Birth Facilities

What are the guidelines for conducting hearing screenings in the neonatal (well-baby) nursery or birth center?

• Test the newborn no sooner than 12 hours after birth.
• Choose a time when the infant is not being seen by other health care professionals.
• Test when infants are quiet or sleeping; optimally, one hour following feeding.
• To help calm a restless infant, swaddle the infant and dim the lights
• Select a time when the infant is medically stable
• Ensure a quiet environment for testing, away from background noise
• Follow standard precautions for infection control (e.g. hand washing, appropriate cleansing of equipment, etc).

To review the complete Newborn Hearing Screening Program Guidelines, Click HERE.

What are the guidelines for conducting hearing screenings in the NICU?
Since the incidence of sensory, as well as neural hearing loss is approximately ten-times higher in the NICU versus well-baby nursery, A-ABR is the recommended screening technology for use in the NICU population (JCIH 2007).

The neonatologist and/or the PCP should be consulted to determine the most appropriate opportunity for hearing screening. Babies should be screened several days prior to discharge to assure the hearing screening occurs.

The A-ABR, however, should not be completed before the infant is 32 weeks gestational age because it tends to generate more referrals for diagnostic testing and therefore screening should be delayed until the baby has reached this age.

For those infants transferred between facilities, the facility discharging the baby to home is responsible for completing the screening, arranging any necessary follow-up, and reporting the outcome to the Department of Health.

Any NICU infant who fails initial A-ABR neonatal hearing screening should receive direct referral to an audiologist for a diagnostic audiologic evaluation that includes a diagnostic ABR (JCIH 2007).

To review the complete Newborn Hearing Screening Program Guidelines, Click HERE.

If a newborn does not pass his/her hearing screening, is it acceptable to repeat the screening more than one time?
If a newborn does not pass the screening, it is acceptable to repeat the screening during the same session using the same technology one time, especially in those cases when the recording conditions were not optimal either due to timing, noise conditions, or state of the newborn.
Multiple screenings (greater than two times) during one session using the same technology are not recommended in order to avoid getting a false positive result (i.e. not a true 'pass').
Screening results at individual frequencies should never be combined across screening sessions in order to obtain a 'pass' result.

What is the responsibility of the birth facility for newborns that did not receive a hearing screening before discharge?
An infant that does not complete an initial hearing screen for any reason should be scheduled for an appointment to return to the birth facility for completion of the hearing screening.

How should the birth facility inform parents of the newborn hearing screening results?
The person performing the hearing screening should give parents the following information in clear, non-technical terms and in the native language of the family:

• Provide results of the screening whether the newborn passed or did not pass the hearing screening and what the results mean. The results should be conveyed verbally and in writing to the parents using a standard notification form prepared explicitly for this purpose.
• Provide written notification to parents if an infant needs a repeat hearing screening. If the infant did not pass the initial screening the parents should understand the importance of obtaining a repeat hearing screening as soon as possible.
• Schedule the repeat hearing screening appointment with parents prior to discharge if an infant does not pass the initial screening. If the infant is discharged from the NICU, refer the family to a pediatric audiologist for a diagnostic evaluation. NOTE: It is recommended that a birth facility have a formal or informal relationship with an audiology facility to refer families for a diagnostic evaluation.
• If the initial screening was not competed (the baby was missed or results were incomplete) prior to discharge, it is the birth facility's responsibility to provide the initial hearing screening to the newborn after discharge and to make an appointment for this hearing screening before the newborn is discharged.
  

Provide all parents with information on milestones of normal auditory, speech and language development in children.
NIDCD Fact Sheet – Speech and Language Developmental Milestones: Click HERE.

There are two parent brochures that birth facilities can use if they do not have their own: one describes newborn hearing screening and the other informs parents that their baby did not pass the newborn hearing screening and needs further testing. Click HERE to open the website link, scroll down to the section "Fact Sheets" and you will see 2 brochures titled "Can Your Baby Hear: Your Baby's First Hearing Test" and "Your Baby Needs Another Hearing Test: Finding Hearing Loss Early Can Make a Big Difference in Your Baby's Life".

What is the responsibility of the birth facility to communicate newborn hearing screening results to primary care providers?
The birth facility must notify the primary care provider via newborn summary, discharge summary sheet, letter or other specific written means that the newborn passed, did not pass or missed the hearing screening, that the screening results were incomplete, or that a repeat screening or referral for diagnostic audiologic evaluation by an audiologist is needed.

What information should be sent to the PA Department of Health and when does it need to be sent?
The "Newborn Hearing Screening Program – Screening Reporting Form" should be completed for every newborn who receives a hearing screening and faxed to the PA Department of Health per the instructions on the form. This form may be reproduced as needed.
The "Birth Hospital Monthly Reporting Form" should be completed monthly for all patients who received a hearing screening in the well-baby
nursery and the NICU. This form should be faxed to the PA Department of Health per the instructions on the form.