Newborn Hearing Screening and Follow-up

Follow-up Process After Failed Screening

Infants who fail the initial in-hospital screening should be referred for repeat testing between 2 and 8 weeks after discharge, according to the American Academy of Family Physicians 1, 2
If the infant fails the second screening, they should be referred for comprehensive audiological evaluation including diagnostic Auditory Brainstem Response (ABR) testing or other electrophysiologic testing, which can be performed as early as 3 months of age, as recommended by the American Academy of Family Physicians 1, 3

Most positive screening tests are false positives - in low-risk populations, only about 2% of infants who fail screening tests are later found to have sensorineural hearing loss (SNHL), according to the American Academy of Family Physicians 2, 4
Overall, approximately 6.7% of infants who fail in-hospital screening tests are eventually diagnosed with bilateral SNHL, as reported by the American Academy of Family Physicians 3
Parents should receive clear communication about test results in a caring and sensitive manner, preferably face-to-face, as recommended by the American Academy of Pediatrics 5

Universal newborn hearing screening has reduced the mean age of identification of hearing impairment from 12-13 months to 3-6 months, according to the American Academy of Family Physicians 1, 3
Early identification allows for earlier intervention, with the mean age for hearing aid fitting reduced from 13-16 months to 5-7 months, as reported by the American Academy of Family Physicians 3

Infants who spent time in the NICU should be screened using ABR technology, as they are at risk for neural hearing loss, according to the American Academy of Pediatrics 5
For infants who fail ABR testing in the NICU, referral should be made directly to an audiologist rather than for general outpatient rescreening, as recommended by the American Academy of Pediatrics 5

Loss to follow-up is a significant challenge - studies show that 13% to 31% of infants who fail initial screening do not return for follow-up testing, according to the American Academy of Family Physicians 1
False-positive results can produce significant anxiety in 3% to 14% of parents, even after follow-up testing, as reported by the American Academy of Family Physicians 1

Between 50-75% of infants with moderate to profound bilateral SNHL have one or more specific risk factors, including NICU admission for 2+ days, family history of childhood SNHL, congenital infections, craniofacial abnormalities, and syndromes known to include hearing loss, according to the American Academy of Family Physicians 3, 6, 7

Children with hearing loss experience delayed development in language, learning, and speech, with impairment evident as early as age 3, according to the American Academy of Family Physicians 6
These developmental delays can lead to lower reading abilities, poorer school performance, and under- or unemployment throughout life, as reported by the American Academy of Family Physicians 6
Any child with risk factors for hearing loss should have ongoing developmentally appropriate hearing screening and at least one diagnostic audiology assessment by 24-30 months of age, as recommended by the American Academy of Pediatrics 8

Infants who fail OAE screening should undergo diagnostic ABR testing as part of a comprehensive audiological evaluation by 3 months of age to confirm or rule out permanent hearing loss, as recommended by the American Academy of Pediatrics 9, 10
The comprehensive audiological evaluation for infants birth to 6 months should include frequency-specific ABR using air-conducted tone bursts, click-evoked ABR with both condensation and rarefaction stimuli, distortion product or transient evoked OAEs, tympanometry using 1000-Hz probe tone, child and family history with risk factor evaluation, and parental report of infant's responses to sound, according to the American Academy of Pediatrics 9, 10
Diagnostic ABR testing is essential after failed OAE screening because automated ABR screening equipment may not detect mild hearing loss, and OAE cannot detect neural hearing loss, as noted by the American Academy of Pediatrics 9, 10

Infants with hyperbilirubinemia, anoxia, or prolonged NICU stays are at particular risk for auditory neuropathy/auditory dyssynchrony and require diagnostic ABR testing, as recommended by the American Academy of Pediatrics 9, 10
Hyperbilirubinemia requiring exchange transfusion and culture-positive sepsis are risk factors that require ongoing surveillance and at least one diagnostic audiology assessment by 24-30 months, according to the American Academy of Pediatrics 9, 10

Diagnosis must be confirmed by 3 months of age, and sedation may be required for diagnostic ABR as infant must remain quiet, as noted by the American Academy of Pediatrics 9, 10 and supported by additional evidence 11, 12