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Newborn Hearing Screen

last modified on: Wed, 03/13/2019 - 17:03

GENERAL CONSIDERATIONS:

  • Primary goal is to identify newborns who are likely to have hearing loss and require further evaluation
  • Identify newborns with conditions associated with late-onset hearing loss
  • Screening protocols differ from country to country and state to state. Guidelines below are based on U.S. National recommendations
  • Recent studies show 98.2% of newborns in the United States undergo screening (CDC)
  • Approximately 1/500 children are born with congenital bilateral hearing loss
  • “Refer” is generally used to describe a failed hearing screen

GUIDELINES:

  • Method of testing:
    • Otoacoustic emissions (OAEs) and/or automated auditory brainstem response (aABR) testing. OAEs will test presynaptic cochlea function where ABRs test brain activity response to stimulus. OAEs will miss auditory neuropathy but are generally more sensitive. Either Transient-evoked OAEs (TEOAEs) or distortion product OAEs (DPOAEs) may be used.
    • Four options for screening:
      • ABR only
      • OAEs only
      • Two-tier (OAEs with immediate ABR if OAE not passed) – UIHC currently uses this protocol, except in the NICU where ABR is used in all children given the high risk population. This is consistent with JCIH 2007 recommendations for all children in the NICU > 5 days.
      • Two-technology (ABR and OAE)
    • A newborn must pass the screening in both ears during one session for the screening to be considered a “pass”. If they do not pass in one ear, both ears must be rescreened.
    • The probability of an erroneous “pass” outcome increases with every screen.
  • Timing:
    • Screening for hearing loss should take place before leaving the birthing facility.
    • If not born in a hospital, hearing screen should be completed before 1 mo.
    • Diagnosis of any hearing loss by 3 months of age
    • Hearing aid selection (if appropriate) and fitting within 1 month of hearing loss confirmation
    • Entry into early intervention services by 6 months of age
  • Follow up:
    • If the child refers on their hearing screen follow up with audiology for an outpatient hearing check should be arranged.
    • Loss to follow up: failing to receive the next step of treatment
    • Lost to documentation: failure to report to state early hearing detection and intervention (EHDI) programs

AT RISK POPULATIONS:

  • The JCIH has identified 10 risk indicators that prompt continued monitoring of hearing status even if newborn hearing results are normal (JCIH 2007):
    • Parental or caregiver concern regarding child’s hearing, speech, language, or developmental delay
    • Family history of permanent hearing loss in childhood
    • Stigmata or other findings associated with a syndrome known to include a sensorineural or conductive hearing loss or eustachian-tube dysfunction
    • Postnatal infections associated with sensorineural hearing loss, including bacterial meningitis
    • In utero infections such as cytomegalovirus infection, herpes, rubella, syphilis, and toxoplasmosis
    • Neonatal indicators such as hyperbilirubinemia at a serum level requiring exchange transfusion, persistent pulmonary hypertension of the newborn associated with mechanical ventilation, and conditions requiring the use of extracorporeal-membrane oxygenation
    • Syndromes associated with progressive hearing loss such as neurofibromatosis, osteopetrosis, and some forms of Usher’s syndrome
    • Neurodegenerative disorders such as Hunter’s syndrome or sensory neuropathies such as Friedreich’s ataxia and Charcot–Marie–Tooth syndrome
    • Head trauma
    • Recurrent or persistent otitis media with effusion for at least 3 months

REFERENCES/SUGGESTED READING: