1. What is the purpose of Universal Newborn Hearing Screening?
2. Why screen all newborns? Why not just those identified as high risk by the Joint Committee on Infant Hearing?
3. Is it mandatory for all infants born on Guam to receive a newborn hearing screening?
4. What is the incidence of hearing loss in newborns?
5. How young can a child’s hearing be effectively tested?
6. What is the difference between AABR and an OAE screening?
7. What are the referral rates for these tests?
8. If a child passes the newborn screening but has risk factors for hearing loss, when should they be tested again?
9. What does it mean if a baby needs to be re-screened?
10. What is a pediatric Diagnostic Audiological Evaluation (DAE)?
11. Why not wait until babies are older before children are tested for hearing loss?
12. How is hearing tested in older babies?
13. What if hearing loss is identified?
14. How can a parent connect with another family of a child with hearing loss?
15. How can the impact of hearing loss be minimized?
16. What can you, as a healthcare professional do?

What is the purpose of Universal Newborn Hearing Screening?

The purpose of newborn hearing screening is to identify children who are at greater risk for hearing loss so they may receive timely diagnostic and intervention services. Screening identifies a need for further diagnostic hearing evaluations.

Why screen all newborns? Why not just those identified as high risk by the Joint Committee on Infant Hearing?

The Joint Committee’s high risk criteria for possible late-onset hearing loss include but are not limited to: any illness or condition requiring admission to a NICU for 48 hours or more, a syndrome associated with congenital or progressive hearing loss, a family history of permanent childhood hearing loss, craniofacial anomalies, bacterial meningitis, severe hyperbilirubinemia, head trauma, recurrent otitis media, and parental concern.

However, 50% of children with congenital hearing loss do not meet any of these risk criteria and would not be identified if the high-risk register was used as the only criterion for screening newborns.

Is it mandatory for all infants born on Guam to receive a newborn hearing screening?

Yes, Public Law 27-150, also known as the “The Universal Newborn Hearing Screening and Intervention Act (UNHSIA) of 2004” mandates that each baby born on Guam receive a hearing screening prior to discharge from the birthing site.

What is the incidence of hearing loss in newborns?

Approximately 3 in 1000 babies are born with a hearing loss. One in 1000 babies is born deaf. Ninety percent (90%) of children with hearing loss are born to hearing parents. The earlier the hearing loss is identified, the sooner medical treatment and critical intervention may begin. If the child has no other disabling condition and intervention begins by age 6 months old, research has shown that the child’s speech and language abilities and later learning will be improved.

How young can a child’s hearing be effectively tested?

Hearing can be assessed at any age, even as young as 12 hours old. There are two major ways hearing in infants can be tested; Automated Auditory Brainstem Response (AABR) and Otoacoustic Emissions (OAE) screenings are an effective and efficient means for determining whether an infant may have a hearing loss.

What is the difference between AABR and an OAE screening?

The major difference is in how the tests are conducted. The AABR screener is conducted by placing electrodes on the child’s forehead and mastoid areas. Earcups are used to deliver sound to the child’s ear, either in the form of a click or pure tone stimulus. The AABR measures the neural response from the cochlea to the brainstem. It is a measure of neural synchrony along the auditory pathway.

The OAE screener is performed by placing a small ear probe into the child’s ear. Sounds are then introduced into the ear. “Echo” responses, or emissions, are measured. OAEs are acoustic signals generated by the cochlea, specifically, outer hair cells, in response to auditory stimulation. In response to click stimuli, OAEs provide information over a broad frequency range (~500 to 6000 Hz).

What are the referral rates for these tests?

Guam’s referral rate is currently around 7%. Referral rates have decreased significantly in the last few years due to advancements in equipment and technology, and continued training of hearing screeners.

If a child passes the newborn screening but has risk factors for hearing loss, when should they be tested again?

Children with any risk factors for hearing loss should be reevaluated at 6 months of age and annually thereafter, at least until the age of 3. If speech-language milestones are delayed, or if a child has more than four episodes of otitis media in one year, the child should have their hearing re-evaluated annually. Additionally, whenever the child’s parent is concerned about the child’s hearing, reevaluation is recommended.

What does it mean if a baby needs to be re-screened?

It is important for parents to understand that referral for a second screening does not necessarily mean that their baby has a hearing loss. Information about hearing screening must be provided to parents in a professional, thoughtful, and sensitive manner. Parental stress should be minimized while conveying the importance of appropriate and prompt follow-up, as well as early intervention, if it is deemed necessary.

What is a pediatric Diagnostic Audiological Evaluation (DAE)?

The DAE is an evaluation that utilizes assessment tools to determine if there is a hearing loss present, and the type and degree of the hearing loss. It typically includes a diagnostic ABR that would determine the child’s hearing thresholds, a repeat OAE, and a tympanogram. Pure tone stimuli are used in order to determine hearing thresholds at specific frequencies.

Why not wait until babies are older before children are tested for hearing loss?

The critical period for the acquisition of speech and language is from birth to 3 years, making early identification crucial. Children with hearing loss, even those with mild to moderate losses, who are identified later in life, may have social-emotional difficulties as well as language and educational delays. These delays may continue throughout the child’s academic years. Parent-child relationships are compromised when there is an unrecognized difference in hearing status between parent and child. The earlier a hearing loss is identified and intervention begins, the more natural parent-child communication may become. This enhances parent-child bonding and the child’s social-emotional, cognitive, and language development.

How is hearing tested in older babies?

As children grow, the testing techniques also change. AABRs and OAEs are commonly used until a child is old enough to provide behavioral responses to sound, usually around 7-8 months of age. By this age, behavioral tests such as Visual Reinforcement Audiometry (VRA) can be used as an additional audiological assessment tool.

What if hearing loss is identified?

The goal of universal newborn hearing screening is to identify children with hearing loss early, in order to initiate intervention services by 6 months of age. Intervention services include properly fitted amplification, family-focused communication strategies, early childhood services, and parental support groups.

How can a parent connect with another family of a child with hearing loss?

If a parent would like to connect with another family of a child with hearing loss, they can call the Guam Early Hearing Detection and Intervention (Guam EHDI) office at 735-2466, or visit the Family Support Group section of the Guam EHDI website. They can also ask their Service Coordinator or Service Provider from the Guam Early Intervention System (GEIS) at 735-2414 to connect them with other parents of a child with hearing loss.

How can the impact of hearing loss be minimized?

Studies have shown that the earlier the hearing loss is identified and intervention services begin, the greater the chance for the child to reach his/her potential and success in life.

What can you, as a healthcare professional do?

Parents rely on and respect your judgment. Your encouragement and recommendations to families regarding follow-up for newborns that need to be re-screened are vital.

Additionally, you are the professional best able to monitor the child’s speech and language development, and are entrusted to refer the child for a hearing evaluation or refer to GEIS when you or the parents have concerns.

If you have any questions or would like more information on newborn hearing screening, please call the Guam EHDI Project at 735-2466 or send an e-mail to nenihearing@guamcedders.org. You may also visit the website at www.guamehdi.org.