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Role of Birthing Facility in the Newborn Hearing Screening Process

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Per the Nebraska Infant Hearing Act, hospitals and birth centers perform hearing screenings on newborns before discharge.  If a newborn does not pass the hearing screening, one follow-up screening is performed before discharge, and an additional screening can be done as an outpatient. 

By Nebraska state law, the hospital or birth center is responsible for performing an inpatient hearing screening on all newborns, and a follow-up screening on newborns that do not pass the initial hearing screening. A repeat hearing screening should be done no later than one month of age.

Best Practices

All hospitals should be aware of the recommended protocols for Newborn Hearing Screening, and incorporate these best practices into their hearing screening program.  

Guidelines for conducting hearing screenings in neonatal (well-baby) nursery or birth center: 

  • Test the newborn no sooner than 12 hours after birth.
  • Choose a time when the infant is not being seen by other health care professionals.
  • Test when infants are quiet or sleeping; optimally, one hour following feeding.
  • To help calm a restless infant, swaddle the infant and dim the lights.
  • Select a time when the infant is medically stable.
  • Ensure a quiet environment for testing, away from background noise.
  • Following standard precautions for infection control (e.g. hand washing, appropriate cleanings of equipment, etc).

Where can hospitals staff get additional training?

Online training is offered for free on the National Center for Hearing Assessment and Management (NCHAM), Utah State University. 

What are the guidelines for conducting hearing screenings in the NICU?

Since the incidence of sensory, as well as neural childhood deafness is approximately ten times higher in the NICU vs. well-baby, A-ABR is the recommended screening technology for use in the NICU population.

  • The neonatologist and/or the Primary Health Care Physician should be consulted to determine the most appropriate opportunity for hearing screening. 
  • Babies should be screened just prior to discharge to assure the hearing screening occurs.
  • The A-ABR, however, should not be completed before the infant is 32 weeks gestational age because it tends to generate more referrals for diagnostic testing and therefore screening should be delayed until the baby has reached this age.
  • For those infants transferred between facilities, the facility discharging the baby home is responsible for completing the hearing screening, arranging any necessary follow-up, and reporting the details to the Nebraska Early Hearing Detection and Intervention Program.
  • Any NICU infant who refers on the initial A-ABR neonatal hearing screening should receive a referral to an audiologist for an audiologic evaluation that includes a diagnostic ABR (JCIH 2019).

If a newborn does not pass his/her hearing screening, is it acceptable to repeat the screening more than one time?

If a newborn does not pass the screening, it is acceptable to repeat the screening during the same session using the same technology one time, especially in cases when the screening conditions are not optimal either due to timing, noise conditions, or state of newborn.

  • Multiple screenings (greater than two times) during one session using the same technology are not recommended in order to avoid getting a false-positive result (i.e. not a true 'pass').
  • Screening results at individual frequencies should never be combined across screening sessions in order to obtain 'pass' results.
  • A maximum of two screening sessions are allowed inpatient.

If the baby fails in one ear, are both ears screened during the second test?

Yes, complete rescreening on both ears is recommended, even if only one ear failed the initial screening (JCIH 2019).

How should the birth facility inform parents of the newborn hearing screening results?

The person performing the hearing screening should give the parents the following information in clear, non-technical terms and in the native language of the family.

  • Provide results of the screening whether the newborn passed or did not pass the hearing screening, and explain what the results mean. 
  • The results should be conveyed verbally and in writing to the parents using a standard notification form prepared explicitly for this purpose.
  • Provide written notification to the parents if an infant needs a repeat hearing screening.  If the infant did not pass the initial screening the parents should understand the importance of obtaining a repeat hearing screening as soon as possible.  When screeners discuss results with families, they should be careful not to downplay a refer result.
  • Schedule the repeat hearing screening appointment with parents prior to discharge if an infant does not pass the initial screening.  If the infant is in the NICU and does not pass the ABR screening, refer the family to a pediatric audiologist for a diagnostic evaluation.
  • If the initial screening was not completed (the baby was missed or results were incomplete prior to discharge), it is the birth facility's responsibility to provide the initial hearing screening to the newborn after discharge and to make an appointment for this hearing screening before the newborn is discharged.
  • Provide all parents with information on milestones of normal auditory, speech, and language development in children.

The National Institute on Deafness and other Communication Disorders (NIDCD) provides a fact sheet on speech and language development. 

There are two parent brochures for birth facilities to use: one describes newborn hearing screening and the second brochure informs parents that their baby did not pass the newborn hearing screening and needs further testing. 

These are available free from the Nebraska Early Hearing Detection and Intervention Program in English, Spanish and 12 other languages. They are "Can Your Baby Hear: Your Baby's First Hearing Screening" and "Your Baby Needs Another Hearing Screening".

What information should be sent to the Nebraska Early Hearing Detection and Intervention Program (NE-EHDI) Program and when does it need to be sent?

The NE-EHDI Program needs the following inpatient screening information entered into the hearing module (HINFO/HSCREENING screens) of the Nebraska Vital Records System within 14 days of birth:

  1. The date of the most recent screening prior to discharge
  2. Results for each ear (pass, refer, not tested)
  3. Name of the primary health care provider (or name of health clinic) for a refer result or not tested situation 

Extended NICU Stays

  • If the outpatient screening is performed at the birth facility, then the data needs to be entered into the Nebraska Vital Records System for the outpatient screening.
  • A "Y" needs to be entered into the "parent educated" box on the HINFO-Patient screen if the parent is educated about the hearing screening results via a brochure or provided with the information through another means.
  • If the infant is in the NICU for more than five days, mark the "NICU" box on the HINFO-Patient screen in vital records as soon as possible. This will notify the NE-EHDI Program that the screening results will possibly be delayed. 
  • NICU infants are also at a greater risk of progressive or late-onset hearing loss, and this needs to be recorded in the system as a risk factor for that child. If the child has any risk factors for late-onset or progressive hearing loss, those risk factors need to be reported to NE-EHDI using the Risk Factor ​​Reporting Form.
  • A two-page guide is available for more details on entering the above data into the hearing information table which is part of the Nebraska Vital Records System. Email if you would like a copy of the data entry guide.

What is the responsibility of the birth facility to communicate newborn hearing screening results to the primary care providers?

The primary care provider is to be notified of the results of the newborn hearing screening. Results should also be reported to the NE-EHDI program within 14 days of birth.

What is the difference between ABR and OAE screening?

For a side-by-side comparison of ABR and OAE screening, read the ABR and OAE infographic.​