NEWBORN HEARING SCREENING

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After years of haggling by various government and medical committees, finally universal newborn screening for possible hearing defects is now available.

Magnitude of the problem

Every year in the U.S. approximately 24,000 babies are born with moderate-to-severe hearing impairment. Approximately 6 out of every 1,000 infants born in the U.S. are deaf, and from 4 to 6 of every 100 infants who graduate from neonatal intensive care units are hearing impaired.

Why newborn hearing screening is important

The reason that pediatricians, especially the American Academy of Pediatrics, has been pushing for universal newborn hearing screening is that the age of detection of hearing impairment has a profound bearing on the eventual language development of the child. Without newborn hearing screening, the hearing impairment in many infants is not detected until between fourteen months and three years. Yet, studies show that if a hearing impairment is detected and treated by six months of age, the language development of the child is much improved.

What's being done?

In 1999 a bill was passed to assist states with funds to develop hearing screening programs. Also, the American Academy of Pediatrics has issued a position statement recommending that hearing screening tests should be implemented nationwide, so that infants with hearing impairment are diagnosed by three months of age and beginning treatment by six months of age. Again, the reason for diagnosing and treating hearing impairment under six months of age is that infants who have been diagnosed and treated by this age have more normal language development than infants diagnosed and treated after six months of age, which may never have normal language development. Early detection and early treatment is the goal of parents and doctors. The nationwide goal is to have all hospitals that have a certified neonatal intensive care unit and certified delivery services to have a program set-up for screening all newborns by December of 2002. Presently, approximately 35 states have mandatory newborn hearing screening and have implemented such programs, as have many of the larger hospitals with many births and a newborn intensive care unit. Some hospitals currently only screen "high risk" infants, such as: family history of congenital deafness, congenital infections (such as measles), infants with craniofacial abnormalities, very low birth weight infants under 1,500 grams, infants with extremely high billirubins, infants who have received medications that may be toxic to hearing nerves, infants with bacterial meningitis, and infants who have had prolonged and assisted ventilation.

Is the newborn screening test accurate?

Yes. Presently, the most popular test that is being used, called an AABR (automated auditory brainstem response), has a false-positive rate of under two percent. This means that just under two percent of infants they test will suggest hearing impairment, but a follow-up, more detailed test will show normal hearing. This initial test is just a screening test in which the sound-sensitive probe is painlessly inserted into the infant's ear and the response of the middle-ear structure to sound waves is recorded.

What should parents and doctors do if the initial test suggests hearing impairment?

Remember, the initial test is just a screening test. If this test suggests hearing impairment, within a week or two after the test the infant is then retested at a hearing center, which has more sophisticated technology. If this hearing test is normal, you can rest assured that your infant is not hearing impaired. If, however, the follow-up tests show hearing impairment, the infant is referred for treatment. In some centers, the newborn screening test is repeated at one month of age. If the test again suggests hearing impairment, the infant is then referred for further testing.

What does newborn screening cost?

The AABR test costs anywhere from $30 - $40 per test and takes a qualified technician only five to ten minutes to administer. In most instances, the cost of the test is covered by either state funding or by most insurance carriers.

What can be done about newborn hearing impairment?

Presently, an infant as young as six-months can be fitted with a hearing aid. Early use has been shown to be associated with profound improvement in language development. Some infants are later candidates for cochlear implants. These have been successfully used in infants as young as twelve months since 1990 and have enabled deaf children to hear and speak enough to attend mainstream schooling.

A summary of what the American Academy of Pediatrics wants every parent to know:

Every newborn has a right to hear.
Every newborn should have their hearing tested.
Hearing impairment detection and treatment should be begun by six months of age.
In most states, newborn hearing testing is mandatory.

Resource for in-depth discussion of early hearing detection and intervention programs: Pediatrics, October 2000, pages 798-817, year 2000 Position Statement: Principles and Guidelines for Early Detection and Intervention Programs from the AAP Joint Committee on infant hearing.

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