Right after birth babies need many important tests and procedures to ensure their health. Some of these are required by law. Check with your healthcare provider to determine which of the following tests are required by law, essential for your child's well-being, or necessary only in some newborns.

What to Expect Right After Birth

The following tests and procedures are recommended, or many time required in most hospitals in the United States:

Apgar Evaluation
Eye Care
Vitamin K Shot
Newborn Metabolic Screening
Hearing Test
Hepatitis B Vaccine
Complete Check-up

Apgar Evaluation

The Apgar test is a fast way for doctors to find out if the baby is healthy or if he or she needs extra medical care. Apgar tests are almost always done twice, 1 minute after birth and then again 5 minutes after birth. A doctor or nurse measures  five signs of the baby's condition. These signs are:

heart rate
activity and muscle tone
skin color

Apgar scores range from 0 to 10. A baby who scores seven or more is considered to be very healthy. A lower score doesn't always mean something is wrong. Many healthy babies often have low Apgar scores in their first minute of life.

In more than 98% of cases, the Apgar score reaches seven after five minutes of life. When it does not reach that, the baby needs medical care and close monitoring. The following chart shows how each sign is rated.


0 points

1 point

2 points

Activity (muscle tone)


Arms and legs flexed

Active movement



Below 100 beats per minute

Above 100 beats per minute

Grimace (reflex irritability)


Below 100 beats per minute

Sneeze, cough, pulls away

Appearance (skin color)

Blue-gray, pale all over

Normal except for extremities

Normal over entire body



Slow, irregular

Good, crying


Eye Care

The Centers for Disease Control and Prevention (CDC) recommend that all newborns receive eye drops or ointment to prevent infections they can get during delivery. Sexually transmitted diseases are a main cause of newborn eye infections. These infections can cause blindness if they are left untreated.

Silver nitrate, erythromycin, and tetracycline are the 3 medicines used in a newborns' eyes. These medicines can sting or blur the baby's vision. You can choose to postpone this treatment for a little while. Some parents question whether this treatment is necessary at all. Many women at low risk for STDs choose not to have their newborn receive eye medicine. However, there isn't any evidence to suggest that this medicine harms the baby.

It is important to note that even pregnant women who test negative for STDs have the possiblity of getting an infection by the time of delivery. Also, most women with gonorrhea or chlamydia don't know it because they do not have symptoms.

Biotinidase Deficiency

Biotinidase deficiency is a blood test to determine whether the baby has insufficient biotin due to a deficiency in the enzyme biotinidase. This is an inherited disorder, but can be treated by administration of free biotin throughout life.

Biotinidase deficiency is a blood test to determine whether the baby has insufficient biotin due to a deficiency in the enzyme biotinidase. This is an inherited disorder. It can be treated by administration of free biotin throughout life.

Vitamin K Shot

The American Academy of Pediatrics recommends that all newborns receive a shot of vitamin K in the upper leg. Newborns usually have low levels of vitamin K. This vitamin is needed for the blood to clot which means that low levels of vitamin K can cause a rare but serious bleeding problem. Research shows that vitamin K shots prevent dangerous bleeding in newborns.

Newborn Metabolic Screening

Doctors or nurses prick your baby's heel to take a tiny sample of blood which is used to test for many diseases.

All fifty states require testing for at least two disorders: phenylketonuria and congenital hypothyroidism. But many states test for up to thrity different diseases, all of which are impossible to spot without a blood test. If left untreated, these diseases can cause mental retardation and even death. The March of Dimes recommends that all newborns be tested for at least twenty-nine diseases.

Hearing Test

Many hospitals offer newborn hearing tests. Tiny earphones or microphones are used to see how the baby reacts to sounds. Newborn hearing tests can spot hearing problems early. This can help cut the risk of serious language and speech problems.


This is a test to determine whether the baby can digest the sugar found in milk. Untreated galactosemia can lead to cataracts, liver damage, mental retardation, and death. Substituting a special formula for milk starting in the first weeks of life helps to avoid these problems. Galactosemia is discovered by testing a blood sample.


Infants are tested for hypothyroidism at the time of discharge from the hospital or before transfer to another hospital or on the fifth day of life. Undetected hypothyroidism can lead to a variety of developmental disabilities, one of which is mental retardation. This blood test is not routine in every state. An affected baby can be treated with supplemental thyroid hormone.


Phenylketonuria (PKU) is a genetic disorder, and it is routinely tested for during the first few days of life. In many states the test is required and is frequently done in conjunction with several other tests such as galactosemia and thalassemia. The test involves taking a sample of blood from the foot of the child. It is accurate only when the baby has been receiving a diet that contains phenylalanine, in both human milk and artificial formulas, for 24 hours. For this reason, a breastfed baby should not be tested until at least 7 days after birth to give your breastmilk a chance to come in and the baby to nurse.

Many healthcare providers do the test before you leave the hospital and then ask you to return in a week to have the test repeated. Consult your pediatrician/family physician about having this test done only once, when the results are most likely to be valid. Left untreated, PKU can cause severe mental retardation. It can be prevented quite readily if detected before symptoms develop and the child is treated with a special diet.

Sickle Cell Disease

Sickle cell disease is caused by an unusual shape of the red blood cells that can lead to anemia, infections, pain, poor growth, and even death. Medical care begun early in life increases the chances of avoiding these problems, which is why early detection is important. The test is performed by examining the red blood cells from the baby's blood sample. This disorder is much more common in African Americans (1 in every 400 babies) and in Hispanics (1 in every 1000-1500 infants). One out of 10 African Americans is a carrier of the gene for sickle cell disease. This condition may also be diagnosed by prenatal analysis in some cases.

Hepatitis B Vaccine

Most hospitals now suggest that newborns get a vaccine to protect against the hepatitis B virus. hepatitis B  can cause a lifelong infection, serious liver damage and even death.

The hepatitis B vaccine is a series of three different shots which The American Academy of Pediatrics and the Centers for Disease Control recommend the first shot soon after birth or before leaving the hospital. If the mother does not have hepatitis B, the first shot can be postponed for 2 months. The second shot and the third shot should be given before 18 months of age.

Complete Check-up

Soon after delivery most doctors or nurses also:

Measure the newborn's weight, length, and head.
Take the baby's temperature.
Measure his breathing and heart rates
Give the baby a bath and clean the umbilical cord stump.