Newborn checks in hospital: what happens before you go home

Newborn · Health · Reviewed 20 June 2026 · All articles

The hours after birth are full of firsts: your baby's first cry, first breath, first skin-to-skin moment. Running alongside all of that, quietly and methodically, is a set of routine checks designed to catch problems early, when treatment works best. Most parents leave hospital without a single concern flagged. But understanding what the clinical team is doing, and why, can help you feel less like a bystander and more like an informed participant.

This article walks through each check in order, from the Apgar score in the first minutes of life to the newborn bloodspot test around day five. It also covers vitamin K, eye checks, hip examination, hearing screening, and the timing of discharge.

The Apgar score: the first two minutes

Within sixty seconds of birth, the midwife or doctor observing the delivery assigns your baby an Apgar score. The name comes from anaesthesiologist Virginia Apgar, who devised the system in 1952, and it also works as a helpful mnemonic for the five things being assessed.

• Appearance (skin colour): blue or pale all over scores 0; body pink but extremities blue scores 1; fully pink scores 2.
• Pulse (heart rate): absent scores 0; below 100 beats per minute scores 1; 100 or above scores 2.
• Grimace (reflex irritability): no response to stimulation scores 0; grimace scores 1; cry or cough scores 2.
• Activity (muscle tone): limp scores 0; some flexion of limbs scores 1; active motion scores 2.
• Respiration (breathing effort): absent scores 0; weak or irregular scores 1; strong cry scores 2.

The five scores are added together for a maximum total of 10. The assessment is repeated at five minutes after birth. Most healthy newborns score between 7 and 9 at both time points. A score of 10 is uncommon because many babies have blue hands and feet for a short while after delivery. A score below 7 at one minute is common and prompts the team to provide warmth, stimulation, and sometimes additional breathing support. If the five-minute score remains below 7, assessment continues at ten minutes.

It is worth knowing that a low one-minute Apgar score, on its own, does not predict long-term outcomes. The score is a snapshot of how a baby is transitioning to life outside the womb, not a measure of brain function or future development.

Vitamin K and eye checks

Shortly after birth, parents are offered vitamin K for their baby. Newborns are born with very low stores of this vitamin, which is essential for blood clotting. Without it, a small number of babies develop vitamin K deficiency bleeding (VKDB), a rare but potentially serious condition that can cause bleeding inside the skull.

The standard offer is a single intramuscular injection into the thigh, which provides lasting protection. Parents who prefer to avoid an injection can request oral vitamin K instead, though this requires multiple doses over the first weeks of life and is slightly less effective for babies at higher risk. The team will explain the options and document your choice.

Eye checks in the first hours focus on the general appearance of the eyes: whether they are present, whether they look structurally normal, and whether a red reflex can be seen when a light is shone into the pupil. The red reflex check is a quick screen for cataracts and other conditions that could affect vision if left untreated. A full assessment of the eyes is repeated as part of the newborn physical examination described in the next section.

The newborn physical examination

The newborn physical examination (sometimes called the NIPE, or newborn and infant physical examination) is a systematic head-to-toe review done within 72 hours of birth, usually before discharge from hospital. It is carried out by a doctor or a specially trained midwife and takes around 20 to 30 minutes.

The clinician reviews your baby's history and then examines the following areas:

• Head and fontanelles: the soft spots (fontanelles) are palpated. The shape of the skull is assessed for signs of moulding from the birth.
• Eyes: the red reflex is checked again and the external appearance reviewed. Any family history of childhood eye problems is noted.
• Heart: the clinician listens for heart sounds and murmurs. A murmur heard in the first day or two is often transient and related to fetal blood vessels closing after birth. Significant murmurs are investigated further.
• Abdomen: the liver, spleen, and kidneys are palpated. The umbilical cord and surrounding area are inspected.
• Genitals: in male babies, the testes are checked to confirm they have descended into the scrotum. Undescended testes are common at birth and often self-resolve; those that do not descend by six months are referred for review. In female babies, the genitals are inspected for normal appearance.
• Spine: the baby is turned over so the full length of the spine can be seen and felt, checking for any skin changes or pits that might indicate an underlying spinal abnormality.
• Feet: the feet are assessed for positional talipes (a common and usually self-correcting foot position) versus true structural talipes, which requires early physiotherapy or orthopaedic referral.
• Hips: this is one of the most important parts of the examination. The clinician uses two techniques to check for developmental dysplasia of the hip (DDH).

For the hip check, the Barlow test gently adducts each hip while applying slight backward pressure, feeling for a clunk or movement that suggests the hip can be pushed out of its socket. The Ortolani test then abducts the hip while lifting the greater trochanter, feeling for a clunk as a displaced hip reduces back into the socket. A positive finding does not always mean the hip is dislocated; it may simply be unstable. An ultrasound of the hips is arranged to clarify the picture, and most cases resolve with either watchful waiting or a soft brace worn for a few weeks.

Risk factors that make DDH more likely include breech presentation, a family history of DDH, and certain neuromuscular conditions. Babies with these risk factors are offered hip ultrasound screening regardless of the clinical examination findings.

A repeat physical examination is offered at six to eight weeks by the GP or primary care team. This is not a sign that anything was missed at birth; it is a scheduled second check at a point when some conditions (such as late-presenting hip problems or heart murmurs) are more reliably detected.

When does a newborn physical examination happen?

The newborn physical examination is usually done within 72 hours of birth, often before discharge. A doctor or trained midwife checks the eyes, heart, hips, and testes (in male babies), and reviews the whole baby from head to toe. A repeat check is offered at six to eight weeks by the GP.

Newborn hearing screening

Newborn hearing screening is offered to all babies, ideally before discharge from hospital, though it can take place in the community in the first few weeks of life. The aim is to identify babies with permanent hearing loss early, so that support, fitting of hearing aids, or other interventions can begin before speech and language development is delayed.

There are two methods in use:

• Otoacoustic emissions (OAE): a small soft earpiece is placed in the baby's ear. It plays a series of gentle clicking sounds and measures the tiny echo produced by the healthy cochlea. The test is automated and takes a few minutes. The baby needs to be calm, ideally asleep.
• Automated auditory brainstem response (AABR): small sensors are placed on the baby's head and soft earphones deliver sounds. The test measures the electrical signals travelling from the ear to the brainstem. It is used for babies who do not get a clear result from OAE, and for babies who spent time in the neonatal unit (where the risk of hearing problems is higher).

Both tests give a result of "clear" or "not clear" for each ear. A "not clear" result does not mean your baby has hearing loss. Fluid in the ear canal, movement, or background noise can all produce a "not clear" result in a baby with perfectly normal hearing. Around 1 in 100 babies needs a second screen, and the majority of those turn out to have typical hearing on further testing.

If the second screen is also not clear, the family is referred to a specialist audiology team for more detailed assessment. This is done promptly, usually within four weeks, because early fitting of hearing aids or cochlear implants makes a substantial difference to language development in babies with true hearing loss.

What happens if my baby does not pass the newborn hearing screen?

A screen that is not passed does not confirm hearing loss. It means a further test is needed, usually within a few weeks. Many babies who need a second screen turn out to have normal hearing. An audiologist will carry out more detailed assessments if required.

The newborn bloodspot test

Around day five of life (day four to eight is the acceptable window), a midwife collects a few drops of blood from your baby's heel by making a small puncture with a lancet. The drops are absorbed onto a special card, dried, and sent to a laboratory for analysis. This is the newborn bloodspot test, often called the heel prick test.

The bloodspot screen checks for a range of rare but serious conditions where early treatment makes a significant difference to long-term health. The specific conditions screened vary slightly by region, but a standard panel includes:

• Phenylketonuria (PKU): an inability to process phenylalanine, an amino acid found in protein. Without treatment (a carefully managed low-phenylalanine diet), PKU causes severe intellectual disability. Detected early, babies with PKU grow up with typical development.
• Congenital hypothyroidism: the thyroid gland is absent or underactive at birth, preventing normal brain development. Daily thyroid hormone replacement started in the first weeks of life is highly effective.
• Sickle cell disease: an inherited condition affecting red blood cells. Early identification allows prophylactic antibiotics to be started, which dramatically reduces the risk of serious infection in infancy.
• Cystic fibrosis: a genetic condition affecting the lungs and digestive system. Early diagnosis allows nutritional support and physiotherapy to begin before damage accumulates.
• MCADD (medium-chain acyl-CoA dehydrogenase deficiency): a fatty acid oxidation disorder that prevents the body from converting fat to energy during fasting. Babies with MCADD can have life-threatening crises if they go without food for too long. Once identified, parents receive guidance on feeding frequency and what to do if the baby becomes unwell.

Many programmes also screen for additional conditions such as maple syrup urine disease (MSUD), homocystinuria, glutaric aciduria type 1, isovaleric acidaemia, and others, depending on the local testing panel.

Results are usually available within six to eight weeks, though most families receive notification only if a follow-up is needed. If a result requires further investigation, you will be contacted promptly and given a clear explanation of next steps. A positive screen is not a diagnosis; it indicates that further testing is needed to confirm or rule out the condition.

What does the heel prick test screen for?

The newborn bloodspot test, done at around five days old, screens for conditions including phenylketonuria (PKU), congenital hypothyroidism, sickle cell disease, cystic fibrosis, and MCADD (a fatty acid oxidation disorder). Early detection allows treatment to begin before symptoms appear.

Understanding the Apgar score in more detail

What does the Apgar score measure?

The Apgar score rates five signs at one minute and five minutes after birth: appearance (skin colour), pulse (heart rate), grimace (reflex response), activity (muscle tone), and respiration (breathing effort). Each sign scores 0 to 2, giving a maximum of 10. Most healthy newborns score 7 to 9; a score below 7 prompts closer monitoring or support.

Discharge timing and what to do if a check raises a concern

For a straightforward vaginal birth with no complications, discharge is typically possible between 6 and 24 hours after birth, once the newborn physical examination has been completed and both mother and baby are well. Many families choose to go home at the earlier end of this window; others prefer the reassurance of a longer stay.

After a caesarean section, the stay is usually longer: typically 24 to 48 hours or more, depending on recovery. The same newborn checks apply, and the timing of the physical examination is not changed by the mode of delivery.

Babies admitted to the neonatal unit for any reason will have their checks completed there, on a schedule adapted to their condition and corrected gestational age.

Before discharge, you should receive written information about what to look for at home in the first days and weeks, including the signs that warrant an urgent call or return to hospital: poor feeding, unusual drowsiness, a high-pitched or abnormal cry, fever, a change in skin colour, or difficulty breathing. In many areas, a community midwife will visit within 24 hours of discharge to check on mother and baby.

When any check raises a concern, the team should explain what was found, what it may mean, and what happens next. Referrals are arranged before discharge where possible so that follow-up is in place from day one. For most findings, the next step is closer monitoring or an outpatient appointment rather than immediate treatment.

If you leave hospital and later have a question about a result, or if you are contacted about a bloodspot or hearing screen result that needs follow-up, the community midwifery team and your GP are the right first point of contact. They can explain findings, arrange referrals, and support you through any further assessment that is needed.

The checks described in this article are offered universally. They are not a response to anything specific about your pregnancy or your family. They exist because the conditions they screen for are rare enough that individual testing would be impractical, but serious enough that missing them carries real consequences. Almost every parent will go through all of them and come out the other side reassured. For the small number of families who receive a follow-up call, the screening system is what makes early, effective treatment possible.