Universal Newborn Hearing Screening Program Research Articles

Why parents refuse newborn hearing screening and default on follow-up rescreening—A South African perspective

ObjectivesThis study describes screen refusal and follow-up default characteristics together with caregiver reasons for screen refusal and follow-up default in two South African universal newborn hearing screening programs. MethodsA retrospective record review of universal newborn hearing screening conducted at two hospitals (Hospital A n=954 infants; Hospital B n=2135) over a 31–33 month period. Otoacoustic emission screening was conducted with rescreen recommended within six weeks for a uni- or bilateral refer. Program efficacy was described according to coverage, referral and follow-up rates. A prospective telephonic interview with caregivers who declined the initial screen (n=25) and who defaulted on follow-up (n=25) constituted the next study component. Caregivers were randomly selected from the screening programs for a survey related to reasons for newborn hearing screening refusal and follow-up default. ResultsScreening coverage (89.3% Hospital A; 57.4% Hospital B), initial referral rates (11.6% Hospital A; 21.2% Hospital B) and follow-up return rates (56.1% Hospital A; 35.8% Hospital B) differed significantly between hospitals and were below benchmarks. The most frequent reasons for screen refusal were related to costs (72%), caregiver knowledge of newborn hearing screening (64%) and health care professional knowledge and team collaboration (16%). Almost all caregivers (96%) indicated that if costs had been included in the birthing package or covered by medical insurance they would have agreed to newborn hearing screening. Reasons for follow-up default were most commonly related to caregiver knowledge of newborn hearing screening (32%) and costs (28%). One in four caregivers (24%) defaulted on follow-up because they forgot to bring their infant for a rescreen. Only half of caregivers (48%) who defaulted on follow-up reported being aware of initial screen results while 60% reported being aware of the recommended follow-up rescreen. ConclusionCaregivers most commonly refused screening due to associated costs and mostly defaulted on follow-up due to an apparent lack of knowledge regarding initial screen outcome and recommendations made for follow-up. Including NHS as a mandated birthing service is essential if coverage is to be increased, while reducing follow-up defaults requires proactive reminders and improved communication with caregivers.

Mild Bilateral and Unilateral Hearing Loss in Childhood

There is some evidence that the presence of even mild degrees of hearing loss and unilateral loss in early childhood can negatively affect typical development. Consequently, the identification of all children with permanent hearing loss including those with milder degrees of hearing loss is currently targeted through some newborn hearing screening initiatives. The objectives of this study were to document the proportion of children identified with mild bilateral or unilateral hearing loss (MBUHL) before and after the implementation of a universal newborn hearing screening program (UNHS). A second objective was to examine the clinical characteristics and audiologic management of this population of children. This population-based study involved an analysis of data on children with hearing loss; these data had been collected prospectively over a 20-year period from 1990 to 2010 in a publicly funded pediatric teaching hospital in Canada, which provided diagnostic audiology services for all children in the region. The proportion of all children with hearing loss identified with MBUHL before and after implementation of UNHS and their clinical profiles were documented. Data related to amplification use were also retrospectively extracted from detailed medical chart reviews to investigate clinical recommendations regarding amplification and subsequent use of hearing devices. Factors affecting amplification decisions and amplification use were examined. A total of 381 of 823 children (46.3%) aged 0 to 18 years who were identified with permanent nonacquired hearing loss presented with MBUHL. The proportions identified were similar in the pre- and post-UNHS periods (p = 0.207). Before UNHS children were identified at a median age of 5.0 years (interquartile range: 3.6 to 7.0) compared with a median of 0.8 years, (interquartile range: 0.3 to 2.3) post-UNHS. Progression of hearing loss was documented for 22% of all children, and for the group identified since UNHS, 32.4% experienced deterioration in hearing thresholds. Although 87.2 % of children received recommendations for amplification, more than 50% experienced considerable delay from identification to amplification. Age at identification and severity of hearing loss in the better ear were associated with amplification decisions for bilateral but not unilateral loss. MBUHL constitutes almost half of childhood hearing loss. UNHS has lowered age of confirmation of MBUHL by 4 to 5 years. Delay to amplification suggests uncertainty of the benefit of intervening early for these losses. Further research is required to determine the effects of early-identified MBUHL on children's development and to document the benefits of early amplification.

Auditory screening in infants for early detection of permanent hearing loss in northern iran.

Background:Undiagnosed hearing loss can cause disorders in speech and language and delay in social and emotional development.Aim:This study aimed to screen for hearing loss in all newborns born in Babol city during 2009-2011.Subjects and Methods:Fifteen thousand one hundred and sixty-five newborns (49% [7430/15165] male and 51% [7735/15165] female) born during a 30-month period in Babol, underwent hearing screening by the otoacoustic emission (OAE) test at the age of 15 days. In infants referred at this stage, an auditory brainstem response (ABR) test was the next investigation. Data analyzed using Statistical Package for the Social Sciences software Version 16 (Chicago, IL, USA, 16) through descriptive statistic method.Results:In the first screening stage, 10.8% (1648/15165) cases were referred to the second stage for further investigation. 9.4% (154/1648) were lost to follow-up from among the referred cases despite continuous contact and education about the importance of the problem. Among the participants in the second stage, 6.2% (92/1494) were referred to the third stage and underwent ABR and OAE testing. 14.1% (13/92) were lost at this stage. Of the remaining participants, 34.2% (27/79) were diagnosed with a hearing loss. Therefore, the incidence of hearing loss in this study was 1.8/1,000 newborns.Conclusion:Given the prevalence of hearing loss in this study, implementation of a universal newborn hearing screening program is recommended.

A questionnaire-based study on parental satisfaction with a universal newborn hearing screening program in Kuala Lumpur, Malaysia

ObjectivesThe present study aimed to determine levels of parents’ satisfaction associated with the universal newborn hearing screening process in a university hospital setting in Kuala Lumpur, Malaysia. MethodsParents whose babies had undergone a hearing screening test at the Pusat Perubatan Universiti Kebangsaan (Universiti Kebangsaan Malaysia Medical Center), Kuala Lumpur, Malaysia, participated in this study. In this study, the original English version of the Parent Satisfaction Questionnaire with Neonatal Hearing Screening Program (PSQ-NHSP) was translated and adapted into Malay language. Thus, this self-administered Malay version of PSQ-NHSP was used to measure parents’ satisfaction on information of newborn hearing screening program, personnel in charge of the hearing testing, hearing screening activities, and overall satisfaction. ResultsOf the 200 questionnaires distributed, 119 parents (59.5%) responded. Overall, more than 80% of parents were satisfied with the program. The highest percentage of satisfaction (95.6%) was related to the contents of an information leaflet. However, parents were not satisfied with items measuring communication aspect of personnel in charge of the hearing screening. In specific, 38.1% of parents were not satisfied with the explanations and information provided by the screeners on the test procedures, while 26.1% of parents found that the information they received on the test results was insufficient. ConclusionsThe findings of the present study revealed that parents were generally satisfied with the UNHS program. However, further intervention is required to improve the communication aspects of the personnel in charge of the hearing testing. Results suggest that the questionnaire is easily employed and effective tool for assessing parental satisfaction with newborn hearing screening programs. Additionally, this study has demonstrated the survey tool to be useful in identifying areas that need changes or improvements.

The effectiveness of the promotion of newborn hearing screening in Taiwan

ObjectiveHearing is a critical ability for the development of a child's speech and language. Many studies in different countries have shown the universal newborn hearing screening and early intervention has greatly reduced the negative impact caused by congenital hearing loss. The first universal newborn hearing screening program in Taiwan took place in MacKay Memorial Hospital in 1998 and was subsequently endorsed by the government. The incidence of bilateral congenital hearing impairment in Taiwan is approximately 2.6 per 1000 live birth. The aim of this paper is to analyze the age of diagnosis, hearing aid fitting, and intervention of congenitally hearing impaired children with and without hearing screening after public awareness and government endorsement of newborn hearing screening. Materials and methodsThere were 263 hearing impaired children participated in this study, receiving their auditory habilitation therapy at Children's Hearing Foundation from 2006 to 2010. 114 of those children went through newborn hearing screening and 149 without it. The age of diagnosis, hearing aid fitting, and auditory intervention were compared between these two groups. The age of diagnosis and intervention of congenitally hearing impaired children among different years were analyzed too. ResultsThe average age of diagnosis was 8.7 months, the age of hearing aid fitting was 12.4 months and age of auditory intervention was 18.8 months for the group of hearing impaired children with newborn hearing screening. For hearing impaired children without newborn screening, their average age of diagnosis was 27.5 months; age of hearing aid fitting was 31.3 months and age of auditory intervention was 40.5 months. There were significant differences in the age of diagnosis, hearing aid fitting and auditory intervention between congenitally hearing impaired children with and without hearing screening. ConclusionsThis research indicates that newborn hearing screening facilitates early identification, diagnosis and intervention of congenitally hearing impaired children in Taiwan. The age of identification, diagnosis and intervention of congenital hearing impaired children has also been reduced gradually over the years after government endorsement of newborn hearing screening in Taiwan.

Principles and Guidelines for Early Intervention After Confirmation That a Child Is Deaf or Hard of Hearing

This document is a supplement to the year 2007 position statement of the Joint Committee on Infant Hearing and provides comprehensive guidelines for establishing strong early intervention (EI) systems with appropriate expertise to meet the needs of children who are deaf or hard of hearing (D/HH). Optimal outcomes can only be achieved when there is high quality to the universal newborn hearing screening programs, the audiologic diagnostic process of confirmation that a child is D/HH and fitting of amplification, and the provision of appropriate, individualized, targeted, and high-quality EI services. There are 12 best practice guidelines for EI programs that include the provision of timely referral to EI services with providers who have knowledge and skills in early childhood deafness and hearing loss, infusion within the system of partnerships with parents as well as professionals who are D/HH, longitudinal developmental assessments for monitoring the child's development, data management systems that include developmental outcomes, a process to monitor the fidelity of the intervention, and appropriate services for children with additional disabilities, those from non-English speaking families, and those from special populations, including unilateral hearing loss and auditory neuropathy/dyssynchrony.

Responsive parenting intervention after identification of hearing loss by Universal Newborn Hearing Screening: The concept of the Muenster Parental Programme

BackgroundParents of newborns with hearing loss (HL) identified by Universal Newborn Hearing Screening (UNHS) programmes wish for educational support soon after confirmation and for contact with other affected families. Besides pedaudiological care, a high level of family involvement and an early start of educational intervention are the best predictors for successful oral language development in children with HL. The implementation of UNHS has made it necessary to adapt existing intervention concepts for families of children with HL to the needs of preverbal infants. In particular, responsiveness has proven to be a crucial skill of intuitive parental behaviour in early communication between parents and their child. Since infants with HL are being fitted earlier with hearing devices, their chances of learning oral language naturally in daily communication with family members have noticeably improved. ObjectivesThe Muenster Parental Programme (MPP) aims at empowering parents in communicating with their preverbal child with HL and in (re-)building confidence in their own parental resources. Additionally, it supplies specific information about auditory and language development and enables exchange with other affected parents shortly after the diagnosis. ConceptThe MPP is a responsive parenting intervention specific to the needs of parents of infants with HL identified by UNHS or through other indices and testing within the first 18 months of life. It is based on the communication-oriented Natural Auditory Oral Approach and trains parental responsiveness to preverbal (3–18 months) infants with HL. The MPP has been developed for groups of 4–6 families and comprises six group sessions (without infants), two single training sessions with video feedback, and two individual counselling sessions. At the age of 24–30 months, an individual refresher training session is offered to the parents for adapting their responsiveness to the current verbal level of the child via dialogic book reading. The programme also benefits parents of paediatric cochlear implant (CI) candidates preimplantation and postimplantation. ConclusionsThe MPP is evidence-based (see Glanemann et al., this volume) and meets the current need for effective family-centred educational intervention after UNHS.

Coverage and screening protocols in UNHS programmes in Italy in 2011: A nationwide survey

Objective: The aim of this study was to provide data on the degree of implementation, coverage and protocols used in Universal Newborn Hearing Screening Programmes (UNHSPs) in Italian birthing hospitals. Methods: Data were collected through a questionnaire that was sent to all birthing hospitals in Italy in 2011. Questionnaires were filled in by the chief of the hospital or by the UNHSPs coordinator. Results: UNHSPs in Italy were activated in 411 (81.3%) birthing hospitals, with 78.3% (413,212) newborns screened in total. Most (91.8%) of the Italian birthing hospitals used a two-stage (test-retest) TEOAE screening. The personnel performing the screening were nurses in 72.4% of hospitals, paediatricians in 10.2%, technicians in 11.0%, audiologists in 2.2% and external staff in 4.2%. In 80.1% of birthing hospitals, the mean referral rate at first screening performed before discharge was below 5%. Conclusion: The present study revealed that in the last three years screening coverage had a rapid growth from 60.6% in 2008 to 78.3% in 2011, without reaching UNHS coverage greater than 95%, as recommended in international guidelines. Our results suggest that close cooperation between audiological centres and maternity units, together with an efficient protocol for collecting screening data, has a positive impact on the implementation of UNHSPs. It is also crucial to improve the training of screening personnel and provide information and education about newborn hearing screening to paediatricians, neonatologists, gynaecologists, and general practitioners.

The universal newborn hearing screening program of Taipei City

ObjectivesTo establish a hearing screening program with high coverage, low referral rate, high follow-up rate, and early intervention in Taipei City. MethodsFrom September 2009 to December 2010, 85% delivery units in Taipei City, which includes 20 hospitals and 14 obstetrics clinics, were recruited into the screening program in two stages. A total of 15,930 babies were born in these participating hospitals and clinics during the program period. Among these neonates, 15,790 underwent hearing screening test with automatic auditory brainstem response (AABR). The screening was free of charge to the parents. The hearing screening examination was performed 24–36h after birth. The same test was repeated between 36 and 60h of age if the baby failed the first hearing test. The neonate was referred to the diagnostic hospitals for further investigations if he failed the second test. ResultsThe screening coverage rate was 99.1% (15,790/15,930). The incidence of bilateral moderate to severe and unilateral hearing loss was 1.4 per 1000 (22/15,790) and 1.5 per 1000 (24/15,790), respectively. Four percent (626/15,790) of newborns failed to pass the initial screening test and 1.0% of newborns failed to pass the second screening test. Therefore, 1.0% newborns were referred for diagnostic assessments. The follow-up rate was 94.4% (151/160). Sixty-four percent (14/22) of babies with bilateral hearing loss completed the full diagnostic hearing tests within 3 months of birth. ConclusionsThe universal newborn hearing screening program is an adequate program for Taipei City with high coverage, low referral rate, and good follow-up rate. Screening fees covered by third parties, two-stage screening steps with AABR strategy, and the stringent monitoring system proved to be effective. Level of evidence2b, individual cohort study

Programa de screening auditivo neonatal universal: Experiencia de más de 10 años

Introduction: Efficient universal newborn hearing screening program (UNHSP) Implementation allows the inquest improvement of newborns with congenital hearing loss (CHL), facilitating an early intervention. Aim: To describe the results of the UNHSP carried out by the Department of Otorhinolaryngology of Clinica Las Condes.

Universal newborn hearing screening in Zefat, Israel: The first two years

ObjectiveUnidentified hearing loss at birth can adversely affect speech and language development as well as academic achievement and social-emotional development. Historically, moderate-to-severe hearing loss in young children was not detected until well beyond the newborn period. Around 0.5 to 5 in every 1000 neonates and infants have congenital or early childhood onset sensorineural hearing impairment. When identification and intervention occur at no later than 6 months of age, the infants perform much higher on school-related measures. Therefore, early detection is vitally important. Toward the end of 2009, the Israeli ministry of health issued a directive establishing a universal newborn hearing screening program in all hospitals in the country from 01.01.10. The objectives of this study are to evaluate a newly established universal newborn hearing screening program, to assess performance and to compare measurements of performance to performance benchmarks representing a consensus of expert opinion. The benchmarks are the minimal requirements that should be attained by high-quality early hearing detection programs. MethodsAs specified by the ministry of health, a two-stage screening protocol was implemented using otoacoustic emissions and automated auditory brainstem response. Screening results of all neonates born from the initiation of the program on 15th March 2010 until the end of 2011 were reviewed. ResultsThe total number of live births during the study period was 5496. Of these, 5334 (97%) started screening for hearing loss but only 5212 completed the screening process, giving a screening coverage of 94.8%. Of the 5212 neonates completing the screening process, 270 (5.18%) were referred for full diagnostic testing. ConclusionsThe newly established universal newborn hearing screening program at the Ziv Medical Center in Zefat closely approaches, but does not yet meet the minimal requirements that should be attained by high-quality early hearing detection programs. Every effort should be made to complete the screening tests before discharge from hospital. Screening staff should actively encourage parents to participate in all stages of early detection.

Monitoramento de crianças com indicadores de risco para a deficiência auditiva

OBJETIVO: descrever uma proposta de monitoramento de crianças, no primeiro ano de vida, que não foram identificadas na triagem auditiva neonatal, mas apresentavam indicadores de risco para deficiência auditiva. MÉTODO: participaram do estudo 258 crianças de risco que haviam obtido o resultado "passa" no Programa de Triagem Auditiva Neonatal Universal da Maternidade Santa Isabel - Bauru/SP no período de junho a novembro de 2008. Foi aplicado, via telefone, um questionário de acompanhamento do desenvolvimento da audição e da linguagem, validado em estudo anterior, contendo questões sobre a audição e a linguagem. Para cada questão havia duas possibilidades de resposta "sim" ou "não" e considerou-se como "falha", a obtenção de pelo menos uma resposta "não". Tal resultado refletia no agendamento da criança para realização de uma avaliação audiológica imediata. RESULTADOS: o questionário foi aplicado com 169 famílias, com as demais não foi obtido contato. Deste total, 164 (97,04%) apresentaram resultado "passa" e cinco (2,96%) resultado "falha". Dentre as cinco crianças, apenas três compareceram para avaliação audiológica e destas, uma não apresentava alterações e duas apresentavam perda auditiva condutiva. Observou-se prevalências distintas entre os fatores de risco e não houve relação (p>0,05) dos mesmos com a evasão no processo de monitoramento. CONCLUSÃO: o monitoramento por meio de aplicação de questionário via telefone mostrou-se viável, entretanto, é necessário o desenvolvimento de estratégias que favoreçam sua execução.

The role of maternal socioeconomic factors in the commitment to universal newborn hearing screening in the Northeastern region of Brazil

ObjectiveThe implementation of early hearing detection in developing countries remains elusive. The fragile health care system along with insufficient funding for health care services leads to inadequate universal newborn hearing screening programs. There is a high incidence of loss to follow-up, at different stages of the program, in these countries, compromising the effect of early hearing screening programs. Strategies must be developed to improve family commitment to such programs. The objective of the present study was to examine factors that predict loss to second-stage follow-up at a municipal based, universal newborn hearing screening program in the Northeastern region of Brazil. MethodThe current cross sectional study includes 577 newborns who underwent hearing screening and failed. The population was divided into two groups: those who returned and those who were lost to second-stage screening. Differences between groups were explored and adjusted odds ratios were derived. ResultsThere was a significantly increased risk of non-adherence to the universal newborn hearing screening program in mothers with low income, few prenatal care visits, minimal education and with a multiparous child. ConclusionSocioeconomic factors may have a significant influence on the effectiveness of hearing screening programs in poorer regions of Brazil and other low-income countries. Improvements in health care politics, tracking system and public awareness is crucial for successful program implementation.

Newborn hearing screening in youth health care in the Netherlands: National results of implementation and follow-up

Objective: The aim of this study is to investigate whether the quality of the Dutch, community based, universal newborn hearing screening programme is consistent over time. Design: Universal newborn hearing screening data from three cohorts are compared on a number of quality targets concerning the outcome of the screening and the process of the screening in a three stage, community based, hearing screening programme. Study sample: A total of 552 820 children entered the study (189 794 in 2002–2006; 181 574 in 2008, and 181 452 in 2009). Results: Participation in the programme is high from implementation onwards and increases over time for all screen stages to percentages above 99%. Refer rates are within quality targets and they are consistent over time. The screening is completed within 42 days of birth for 91.5% of the children in the last cohort. Of all children screened, 0.29% to 0.30% are referred to a speech and hearing centre. Participation in diagnostic testing is 93.3% to 95.2%. Of all referred children 77% to 85% receive a diagnosis within 122 days of birth. Conclusions: A good quality neonatal hearing screening programme in youth health care has been established in the Netherlands. However, both participation in diagnostic testing after a positive screen result and the timing of the diagnostic testing can still be improved.

Pneumococcal Serotype–specific Unresponsiveness in Vaccinated Child with Cochlear Implant

Pneumococcal Serotype–specific Unresponsiveness in Vaccinated Child with Cochlear Implant

The impact of early identification of permanent childhood hearing impairment on speech and language outcomes

It is well established that permanent childhood hearing impairment (PCHI) has a detrimental impact on speech and language development. The past two decades have seen the gradual introduction of universal...

Identifying Quality Improvement Opportunities in a Universal Newborn Hearing Screening Program

Hospital-based universal newborn hearing screening (UNHS) programs are encouraged to maintain quality assurance protocols, but many hospitals lack the time and resources to initiate this process. We studied a practical approach to measuring baseline quality indicators and identifying improvement opportunities in UNHS programs. We determined screening processes and quality indicators for UNHS programs at 4 hospitals through site visits and a 2-year retrospective review of nursery and audiology records. Nurses, audiologists, and otolaryngologists met for feedback of hospital-specific quality indicators. The sessions identified improvement opportunities and proposed system changes for immediate implementation. Hospitals screened 21 957 newborns for hearing loss. Screening rates were >99% at all hospitals. Rates of referral and diagnostic testing varied significantly between hospitals. Low referral rates prompted 2 hospitals to adjust screening processes to reduce potential false-negative screening results. Two other hospitals addressed poor diagnostic follow-up by changing the referral process to include additional family contact information. Hospitals also increased referrals to Early Intervention Child Find services on the basis of our finding that these referrals increased the likelihood of diagnostic follow-up fourfold. We could not fully assess indicators of hearing aid eligibility and enrollment in early intervention services due to insufficient documentation. Review of nursery and audiology records successfully established most quality indicators for the UNHS programs we studied. Feedback of quality indicators identified multiple improvement opportunities and facilitated endorsement of immediate system changes. This study demonstrates a practical and data-driven approach to quality improvement that can be used by any UNHS program.

Quality Improvement in Universal Newborn Hearing Screening

Objective: Hospital-based universal newborn hearing screening (UNHS) programs are encouraged to maintain quality improvement protocols, but many hospitals lack the time and resources to initiate this process. A practical approach to measuring baseline quality indicators and identifying improvement opportunities in UNHS programs was studied. Method: Screening processes and quality indicators for UNHS programs at 4 hospitals were determined through site visits and a 2-year retrospective review of nursery and audiology records. Nurses, audiologists, and otolaryngologists met for feedback of hospital-specific quality indicators. Improvement opportunities were discussed, and system changes were proposed for immediate implementation. Results: Hospitals screened 21,957 newborns for hearing loss. Rates of screening were greater than 95% at all hospitals. Rates of referral and diagnostic testing varied significantly between hospitals. Low referral rates prompted 2 hospitals to adjust inpatient screening processes to reduce potential false-negative screening results. Two other hospitals addressed poor diagnostic follow-up by changing the referral process to include additional family contact information. Hospitals also recognized that referral to Early Intervention Child-Find services increased the likelihood of diagnostic follow-up four-fold ( P = .03). Documentation of hearing aid eligibility and enrollment in Early Intervention services was insufficient for retrospective determination of these quality indicators. Conclusion: Review of nursery and audiology records successfully established most quality indicators for the UNHS programs studied. Feedback of quality indicators identified multiple improvement opportunities and led to immediate system changes. This study demonstrates a practical and data-driven approach to quality improvement that can be used by any UNHS program.

Midwives' knowledge, attitudes, and practices related to newborn hearing screening.

Hearing loss is the most common congenital condition screened for at birth in the United States, and more than 95% of newborns are currently screened for hearing. Newborn hearing screening is most effective when infants receive timely and effective interventions. Unfortunately, follow-up rates for newborns not passing their initial hearing screenings are as low as 50% in some states. Midwives are well-positioned to encourage families to follow-up with their neonatal providers when newborns are referred for further testing. Newborn hearing screening is a relatively new practice in the United States and, to date, there has been no research regarding the informational needs and practices of certified nurse-midwives or certified midwives related to hearing screening. This study examined the knowledge, attitudes, and follow-up practices of midwives related to newborn hearing screening and intervention. A survey instrument was developed and sent to 5255 American College of Nurse-Midwives members in 50 states and 2 territories. Five hundred and eighteen surveys were returned, yielding a response rate of 9.9%. Only 68% of respondents said it was very important to screen all newborns for hearing loss. Respondents reported significant gaps in their knowledge about screening procedures, steps for referral, and the availability of resources when newborns did not pass the test. Midwives also reported the need for information about hearing loss conditions and genetics, screening guidelines, protocols for follow-up, referral networks, and therapies available. Current practices in newborn hearing screening and intervention programs can be enhanced by strengthening the basic midwifery knowledge of and rationale for follow-up when newborns fail their hearing screenings. Midwives can play an integral role in optimizing hearing, speech, and family interaction by assuring that each newborn has access to the best hearing screening and referrals.

Cribado auditivo neonatal con potenciales evocados auditivos de estado estable a múltiples frecuencias

Introduction The techniques most frequently used within a screening context (otoacoustic emissions and click auditory brainstem response) have well-known limitations in hearing loss detection. Objective This study examines the feasibility of a semi-automated multiple auditory steady-state responses (MSSR) system designed for neonatal hearing screening. Methods A sample of 50 newborns without risk factors (well-babies) was tested within two weeks of birth. All had detectable auditory brainstem responses to clicks down to 40 dB nHL in both ears. Two amplitude modulated carrier tones of 500 and 2,000 Hz were mixed together and presented simultaneously. Each infant (and ear) was screened with the MSSR system; to simulate a hearing loss, a recording without stimulation was also obtained. Results Mean auditory thresholds were 42.5 ± 7 dB HL at 500 Hz and 35.5 ± 6 dB HL at 2,000 Hz. The average duration of the MSSR recording was 2.6 ± 1.6 minutes for each tested ear and the overall duration of the screening procedure (including electrode fitting and infant preparation) was 17.8 ± 3.7 minutes. The diagnostic sensibility and the positive predictive values of the MSSR semi-automatic screening system was 100% and 96% respectively, with specificity of 96% and negative predictive values of 100%. Conclusions Although the diagnostic efficiency of the semi-automated MSSR system was found adequate, further technological improvements are still necessary to facilitate its use in the context of universal newborn hearing screening program.