Hearing Loss Screenings Mandatory for Infants

Could your children suffer if you pass up a hearing screen after they are born? According to a new recommendation from the U.S. Preventive Services Task Force, all newborn infants should be screened for congenital hearing loss that is presented at birth. This recommendation as well as the accompanying summary of evidence can be found in the July 7th issue of Pediatrics.

Children who are hearing impaired at birth, during infancy, or during early childhood can have problems with nonverbal and verbal communication and social skills, lower academic achievement, and increased problems with behavior compared with children that do not suffer from hearing problems. Newborns that are at a higher risk for hearing loss problems, include those who are diagnosed with certain syndromes (such as Usher or Waardenburg), those infants who have spend more than 2 days in a neonatal intensive care unit, and the infants that have a family history of childhood hearing impairments. Unfortunately, approximately half of the infants with hearing loss will have no identifiable risk factors. This is why the Task Force is proposing a universal screening at birth, rather than targeted screening. This will improve the effort to detect and treat the infants for hearing loss rather than finding it at a later age. This will also provide a better chance for positive outcomes such as stronger language skills.

For every 1,000 newborns in the United States, congenital hearing loss occurs in approximately one in three infants. This type of hearing loss happens much more frequently than other conditions typically screened before the infants are one month old. The infants that do not pass the screening should receive further medical and hearing evaluation before they reach 3 months old. Thirty-nine states in the U.S. have enacted legislation related to universal hearing screenings for newborns. However, each states laws differ on whether the screening is to be mandated or encouraged and how the results are reported and how the screenings are funded.

The Task Force is also recommending screening using a method that has two steps. The first step would include testing otoacoustic emissions, which is followed by auditory brainstem response to the infants that fail the first test. The first type of test Otoacoustic emissions will check the inner ear response to sounds and are measured by placing a very sensitive microphone in the ear canal so it can measure the ear's response. The next type of test, which is auditory brainstem response, will check the brain's response to sound at it is measured by placing electrodes on the infant's head to record the brain's response to sound. The evidence shows that these newborn hearing screenings are highly accurate and leads to the early identification and treatment of infants that suffer from hearing loss. The evidence also has found that demonstrating that early detection and treatment will improve the outcome of language.

The Task Force is the leading independent panel of experts in primary and prevention care. They are supported by the AHRQ and conduct rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services that include counseling for patients with hearing loss, screening to detect hearing loss factors, and preventative medications. The Task Force's recommendations are considered to be of the gold standard for clinical and preventive services. The Task force based its conclusions on a report from a research team that was led by an M.D. at AHRQ'S Evidence-based Practice Center at the Oregon Health & Science University in Portland named Heidi Nelson.

You can look further into these recommendations and materials for clinicians by going to the AHRQ website at http://www.ahrq.gov/clinic/uspstf/uspsnbhr.htm.