Academic journal article International Public Health Journal

Universal Newborn Hearing Screening in the United States

Academic journal article International Public Health Journal

Universal Newborn Hearing Screening in the United States

Article excerpt


Hearing impairment or loss is the partial or total inability to hear sounds experienced in the environment. According to the World Health Organization (WHO), there are approximately 360 million people worldwide with hearing impairment (1). Hearing impairment is a diagnosis encompassing a wide spectrum of presentations and disease processes, a vital impact on human development, a major public health concern, a battleground for cultural identity and the conception of health, and a research field rich with ongoing questions. Hearing loss can be further differentiated into conductive and sensorineural hearing loss (SNHL) and can be unilateral or bilateral or differentiated by different risk factors (2). Auditory anatomical and physiological shaping begins early in embryologic development and is refined throughout early childhood, which has important implications for possible congenital and acquired hearing impairment resulting from toxic exposures to underlying genetic defects. The epidemiology of newborn hearing loss along with the ease of available technology was instrumental in the development of "Universal newborn hearing screening" (UNHS) programs in the US and worldwide. Discussion about UNHS in the United States is incomplete without understanding the history and evolution as a public health program with active participation of all stake holders-parents, specialists, professional societies and the government.


Best evidence on national prevalence of newborn hearing loss is noted in the MMWR 2010 report (3) with CDC (Center for Disease Control and Prevention analysis of EHDI (Early hearing detection and intervention) surveillance data in United States from 1999-2007; geared to determine the status of efforts to identify newborns and infants with hearing loss. Though, data until 2005 was passively reported to CDC, 2005-2007 CDC-EHDI active data collection did not demonstrate a huge difference between prevalence of newborn hearing loss - 1.1 versus 1.2 per 1,000 screened; even though the percentage of infants screened increased from 46.5% in 1999 to 97% in 2007 and the number of States reporting increased from nine States and territories to 44 States and territories. In January 2000, Statement of the American College of Medical Genetics on Universal Newborn Hearing Screening noted that hearing loss is present at birth in 1-2 per 1,000 infants (4). The CDCEHDI prevalence data in the US is similar to public and private institution reports in different European countries/regions, but there seems to be reports of higher prevalence of newborn hearing loss reported from developing countries as noted in Table 1.

The history of Universal Newborn Hearing Screens (UNHS) in the United States

The history of Newborn Screening for any disorder is incomplete without mentioning Dr. Robert Guthrie's (1916-1995) work establishing PKU (phenylketonuria) screening in 1960s as a public health program initiative in the State of Massachusetts. Though, around the same time as initial PKU screening, a varied range of efforts by different disciplines towards early detection, diagnosis and intervention for hearing loss were in the works Downs et al. (15, 16) and, initial hospital based screening for hearing loss took place as early as 1970s. By the late 1980s, Dr. C. Everett Koop (1916-2013), then US Surgeon General, pioneered that detection of hearing loss to be included in the Healthy People 2000 goals for the nation (17).

In 1988, the Maternal and Child Health Bureau (MCHB), a division of the US Health Resources and Services Administration (HRSA), funded pilot projects in Rhode Island, Utah, and Hawaii to test the feasibility of a universal statewide screening program to screen newborn infants for hearing loss before hospital discharge (18). Wide spread practice of hospital based screening did not occur until after the 1993 NIH Consensus Development Conference on Early Identification of Hearing Impairment in Infants and Young Children that recommended that all newborn infants be screened for hearing shortly after birth (19). …

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