Universal neonatal hearing screening

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Universal newborn hearing screening (UNHS) is a strategy for early detection of permanent congenital hearing loss. It describes the use of objective testing methods (usually otoacoustic emission (OAE) testing or automated auditory brainstem response (AABR) testing) to screen the hearing of well newborns in a particular target region.

This screening separates children into two groups—those with a high index of suspicion (more likely to have permanent congenital hearing loss) and those with a low index of suspicion (less likely to have permanent congenital hearing loss). Those in the first group are referred for diagnostic testing.

Newborn hearing screening is becoming popular as it aims to reduce the age of detection for hearing loss—meaning that diagnosed children can receive early intervention, which is more effective because the brain's ability to learn language (spoken, cued, or signed) reduces as the child ages.[1] Children born with permanent congenital hearing loss have historically performed worse educationally, had poorer language acquisition, social functioning and vocational choices than their hearing peers.[2][3][4][5]

Interventions for children with permanent congenital hearing loss ranges from devices that amplify sound (e.g., hearing aids) to devices that replace the function of a damaged inner ear (cochlear implants) to communication modalities including spoken language, sign language, and Cued Speech.

Newborn hearing screening programmes exist in many countries, including the United States,[6] the United Kingdom [7] and New Zealand.[8]

Prevalence of Congenital Hearing Loss[edit]

Hearing loss in neonates is the most common congenital sensory disorder. Research has placed the prevalence of significant permanent hearing loss in neonates at 1-2 per 1000 live births.[9][10]

Screening Methodology[edit]

Typically a two-stage process occurs in the actual screening of the hearing. Children are screened with either OAE's or AABR. Children passing the test receive no further assessment. Children who fail the initial screen are usually referred for a second screening assessment either with OAE's or AABR. Children failing this second assessment will usually be sent for diagnostic assessment of their hearing. There is some variation in procedure by region and country but most follow this basic principle.

Screening personnel vary also, in some regions Audiologists are used, whereas technicians, nurses, or volunteers are used in other programmes.

Challenges[edit]

Universal newborn hearing screening programmes aim to have high coverage rates (participation) and many aim to screen babies by 1 month of age, aim to complete the diagnostic process for referred babies by three months of age, and aim to begin intervention services by six months of age.

In addition to meeting these targets, one of the key challenges for newborn hearing screening programmes is to reduce 'loss to follow-up' (where a child doesn't return for the next stage of the process). The Joint Committee on Infant Hearing (US) has reported that this is a significant problem in state screening programmes in the United States and other jurisdictions.[11] Measuring loss to follow-up is an important step in understanding and reducing it.

Targeted hearing screening[edit]

Targeted neonatal hearing screening describes the process by which only a specific subset of a population are screened (for instance those infants in the neonatal intensive care unit or with risk factors for hearing loss).

References[edit]

  1. ^ Downs MP, Yoshinaga-Itano, C. The efficacy of early identification and intervention for children with hearing impairment. Pediatr Clin North Am 1999; 46:79-87.
  2. ^ Mayberry RI, Lock, E., Kazmi, H. Linguistic ability and early language exposure. Nature 2002; 417:38.
  3. ^ Johnson JS, Newport, E. L. Critical period effects on universal properties of language: The status of subjacency in the acquisition of a second language. Cognition 1991; 39:215-58.
  4. ^ Yoshinaga-Itano C. From screening to early identification and intervention: Discovering predictors to successful outcomes for children with significant hearing loss. Journal of Deaf Studies and Deaf Education 2003; 1.
  5. ^ Neville H, Bavelier, D. Human brain plasticity: evidence from sensory deprivation and altered language experience. Prog Brain Res 2002; 138:177-88.
  6. ^ "EHDI Programs - Hearing Loss - NCBDDD - CDC". cdc.gov. 
  7. ^ "NHS Newborn Hearing Screening Programme Home Page". screening.nhs.uk. 
  8. ^ "Universal Newborn Hearing Screening Programme". nsu.govt.nz. 
  9. ^ Universal Newborn Hearing Screening: Summary of Evidence Diane C. Thompson, Heather McPhillips, Robert L. Davis, Tracy A. Lieu, Charles J. Homer, Mark Helfand JAMA. 2001;286(16):2000-2010. doi:10.1001/jama.286.16.2000
  10. ^ "Universal Newborn Hearing Screening". aafp.org. 
  11. ^ Joint Committee on Infant Hearing. (2007). Year 2007 position statement: Principles and guidelines for early hearing detection and intervention. Available from www.asha.org/policy.