Conditions Tested in Early Check

Conditions Tested in Early Check

Which conditions will Early Check test for?

All babies born in North Carolina are already screened for a set of 37 health conditions shortly after birth as part of standard testing. Early Check provides extra, optional tests for babies whose parents sign up for the program: spinal muscular atrophy and fragile X syndrome.

Over time, we plan to offer tests for additional conditions as part of Early Check. Our team of experts will review and select these conditions using a common set of guidelines. Learn how we choose conditions for Early Check.

What is spinal muscular atrophy?

SMA is a genetic condition affecting about 1 in 10,000 new babies in the United States. Over time, muscles of people with SMA get smaller and weaker from poor communication between the spinal cord and muscles. This weakness can be very mild or very severe. People with SMA can begin showing signs and symptoms at different ages, ranging from shortly after birth to adulthood. The condition can lead to death in early childhood or later depending on the type of SMA. Currently, there is no cure for SMA, but there is one approved treatment.


SMA is a genetic condition that robs people of physical strength by affecting the motor nerve cells in the spinal cord. This can take away their ability to walk, eat, or breathe. It's the number one genetic cause of death for infants.

SMA is caused by a variation in a gene in the survival motor neuron gene 1 (SMN1). In a healthy person, this gene manages nerves that control our muscles. Without it, those nerve cells can’t properly function and eventually die, leading to debilitating muscle weakness. About 1 in every 50 Americans is a genetic carrier of SMA, which can affect any race or gender.

People with SMA have difficulty performing the basic functions of life, like breathing and swallowing. However, SMA does not affect a person’s ability to think, learn, and build relationships with others.

For now, there is no cure for SMA, but there’s great reason for hope. Thanks to the dedication of the SMA community and the hard work of researchers, there is now Spinraza, the first-ever approved treatment that targets the underlying genetics of SMA. Also, other support services can help with breathing, eating, mobility, palliative care, and other symptoms and challenges.

"There is hope in treating SMA, particularly for children who are diagnosed at or very soon after birth and receive prompt treatment! My family is proof of that."

– Amy Medina, mother of two sons with SMA

Family with children who have spinal muscular atrophy

What is fragile X syndrome?

Although FXS is a rare health condition, it is the most common intellectual disability passed through genes from parents to babies. About 1 in every 4,000 males, and 1 in every 6,000 females has FXS. It causes moderate to severe intellectual challenges and language problems. Children with FXS may also have social and behavioral difficulties. This means they may have problems with attention, impulsive actions, and anxiety. Boys with FXS usually have more severe problems than girls. Individuals with FXS typically have normal life spans.


FXS is a genetic condition caused by changes in a gene that is on the X chromosome. This gene is called the FMR1. Everyone has this FMR1 gene on their X chromosome. Women have two X chromosomes, so they have two copies of this gene. Men have one X chromosome and one Y chromosome, so they have only one copy of the gene.

The FMR1 gene usually makes a protein that is needed for normal brain development. People who have FXS do not make this protein. Women often have milder symptoms than men because they have two X chromosomes. While one of their X chromosomes may not be producing the healthy FMR1 protein, the other one is.

A child with FXS might have learning disabilities or developmental delays in walking and talking. They might also experience anxiety, hyperactivity, and a short attention span. Some children with FXS also have autism. Physically, they may have an elongated face, large ears, and loose connective tissue, which can result in ear infections, hernias, and loose joints.

There is no cure for FXS, but if your child has the condition, you can begin early support services. These services can help your child learn to walk and talk. They can also help you, as a parent, prepare to address characteristics of FXS in your child, such as difficulties processing tastes and smells. There are doctors who work specifically with people who have FXS to develop the best treatment plan.

Early Check offers an extra result called fragile X premutation, which can have milder symptoms than fragile X syndrome or no symptoms at all. Early Check will know if a baby has fragile X premutation through the same screening test used for fragile X syndrome. Adult mothers who sign up for Early Check can choose to get the extra result. Moms must log in and do a separate sign up within 48 hours after enrolling their babies in Early Check. Moms only have 48 hours to sign up because the lab does all the screening together.”

"Early intervention has given us the opportunity to give our son Jack access to therapies, such as occupational therapy and speech therapy, that helped him learn to talk and learn to play with toys. Jack has come a long way, in part due to all the early intervention therapies he received."

– Lisa Thomas, mother of a son with FXS

Jack Thomas, who has Fragile X syndrome, in photo with his mother

How does Early Check select the conditions to include?

Our team has outlined a set of guidelines for reviewing and selecting health conditions for screening in Early Check. The condition must be one that:

  • Usually begins showing signs and symptoms in childhood
  • Is difficult to diagnose early
  • Causes serious sickness, death, or has a big impact on families
  • Has a low-cost and proven lab test that can be performed on blood taken from a heel prick
  • Has follow-up support services available for affected children
  • Has new treatments being developed that may be more effective when used very early in life

Another important guideline for selecting conditions is that screening would likely lead to an overall benefit for babies or families.

In time, we plan to add a third condition or set of conditions to Early Check. We’ll draw on our guidelines, the advice from our board of expert advisors, and the most up-to-date scientific evidence to find conditions that fit with the goals of Early Check.

"Without early screenings, it is extremely hard to conduct clinical studies to help infants with rare conditions. This creates a barrier to developing new therapies. Early Check will fill this gap, benefitting science as well as patients."

– Dr. Lisa Gehtland, Early Check project director

Lisa Gehtland