditions can be treated but not cured. In these cases, early and continuous treatment can result in dramatic positive outcomes for the child and help prevent or control the serious effects of these disorders. Severe Combined Immunodeficiency (SCID), which was added to the newborn screening panel in 2012, is the one disorder on the panel that if identified early in life can be treated and for which most patients can be cured.

A parent/guardian can only refuse to have their child screened if the screening conflicts with the parent’s religious tenets or practices (see Texas Health & Safety Code Sec. 33.012).  

There are important medical benefits of newborn screening to consider: 

• All disorders have intervention or treatment options available. 
• Prevention of complications.  
• Improved long-term health for the child. 

Newborn screening of the blood spot consists of a series of tests to look for over 50 diseases that can cause a baby to get very sick or die if they are not identified and treated early. The diseases can cause growth problems, mental or physical disability, deafness, blindness, seizures, and early death. Most babies with these conditions look healthy when 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. 

Texas law mandates newborn screening to help protect babies from health problems. The parent/guardian must sign a form stating they are refusing the screening due to their religious tenets or practices. 

If a parent/guardian has concerns, they should talk to their baby’s physician or contact the Newborn Screening Program Staff by phone at (888) 963-7111, ext. 7333 or email newbornscreeninglab@dshs.texas.gov. 

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.