U.S. Preventive Services Task Force
Universal Screening for Hearing Loss in Newborns: Recommendation Statement
Am Fam Physician. 2010 Jan 15;81(2):185-186.
Summary of Recommendation
The U.S. Preventive Services Task Force (USPSTF) recommends screening for hearing loss in all newborn infants (Table 1). B recommendation.
Table 1. Universal Screening for Hearing Loss in Newborns: Clinical Summary of the USPSTF Recommendation
Universal Screening for Hearing Loss in Newborns: Clinical Summary of the USPSTF Recommendation
Screen for hearing loss in all newborn infants.
The prevalence of hearing loss in newborn infants with specific risk indicators is 10 to 20 times higher than in the general population of newborns.
Risk indicators associated with permanent bilateral congenital hearing loss include:
• Neonatal intensive care unit admission for two or more days
• Family history of hereditary childhood sensorineural hearing loss
• Craniofacial abnormalities
• Certain congenital syndromes and infections
Approximately 50 percent of newborns with permanent bilateral congenital hearing loss do not have any known risk indicators.
Screening programs should be conducted using a one- or two-step validated protocol.
A frequently used two-step screening process involves otoacoustic emissions followed by auditory brain stem response in newborns who do not pass the first test.
Infants with positive screening test results should receive appropriate audiologic evaluation and follow-up after discharge.
Procedures for screening and follow-up should be in place for newborns delivered at home, birthing centers, or hospitals without hearing screening facilities.
Timing of screening
All infants should be screened for hearing loss before one month of age.
Infants who do not pass the newborn screening should undergo audiologic and medical evaluation before three months of age.
Early intervention services for infants with hearing impairments should meet the individualized needs of the infant and family, including acquisition of communication competence, social skills, emotional well-being, and positive self-esteem.
Early intervention comprises evaluation for amplification or sensory devices, surgical and medical evaluation, and communication assessment and therapy.
Cochlear implants are usually considered for children with severe-to-profound hearing loss only after inadequate response to hearing aids.
Other relevant recommendations from the USPSTF
Additional USPSTF recommendations regarding screening tests for newborns can be accessed at http://www.ahrq.gov/clinic/cps3dix.htm#pediatric.
note: For the full USPSTF recommendation statement and supporting documents, visit http://www.preventiveservices.ahrq.gov.
USPSTF = U.S. Preventive Services Task Force.
Importance. Children with hearing loss have increased difficulties with verbal and nonverbal communication skills, increased behavioral problems, decreased psychosocial well-being, and lower educational attainment compared with children with normal hearing.
Detection. Because one half of children with hearing loss have no identifiable risk factors, universal screening (instead of targeted screening) has been proposed to detect children with permanent congenital hearing loss. There is good evidence that newborn hearing screening testing is highly accurate and leads to earlier identification and treatment of infants with hearing loss.
Benefits of detection and early treatment. Good-quality evidence shows that early detection improves language outcomes.
Harms of detection and early treatment. There is limited evidence about the harms of screening, with conflicting research findings regarding anxiety associated with false-positive test results. There is limited information about the harms of treatment. Complications of cochlear implant surgery include increased risk of meningitis; however, the overall risks of complications of screening and treatment are estimated to be small.
USPSTF assessment. The USPSTF concludes that there is moderate certainty that the net benefit of screening all newborn infants for hearing loss is moderate.
Patient population. This recommendation applies to all newborn infants.
Assessment of risk. Risk factors associated with a higher incidence of permanent bilateral congenital hearing loss include neonatal intensive care unit admission for two or more days, several congenital syndromes, a family history of hereditary childhood sensorineural hearing loss, craniofacial abnormalities, and certain congenital infections. However, approximately 50 percent of infants with permanent bilateral congenital hearing loss do not have any known risk factors.
Screening tests. Screening programs should be conducted using a one- or two-step validated protocol. One frequently used protocol requires a two-step screening process, which includes otoacoustic emissions followed by auditory brain stem response in those who do not pass the first test. Equipment should be well maintained; staff should be thoroughly trained; and quality control programs should be in place to reduce avoidable false-positive test results. Screening programs should develop protocols to ensure that infants with positive screening test results receive appropriate audiologic evaluation and follow-up after discharge. Newborns delivered at home, at birthing centers, or at hospitals without hearing screening facilities should have some mechanism for referral for newborn hearing screening, including tracking of follow-up.
Treatment. Early intervention services for infants with hearing impairment should be designed to meet the individualized needs of the infant and family, including acquisition of communication competence, social skills, emotional well-being, and positive self-esteem. Early intervention includes evaluation for amplification or sensory devices, surgical and medical evaluation, and communication assessment and therapy. In recent years, cochlear implants have become more available for appropriate candidates; this surgery is usually considered in children with severe-to-profound hearing loss only after inadequate response to hearing aids.
Screening intervals. All infants should be screened for hearing loss before one month of age. Infants who do not pass the newborn screening should undergo audiologic and medical evaluation before three months of age for confirmatory testing. Because of the elevated risk of hearing loss in infants with risk indicators, an expert panel has recommended that these children undergo periodic monitoring for three years.1
This recommendation statement was first published in Pediatrics. 2008;122(1):143–148.
The “Other Considerations,” “Discussion,” and “Recommendations of Others” sections of this recommendation statement are available at http://www.ahrq.gov/clinic/uspstf08/newbornhear/newbhearrs.htm.
The U.S. Preventive Services Task Force Recommendations are independent of the U.S. government. They do not represent the views of the Agency for Healthcare Research and Quality, the U.S. Department of Health and Human Services, or the U.S. Public Health Service.
1. Joint Committee on Infant Hearing, American Academy of Audiology, American Academy of Pediatrics, American Speech-Language-Hearing Association, Directors of Speech and Hearing Programs in State Health and Welfare Agencies. Year 2000 position statement: principles and guidelines for early hearing detection and intervention programs. Pediatrics. 2000;106(4):798–817.
This summary is one in a series excerpted from the Recommendation Statements released by the U.S. Preventive Services Task Force (USPSTF). These statements address preventive health services for use in primary care clinical settings, including screening tests, counseling, and preventive medications.
A collection of USPSTF recommendation statements reprinted in AFP is available at http://www.aafp.org/afp/uspstf.
The complete version of this statement, including supporting scientific evidence, evidence tables, grading system, members of the USPSTF at the time this recommendation was finalized, and references, is available on the USPSTF Web site at http://www.ahrq.gov/clinic/uspstf/uspsnbhr.htm.
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