Universal Newborn Hearing Screening

Approximately 3 out of every 1,000 infants are born with significant hearing loss, making it the most common birth defect.  Technology is currently available to conduct cost-efficient, physiological screening on a universal basis prior to hospital discharge.  There is clear evidence that the implementation of universal newborn hearing screening substantially lowers the age at which children with congenital permanent hearing loss are identified.  Children who are identified early and receive intensive early intervention perform as much as 20-40 percentile points higher than children who do not receive such intervention on school related measures (reading, arithmetic, vocabulary, articulation, and percent of the child's communication understood by non-family members, social adjustment and behavior).

In 1993, less than 5 percent of all infants were screened for hearing loss prior to hospital discharge.  Today, more than 90 percent of newborns are screened before hospital discharge.  Universal newborn hearing screening prior to hospital discharge is now the standard of care in the United States.  Typically, 1-3 percent of those screened require referral for diagnostic evaluation.

The provision of timely and appropriate follow-up services for those infants needing further evaluation continues to be a problem in some parts of the country.  Loss to follow-up rates range from less than 10 percent in States with a well developed infrastructure, to as high as 50 percent in states that do not yet have the infrastructure to track and retrieve infants and families needing further services.  States with infrastructure tend to be those with a mandate to screen and report.  Forty States have legislative support for the hearing screening program.  Several additional States are continuing to work with their State legislatures. 

Background:  Every day 33 infants are born in the U.S. with significant hearing loss.  Research shows that infants who are enrolled in an intervention program by 6 months of age enjoy a significant social and academic advantage over their non-hearing peers who are not in a program by 6 months.  In 2000 the first state Universal Newborn Hearing Screening grants were awarded.  This award was the culmination of a concerted effort to promote the implementation of newborn hearing screening programs using physiologic testing prior to hospital discharge.  The program enjoys strong support from professional organizations, including the American Academy of Pediatrics. 

Currently:  There are 53 grants to states and territories supporting statewide systems of newborn hearing screening, audiologic diagnostic testing before 3 months of age and enrollment in early intervention programs before the age of 6 months, with ties to a medical home and family-to-family support services.  Some of the programs are supported by state law, others are not.  A cooperative agreement was awarded for the purpose of providing nationwide technical assistance and consultation to projects in all of the programmatic areas. The national technical support center is the National Center for Hearing Assessment and Management (NCHAM) at Utah State University. One major feature of NCHAM is an extensive website, at www.infanthearing.org.  This site is also linked to many additional sites with information on newborn hearing screening and intervention.

Looking Forward:  Current focus is on continuing to reduce the loss to follow-up rates by sharing lessons learned in those States that have resolved many of the difficulties.