Newborn Hearing Screening and Diagnostics

Approximately 3 in 1000 babies are born with a hearing loss (CDC, 2004). Hearing loss in children can negatively impact speech and language development (Yoshinaga-Itano et al., 1998). Early detection, diagnosis and intervention of hearing loss is essential to developing normal speech and language skills. The National Institutes of Health’s Consensus Development Conference on Early Identification of Hearing Loss in 1993 concluded that all infants should be screened for hearing loss prior to hospital discharge. The Early Hearing Loss, Detection, Diagnosis, and Intervention (EHDDI) Program at the Washington State Department of Health provides protocols for screening and diagnostic evaluation of newborns’ hearing.

One of the primary goals of the EHDDI program is to ensure that all infants born in the state of Washington:

• Are screened for hearing loss before hospital discharge or by one month of age
• Receive diagnostic audiological evaluation by three months of age
• Are enrolled in early intervention services by six months of age if needed

This is also known as the 1-3-6 goal.

Universal Newborn Hearing Screening (UNHS) is not mandated by law in Washington State; however, all of the birthing hospitals in the state have UNHS programs and perform newborn hearing screens. An electrophysiological test, either automated Auditory Brainstem Response (ABR) or Otoacoustic Emissions (OAE), is used to evaluate the newborn’s hearing. If the baby passes the test they do not need to receive further hearing tests, unless they have risk factors for hearing loss, experience chronic ear infections, or if there is concern regarding their hearing. If the baby does not pass, or refers, on the hearing screen for one or both ears, it is recommended that they receive a diagnostic hearing evaluation.

There are many risk indicators for hearing loss. The five main risk factors that hospitals record when screening the infants’ hearing are:

1. Stay of 48 hours or more in a Neonatal Intensive Care Unit (NICU)
2. Diagnosis of a syndrome associated with hearing loss
3. Family history of permanent childhood sensorineural hearing loss
4. Craniofacial anomalies such as cleft lip or palate, ear tags or pits
5. Maternal illness such as infection with rubella or cytomegalovirus

Seattle Hearing and Balance Center provides Auditory Brainstem Response (ABR) and Otoacoustic Emission (OAE) evaluations to test infants’ hearing. ABR and OAE testing can be used to test newborns through adults. They are physiologic tests which allow testing of the auditory nerve and the outer hair cells of the cochlea. Although ABR and OAE cannot tell us how the child will use their hearing, it tells us how the outer hair cells and auditory nerve respond to auditory stimuli.

Follow these links to view the Department of Health’s Best Practice Protocols:

Protocol for Newborn Hearing Screening:
www.doh.wa.gov/cfh/mch/Genetics/ehddi/Documents/newborn_protocol.pdf

Protocol for Diagnostic Audiological Assessment: Follow-up for Newborn Hearing Screening:
www.doh.wa.gov/cfh/mch/Genetics/ehddi/Documents/Audiological_Protocol.pdf

Best Practice Guidelines in Early Intervention for Children with Hearing Loss:
www.doh.wa.gov/cfh/mch/Genetics/ehddi/Documents/Best_Practices.pdf

Follow this link to the American Speech-Language Hearing Association for more facts on childhood hearing loss: www.pediatrics.aappublications.org/cgi/reprint/102/5/1161