Newborn hearing screening is one part of early hearing detection and intervention, or EHDI programs. Without newborn hearing screening, it is difficult to detect hearing loss in infants and young children. Prior to the implementation of newborn hearing screening, on average, children with hearing loss were not identified until approximately two years of age or later. Universal newborn hearing screening is the standard of care in the United States and many other countries. It's purpose is to identify infants who may have hearing loss and require further evaluation. The Joint Committee on Infant Hearing was formed in the United States, and it's comprised of experts in the areas of audiology, speech language pathology, pediatrics, and many other professions. These individuals are tasked with recommending research-based preferred practices for the EHDI system, or newborn hearing screening, early diagnosis, fitting of amplification when selected, and intervention services for children with or at risk for hearing loss. Joint Committee on Infant Hearing currently recommends that; number one, all infants receive a hearing screen by one month of age. Number two, those who do not pass the hearing screen receive appropriate audio logic and medical services to confirm presence of hearing loss by three months of age. Number three, those with confirmed hearing loss have access to appropriate early intervention services as soon as possible following confirmation, and within the first six months of life. Fitting of amplification if selected by the family is recommended within one month of conformation of hearing loss. Research has shown that meeting these recommended timelines results in improved expressive and receptive language skills in children with hearing loss, more similar to those of their typically hearing peers. Over 97% of infants in the United States receive a newborn hearing screen. Newborn hearing screening are typically performed in the hospital prior to discharge, and can be performed by nurses, volunteers, technicians, or audiologists. They also may be performed outside the hospital setting by midwives, staff at pediatricians offices, or other professionals who receive appropriate training. If an infant does not receive a newborn hearing screen and live in a region where they are available, they should reach out to their pediatrician for recommendations on where to have one completed. Newborn hearing screening must be completed for both ears to ensure hearing loss in one ear is not missed. Information for how to complete newborn hearing screening and other considerations for providing these services are provided more in depth through the National Center of Hearing Assessment and Management at Utah State University's interactive web-based newborn hearing screening training curriculum, which is referenced at the end of this module. So, how can you tell if a newborn baby can hear? There are two types of newborn hearing screens. Otoacoustic emissions, or ODEs, and auditory brainstem response, or ABR. Both are safe, non-invasive, and used regularly in screening programs. Both can be completed relatively quickly, usually between five and 10 minutes, and families can be given the results immediately. Each screening method has its own benefits and limitations. Both are affected by patient movement and noise, and are best completed when the infant is asleep. A screening program may use either screening method both together or a tiered approach where an ABR screen is completed only after a refer on an OAE screen. Let's learn more about these hearing screening options. OAE screens evaluate the cochleas or hearing portion of the inner ear's response to sound. A small probe similar to an earbud is placed snugly in the infant's ear, and measures the ear's response to a sound emitted from the probe. The machine measures the response and produces a pass or refer result. Benefits of this screen are that it is affordable, fast, and detects high frequency hearing loss well. Limitations are that it will not detect ANSD, or hearing disorder occurring in the hearing nerve, or connection between the inner ear and hearing nerve. It also may miss milder hearing loss and those with rising or atypical configurations. ABR screens evaluate the hearing nerves response to sound. Soft sound is presented through earphones placed on or in the baby's ear. Activity in the hearing nerve is measured by three electrodes placed on the infant's head. The machine measures this activity and produces a pass or refer result. Benefits of this screen are that it detects ANSD and is more likely to identify milder hearing losses. Limitations are that it may miss sloping or rising hearing losses and may take slightly longer to perform compared to an OAE screen. Due to its sensitivity for detecting ANSD, this method is recommended for screening babies in an AQ as ANSD is more likely to occur in this group.
