The Physician's Role in Newborn Hearing Screening and Follow-Up
Approximately 1 to 3 babies per 1,000 are born with a hearing loss. Of babies with hearing loss, about 90% are born to hearing parents. Early identification of hearing loss and early intervention is crucial for the development of language and for a child to reach his or her potential.
What is the role of the primary care physician in the Early Hearing Detection and Intervention Program?
The primary care provider (PCP) directs and coordinates the evaluation and referral process within the child’s medical home through these steps:
- Refer a newborn that does not pass a hearing screening to a pediatric audiologist for a diagnostic audiologic evaluation.
- Provide a statement to parents stressing the importance of follow up, the time and location of the follow-up appointment, and the telephone number of the screening audiology center.
- Refer a baby diagnosed with hearing loss to appropriate medical specialists (ENT, Geneticist and etc.) and to agencies capable of providing intervention services as may be indicated by the diagnostic audiologic evaluation.
- Monitor individual cases to assure that the diagnostic audiologic evaluation was completed, and facilitate the infant’s receipt of early intervention services, preferably by 6 months of age.
- Provide update regarding the infant’s hearing status to the EHDI program.
- Provide on-going monitoring and surveillance of ALL children, especially those with risk factors for late-onset and early childhood hearing loss.
How do I find out the results of the newborn hearing screen?
A provider may contact the birth hospital and review the discharge summary to find out the newborn hearing screen results. Also, providers may access EHDI hearing results online by visiting Michigan Care Improvement Registry (MCIR). The hearing results from year 2004 to present can be viewed on MCIR approximately 2 weeks after birth. Additionally, MCIR batch reports include EHDI follow-up.
Sample of a batch report
View a sample of hearing results on MCIR. Hearing Tab
If my patient did not pass his/her hearing screening, what should I do?
A baby who did not pass his/her hearing screening should be referred for an outpatient follow-up evaluation that typically begins with a second hearing screening. Information about hearing screening should be provided to parents in a professional and compassionate manner while stressing the importance of prompt and appropriate follow-up. Hearing screenings should be completed before an infant is one month of age and a full diagnostic audiologic evaluation should be completed before 3 months of age.
Hospital list and rescreen site
What is the PCP’s role in reducing the number of infants who are considered lost- to-follow up after not passing the Newborn hearing screen?
The primary care or medical home play an important role in ensuring that timely follow-up and the appropriate documentation of that follow-up occurs when an infant does not pass the newborn hearing screening or does not receive a newborn hearing screening. Without the active assistance of the medical home, the infant may be considered “lost” in the early hearing detection and intervention (EHDI) system, which undermines the potential benefits of newborn hearing screening. A “wait and see” approach is never appropriate. An infant who does not pass his/her newborn hearing screening has a potential developmental emergency.
What medical specialists should I refer my patient to if he/she is diagnosed with a hearing loss?
Referrals to appropriate medical specialists such as an otolaryngologist and geneticist are recommended. The majority of children with hearing loss have a genetic component even if they do not have a syndrome or dysmorphic features. Additional medical referrals may need to be made to neurology, cardiology, nephrology and developmental pediatrics.
How do I help families find parent support?
Michigan Guide By Your Side™ (GBYS) is a program for families of children who are diagnosed as Deaf or Hard of Hearing. GBYS is a program of Hands & Voices™. It gives families an opportunity to visit with a Parent Guide, a trained and experienced parent of a child who is Deaf or Hard of Hearing. Families receive tremendous benefits from talking with someone who has “been there” and can help connect new families to resources. http://mihandsandvoices.org/guide_by_your_side.html
What are the risk factors for late-onset and early childhood hearing loss?
The Joint Committee on Infant Hearing (JCIH) recommends in the JCIH Position Statement 2007 that infants who have a risk factor for late onset hearing loss should have at least one comprehensive audiologic evaluation by 24 to 30 months of age. Testing should also occur any time there is parent, caregiver or professional concern regarding communication development.
Additional resources for families and providers
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 evaluation may be covered under private insurance, Medicaid or CSHCS. For more information about CSHCS visit http://michigan.gov/mdch/0,1607,7-132-2942_4911_35698-15087--,00.html
Pediatric Audiology site list
Hospital list with rescreen sites
Surveillance of All Children in the Medical Home
Medical Evaluation When the Hearing Loss Has Been Confirmed
Audiological Intervention & Communication Options
Medical Home Check List