Your newborn's first days: screening tests and discharge

Key rules

• Heel-prick timing: The sample is taken 48 to 72 hours after birth, even if you leave hospital early.
• Abnormal result: A call asking you to repeat a sample is common and does not mean your baby is ill.
• Missed test: If any test was missed, contact your paediatrician, health centre or maternity hospital straight away.
• Regional differences: The heel-prick list of conditions depends on your region, so ask the maternity unit what it covers.
• Declining items: You may decline some routine items, such as vitamin K, but discuss it with staff first.

What your baby gets before you leave hospital

Every newborn in Spanish hospitals gets a set of routine checks and preventive treatments. Most happen without you needing to ask. They are: identification and weighing, the Apgar score (a quick health rating just after birth), a physical check, skin-to-skin contact with early breastfeeding, and the tests below.

The heel-prick test

The heel-prick test (cribado neonatal, also called prueba del talón) looks for rare metabolic and hormonal conditions. A nurse takes a few drops of blood from your baby's heel. It is done 48 to 72 hours after birth, once feeding has started.

Each region runs its own screening, so the list of conditions differs. The core list covers congenital hypothyroidism, phenylketonuria, cystic fibrosis and fatty-acid oxidation disorders. Most regions test for more, such as sickle cell disease and congenital adrenal hyperplasia. Ask your maternity unit which conditions your region covers.

If you leave hospital early or give birth at home, the sample must still be taken in that window. Ask the maternity unit or your health centre how to arrange it before you go.

Hearing screening

Hearing screening is routine in the public system, and most private hospitals offer it too. It is done in hospital in the first days, takes only a few minutes and is painless. If your baby does not pass, they are retested and then referred to an ear, nose and throat (ENT) or audiology unit for diagnostic tests. The aim is a diagnosis by about 3 months and support or treatment by about 6 months.

Preventive treatments

• Vitamin K: one injection soon after birth to prevent a bleeding disorder.
• Eye ointment: an antibiotic ointment, given in many hospitals but not all.
• Hepatitis B vaccine: given in the first 24 hours in most regions. If the mother has hepatitis B, the baby also gets extra immunoglobulin.
• Heart oximetry: a painless sensor test at 24 to 48 hours that checks for serious heart defects. Many hospitals do it, but not every one.

You can decline some items, such as vitamin K. Talk it through with the staff first.

If a result is abnormal or a test was missed

An abnormal result does not mean your baby is ill. The regional laboratory may ask for a new sample because the first was taken too early, was too small or was poor quality. If there is a real concern, the laboratory, hospital or paediatrician usually calls you quickly. They will repeat the sample or refer your baby to a specialist unit for confirmation and treatment. Answer calls from unknown numbers in the first weeks.

If a test was missed, for example after a home birth, an early discharge or a move from another country, contact your paediatrician, health centre or the maternity hospital. They can arrange the heel-prick as soon as possible. Aim for the first days, and in any case within the first weeks. A missed or failed hearing test leads to a retest or an ENT referral.

Papers you take home

The hospital gives you a discharge report for you (informe de alta) and one for your baby (informe de alta neonatal). It also gives you the screening results or a note of when they will arrive, and the paperwork to register the birth. Registering is usually done within 72 hours through the hospital's own service, or within 10 days if you do it directly yourself. Depending on your region, you may also get a vaccination record or health book (cuaderno or cartilla de salud infantil). The documents list below has the full set.

Timeline and deadlines

• Hearing screening in hospital, which takes a few minutes: in the first days after birth, before discharge

• Register the birth through the hospital's own service: usually within 72 hours of the birth

• Register the birth directly yourself if you do not use the hospital service: within 10 days

• Hearing diagnosis if your baby did not pass the retest: by about 3 months

• Start any hearing treatment or support: by about 6 months

Documents you need

• Your discharge report (informe de alta), given to you by the hospital, with your delivery details and recommendations.

• Your baby's neonatal discharge report (informe de alta neonatal), given by the hospital, with birth data, weight and treatments such as vitamin K and vaccines.

• The heel-prick and hearing screening results, or a note saying when they will be sent to you.

• The birth declaration paperwork (cuestionario or parte de nacimiento), provided by the hospital, to register the birth in the Registro Civil (civil registry).

• A vaccination record or your baby's health book (cuaderno or cartilla de salud infantil), depending on your region.

Checklist

• Ask the maternity unit that your baby's heel-prick sample is taken 48 to 72 hours after birth, even if you leave early.

• Ask which conditions your region's heel-prick panel covers.

• Confirm your baby has had the hearing screening before you leave hospital.

• Check that vitamin K was given and ask about eye ointment, the hepatitis B vaccine and heart oximetry.

• Discuss with staff before declining any routine item, such as vitamin K.

• Ask who will contact you with the heel-prick and hearing results, and how.

• Keep your phone on and answer calls from the hospital or health centre, in case a sample needs repeating.

What to watch out for

• A missed heel-prick test: A baby sent home early, born at home or newly arrived from another country can miss the heel-prick test. Contact your paediatrician, health centre or the maternity hospital and ask for the test as soon as possible, ideally in the first days and in any case within the first weeks.

• A call asking to repeat a sample: The screening laboratory may phone to repeat the sample if it was taken too early, was too small or was poor quality. This is not necessarily a sign of disease. Answer the call and take your baby for the repeat quickly, or to the specialist unit if you are referred.

• A missed or failed hearing test: If your baby misses or does not pass the hearing test, the next step is a retest or a referral to an ear, nose and throat (ENT) specialist. Go to the retest or ENT appointment you are given, so diagnosis can happen by about 3 months.

Frequently asked questions

Does my baby still get the heel-prick test if we leave hospital early?

Yes, a baby discharged early or born at home must still have the heel-prick sample taken in the same window after birth. Ask the maternity unit before you leave how and where it will be done. Home births need the same arrangement with the midwife or health centre.

Does an abnormal screening result mean my baby is ill?

No, an abnormal or repeat request does not necessarily mean your baby has a disease. The sample may have been taken too early, been too small or been poor quality. The regional screening laboratory usually phones the family, hospital or paediatrician to repeat the sample or refer your baby to a specialist unit.

What can I do if my baby missed the heel-prick test?

Contact your paediatrician, health centre or the maternity hospital as soon as you can and ask for the heel-prick to be arranged. It is best done in the first days and in any case within the first weeks. This also applies if you moved from another country.

Can I say no to vitamin K for my newborn?

Yes, parents may decline some items such as vitamin K, but you should discuss it with the hospital staff first. Vitamin K is a single injection soon after birth to prevent bleeding disease.