Newborn Hearing Screening: An Analysis of Current Practices

By Houston, K. Todd; Bradham, Tamala S. et al. | The Volta Review, Summer 2011 | Go to article overview

Newborn Hearing Screening: An Analysis of Current Practices


Houston, K. Todd, Bradham, Tamala S., Muñoz, Karen F., Guignard, Gayla Hutsell, The Volta Review


State coordinators of early hearing detection and intervention (EHDI) programs completed a strengths, weaknesses, opportunities, and threats, or SWOT, analysis that consisted of 12 evaluative areas of EHDI programs. For the newborn hearing screening area, a total of 293 items were listed by 49 EHDI coordinators, and themes were identified within each SWOT category. A threats, opportunities, weaknesses, and strengths, or TOWS, analysis yielded 12 recommendations that focused on similar themes. Out of these 12 recommendations, 3 distinct strategies emerged. States are encouraged to: 1) enhance existing screening practices by requiring systematic data collection, reporting, and automation as well as integration of universal newborn hearing screening database systems with other public health initiatives; 2) leverage existing state legislative support to update and expand current universal newborn hearing screening policies and garner increased resources (i.e., personnel and funding); and 3) reduce loss to follow-up by integrating and centralizing data collection and tracking among various agencies and addressing the screening needs of special populations (e.g., home births, non-native English speaking families, religious and cultural minorities). Addressed appropriately, these recommendations can substantially strengthen newborn hearing screening efforts in state EHDI programs.

Introduction

In the United States, permanent hearing loss is the most common birth defect, affecting approximately 3 newborns per 1,000 births (White, 2004). Since the late 1990s, several studies have demonstrated that diagnosis of hearing loss and intervention delivered early - before the child is 6 months old - often leads to age-appropriate communication outcomes by the time the child enters kindergarten or first grade (Calderón, 2000; Calderón & Naidu, 2000; Moeller, 2000; Yoshinaga-Itano, Sedey, Coulter, & Mehl, 1998). The past decade has also seen remarkable progress in establishing strong and viable universal newborn hearing screening (UNHS) programs in hospitals and birthing centers in all 50 states, U.S. territories, and the District of Columbia. Local UNHS programs provide the underpinnings of effective state-level EHDI systems, which now follow national standards established by federal agencies (Centers for Disease Control and Prevention [CDC], 2010a). These standards, which outline screening practices, strategies for data collection and tracking, and follow-up procedures, have been adopted widely, resulting in 43 states (plus the District of Columbia and Puerto Rico) now requiring or mandating UNHS and tracking programs (National Center for Hearing and Assessment [NCHAM], 2010). As a result, more than 97% of all newborns today receive a hearing screening before they leave the hospital or birthing center (CDC, 2010b). Most importantly, because of these efforts, the age of identification of hearing loss has decreased from an average of 2 to 3 years of age to an average of 2 to 3 months of age (White, Forsman, Eichwald, & Muñoz, 2010).

Although UNHS has proven to be effective, an estimated 50% of infants referred from UNHS do not receive a timely diagnosis and intervention, or they receive services but are not documented in the tracking system (CDC, 2008). In 2007, the Joint Committee on Infant Hearing (JCIH) released its current position statement QCIH, 2007) that addressed various issues related to UNHS in all settings (e.g., well-baby nursery, neonatal intensive care unit (NICU), outpatient screening, home births) and made recommendations that support a more effective and seamless EHDI system to decrease loss to followup and improve outcomes for infants with hearing loss. Considerable efforts are now being employed at the state and national levels to ensure that infants receive a timely diagnosis of hearing loss and are promptly enrolled in early intervention services.

The purpose of this study was to provide a systematic review of UNHS efforts using a strengths, weaknesses, opportunities, and threats, or SWOT, and a threats, opportunities, weaknesses, and strengths, or TOWS, analysis to determine the current status of UNHS programs, and to identify factors that contribute to successful practices as well as those that may reduce overall effectiveness. …

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