The Task Force on Newborn and Infant Hearing of the American Academy of Pediatrics (AAP) has issued a new policy statement recommending development of universal newborn hearing screening programs nationwide. The statement, published in the February 1999 issue of Pediatrics, discusses the justifications for universal hearing screening, tracking and follow-up, identification and intervention, evaluation, and other recommendations and issues. The AAP establishes parameters with the goal of ensuring that all newborns with hearing loss be identified.
“Significant hearing loss is one of the most common major abnormalities present at birth and, if undetected, will impede speech, language and cognitive development,” according to the policy statement. The average age for detection of significant hearing loss in the United States is less than 14 months, but the AAP would like to see all newborns screened before they leave the hospital so that treatment can be initiated before these infants are six months old. The policy states that about one to three per 1,000 infants in well-baby nurseries have significant loss of hearing in both ears, and about two to four per 100 infants in the intensive care unit have hearing loss.
The following five essential elements for an effective screening program were identified by the AAP: initial screening with a test having a high degree of sensitivity and specificity; tracking and follow-up; identification; intervention; and evaluation. Guidelines for each of the five essential elements are discussed in the statement. The following guidelines have been excerpted from the section of the guidelines that discusses identification and intervention in a universal neonatal hearing screening program:
The goal of universal screening is that 100 percent of infants with significant congenital hearing loss be identified by three months of age, and appropriate and necessary intervention be initiated by six months of age.
Appropriate and necessary care for the infant with significant hearing loss should be directed and coordinated by the child's physician within the medical home, with support from appropriate ancillary services.
A regionalized approach to identification and intervention for infants with significant hearing loss is essential, ensuring access for all children with significant hearing loss to appropriate expert services. The AAP recognizes that professionals with competency in this area may not be available in every community. The child's physician, working with the state department of health, must ensure that every infant with significant hearing loss is referred to the appropriate professionals within the regionalized system.
Implementation of a universal neonatal hearing screening program may increase demand for qualified personnel to provide age-appropriate identification and intervention services for infants with significant hearing loss. As a result, the AAP recommends the training and education of additional expert care professionals.
The AAP does not recommend a preferred screening method. The statement discusses both evoked otoacoustic emissions and auditory brainstem response to be used either alone or in combination. Both methods, according to the AAP, are easy to perform and are noninvasive.