The Physician's Role in Follow-Up to Newborn Screening

• EHDI is on Michigan Care Improvement Registry (MCIR). The hearing results starting with the Year 2004 to present, can be viewed on MCIR now.
• EHDI is also on MCIR batch reports. Sample of a batch report 
• Sample of hearing results on MCIR. Hearing Tab 
• Physicians Role in the Follow-Up of Newborn Screening 
• Otolaryngologic Evaluation of Infants with Hearing loss

Hospitals use two objectives physiologic methods to screen for hearing loss

• Otoacoustic emission (OAE)- a microphone placed in the ear canal measures sound waves generated in the cochlea in response to clicks or tone bursts. Quicker and easier to perform than A-ABR but may be affected by debris or fluid in the external or middle ear in the first 24 hrs. after birth.
• Automated Auditory Brainstem Response (A-ABR) clicks are introduced into the ear canal from either a probe or earphone.  Three electrodes are positioned on the baby's head, which record the neural response to sound.  Baby must be in a quiet state but screening is less affected by debris or fluid in the external or middle ear.
• Combination of the two.  OAE is performed first and if the baby does not pass, then an A-ABR is performed before discharge.

TEST RESULTS 

• Bilateral Pass (both ears pass)
• Bilateral referral (neither ear passes)
• Unilateral referral (only one ear passes)

REFER RESULTS

Bilateral and unilateral refers need to have a re-screen by one month of age. (Hospital sites) Infants should return promptly for re screening within the first few weeks of life.  Physicians need to educate and counsel parents in a way that facilitates their return for follow-up without producing undue anxiety.  Research indicates that the benefits of early identification far out weigh the anxiety of a failed initial screen.

If the baby refers a second time, then a complete audiologic assessment is needed by 3 months. (Audiology tests) Note: not all communities will have the ability to provide the tests or possible sedation if needed . The sooner a baby is seen for additional testing the less likely sedation will be needed.    (Pediatric audiology sites) Repeating the screening multiple times is not recommended. Stress to families that most infants pass diagnostic testing and that hearing loss cannot be confirmed until after this evaluation.

PASS RESULTS 

A pass result indicates that the baby passed the screen in both ears at birth, indicating that hearing levels appear to be adequate for normal speech and language development. However hearing loss can occur at any time and physicians should be alert to acquired, late onset and progressive hearing loss.  Even with a pass result normal speech language milestones should be monitored closely.

• Risk Factors 
• Surveillance of All Children in the Medical Home 
• Medical Evaluation When the Hearing Loss Has Been Confirmed 
• Audiological Intervention & Communication Options 
• New Medical Home Check List 

Additional Resources For Families 

       Financial Support

Children's Special Health Care Service (CSHCS) is a program within the Michigan Department of Community Health that can help families with medical coverage and referral for specialty services and support. The fees associated with the cost of the diagnostic audiological evaluation may be covered under private insurance, Medicaid or  CSHCS. 

      Parent Support 

Guide By Your Side is a free program that links an experienced parent of a deaf or hard of hearing child with a parent of a newly identified deaf or hard of hearing infant.  (GBYS)

      Resources: 

Informational flyer about the EHDI Pedialink module (Flyer) 

www.infanthearing.org 
www.cdc.gov/ncbddd/ehdi 
http://migrc.orgwww.jcih.org 
www.nichq.org