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Screening Tests for Newborns

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Not everyone in this age group may need screening for every condition listed here. Click on the links above to read more about each condition and to determine if screening may be appropriate for you or your family member. You should discuss screening options with your health care practitioner.

Infectious Diseases

Typically, newborns are tested for infectious diseases only if they show signs and symptoms. Currently, asymptomatic newborns may be screened for two infectious diseases: HIV or hepatitis B. Usually these screening tests are only performed if it is known that the mother has the disease or if she was not tested during the pregnancy and therefore her disease status is unknown. Some states mandate HIV testing of all newborns. Though the newborns may show no signs or symptoms of infection, they may have contracted the disease during the pregnancy or birth. Treatment can be administered soon after birth to protect the health of the newborn.

HIV

Human immunodeficiency virus (HIV) is the virus that causes AIDS (acquired immunodeficiency syndrome). The infection can pass from an infected mother to her child during pregnancy, delivery, or breastfeeding (see HIV Screening during Pregnancy).

Most AIDS cases in children in the United States result from mother-to-baby transmission. If a mother with HIV does not receive treatment during the pregnancy, the child has a 1 in 4 chance of getting HIV. With timely treatment, however, fewer than 2% of children of infected mothers get the virus.

Thanks to aggressive screening and early intervention, the United States has seen a steady decline in new AIDS cases in children. The best way to protect the child's health is to detect the HIV infection as early as possible during pregnancy (or before a woman gets pregnant), treat the mother with medication, and make birthing plans to help the baby avoid infection (such as a C-section rather than vaginal birth).

If the mother was not tested during the pregnancy or at the time of the delivery, the newborn can be screened and, if positive, treated shortly after birth. HIV testing has become routine prenatal care in this country; some states even require that all pregnant women or their newborns be tested.

  • Screening the mother: All pregnant women in the United States should be counseled about HIV early in their pregnancy and receive voluntary HIV testing to protect the child's health. This is the recommendation of many groups, including the Centers for Disease Control and Prevention, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and U.S. Preventive Services Task Force. Women who are at high risk for HIV should be tested again in the third trimester.
  • Screening the baby: In the United States, if the mother's HIV status is not determined before or during pregnancy or during labor and delivery, healthcare practitioners recommend that the newborn be given an HIV test (see FAQ #4 here). In a few states, this is a requirement. Treatment begun quickly after birth can help to prevent a baby who was exposed to the virus from becoming infected.

Treatment of HIV-infected mothers during pregnancy, precautions at birth, and avoiding breast-feeding can minimize the risk of passing the infection from mother to child. Giving the antiretroviral drug zidovudine intravenously during labor and delivery and also to the newborn twice a day by mouth for 6 weeks reduces the rate of transmission from 25-33% to about 1-2%. A combination of antiretroviral therapies is most effective at reducing the risk of HIV transmission to the baby.

Hepatitis B
It is recommended that all pregnant woman be screened for hepatitis B infections either before or early in her pregnancy regardless of previous hepatitis B vaccination or previous negative hepatitis B (HBsAg) test result. Women at increased risk of hepatitis B infection, such as those with intravenous drug use, should be screened again at delivery. Infection with the hepatitis B virus causes an inflammation of the liver.

It is important to detect active hepatitis B infections in pregnant women because newborns are especially vulnerable to developing chronic infection, which can over the course of many years cause progressive liver damage. If a hepatitis infection is detected in a pregnant woman, she can be monitored and the baby can receive treatment at birth to minimize the risk of developing hepatitis B. Without treatment, about 40% of babies born to mothers infected with hepatitis B develop chronic hepatitis.

With the advent of screening pregnant women for hepatitis B and the vaccination of newborns, the number of infected babies has fallen. However, a newborn may be screened if there is concern that the mother is at high risk of infection and/or she was not tested during the pregnancy.


Links
CDC: 10 Tips for Preventing Infections Before and During Pregnancy
AIDS.gov: Preventing Mother-to-Child Transmission of HIV


Sources Used in Current Review

(2013 April). Human Immunodeficiency Virus (HIV) infection: Screening. U.S. Preventative Services Task Force. Available online at https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/human-immunodeficiency-virus-hiv-infection-screening. Accessed April 2017.

(2014 October). Hepatitis B in pregnant women. U.S. Preventative Services Task Force. Available online at https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/hepatitis-b-in-pregnant-women-screening. Accessed April 2017.

(2016 March 23). HIV among pregnant women, infants, and children. Centers for Disease Control and Prevention. Available online at http://www.cdc.gov/hiv/group/gender/pregnantwomen/index.html. Accessed April 2017.

(Updated 2016 August 22). Screening recommendations and considerations referenced in treatment guidelines and original sources. Centers for Disease Control and Prevention. Available online at http://www.cdc.gov/std/tg2015/screening-recommendations.htm. Accessed April 2017.

(2016 October 4). Viral hepatitis: Perinatal transmission. Centers for Disease Control and Prevention. Available online at http://www.cdc.gov/hepatitis/hbv/perinatalxmtn.htm. Accessed April 2017.

(May 16, 2017) AIDS Info. Preventing Mother-to-Child Transmission of HIV. Available online at https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/20/50/preventing-mother-to-child-transmission-of-hiv. Accessed May 2017.

(June 4, 2015) CDC. Screening Recommendations and Considerations Referenced in Treatment Guidelines and Original Sources. Available online at https://www.cdc.gov/std/tg2015/screening-recommendations.htm. Accessed May 2017

(June 2009) USPSTF. Final Recommendation Statement, Hepatitis B in Pregnant Women: Screening. Available online at https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/hepatitis-b-in-pregnant-women-screening. Accessed May 2017.