This document discusses newborn hearing screening and intervention. It notes that hearing loss is the most common birth defect and undetected hearing loss can have negative consequences for child development. Early identification of hearing loss before 6 months of age is important for language acquisition. The document reviews data on language outcomes for children identified with hearing loss before versus after 6 months. It describes South Carolina legislation requiring universal newborn hearing screening and the goals of screening by 1 month, diagnosis by 3 months, and early intervention by 6 months (1-3-6 goals). Data on screening, diagnosis and early intervention rates in South Carolina from 2002-2011 are presented. Opportunities for collaboration between various programs to improve follow-up and outcomes are discussed.

1. Early Hearing Detection and
Intervention:
Opportunities for
Collaboration to Impact
Outcomes

2. Why Do Newborn Hearing
Screening……
 Hearing loss is the most frequent occurring birth
defect Incidence Per 10,000 Births
30
25
20
15
10
5
0

3. Why Do Newborn Hearing
Screening……
 Hearing loss is the most frequent occurring birth
defect
 Undetected hearing loss in children has serious
negative consequences
 Poorer academic achievement
 Reduced educational and social opportunities
 Increased cost in special education
 Miss the “critical window” for language acquisition
 Birth – 2 y.o.

4. Why Do Newborn Hearing
Screening……
Boys Town National Research Hospital Study of Earlier vs. Later
6
5 Identified <6 mos (n = 25)
Language Age (yrs)
Identified >6 mos (n = 104)
4
3
2
1
0
0.8 1.2 1.8 2.2 2.8 3.2 3.8 4.2 4.8
Age (yrs)
Moeller, M.P. (1997).Personal communication moeller@boystown.org
,

5. Why Do Newborn Hearing Screening……
Vocabulary Size for Hearing Impaired Children
Identified Before and After 6 Months of Age
300
Identified BEFORE 6 Months
250
Vocabulary Size
Identified AFTER 6 Months
200
150
100
50
0
13-18 mos 19-24 mos 25-30 mos 31-36 mos
(n = 15/8) (n = 12/16) (n = 11/20) (n = 8/19)
Chronological Age in Months

6. SC Legislation – 1976 Code Section 44-37-40
"Universal Newborn Hearing Screening and Intervention Act"
 Effective June 30, 2001
 All hospitals required to screen newborns during
birth admission for hearing loss
 Exception: Hospitals with less than average of 100 births
annually
 All hospitals required to give parents educational
information regarding the importance of hearing
screening regardless of number of births (April
1, 2001)

7. SC Legislation – 1976 Code Section 44-37-40
"Universal Newborn Hearing Screening and Intervention Act"
 Follow Up  Reporting &
 All babies referred by hospital
screening are to receive: Monitoring
 Audiologic Evaluation by  NBHS reporting
Audiologist, or
procedures must be
 Medical Evaluation by
Physician or followed by:
Otolaryngologist, or  Hospitals
 Both if indicated
 Audiologists
 Confirmed HL:
 Medical Intervention  Early Interventionists
 Audiologic Habilitation
 Early Intervention services
 Augmentative Hearing Devices

8. SC Legislation – 1976 Code Section 44-37-40
"Universal Newborn Hearing Screening and Intervention Act"
 Miscellaneous
 Establish Advisory Council to include reps from:
 Agencies
 Professional Disciplines
 Hospitals
 Consumers
 DHHS shall provide reimbursement
 DHEC shall provide reimbursement

9. First Sound Process
Refer to
BabyNet
Hospital Referred to Audiology
Hearing Fail Audiologist for Fail Diagnostic CHL Habilitation
Screening Re-Screen Evaluation Recs
Pass Hearing
Pass Normal Aids
CI
Sign
Literature Lang
Literature Literature
Parent
Support

10. DATA COLLECTION
 HOSPITALS  AUDIOLOGISTS
 Started with paper data  Started with paper data
collection collection
 ~ 2003 began electronic  ~ 2003 began electronic
data collection data collection
 April 1, 2008 data  Report results of any
collection process newborn referred by
integrated with Vital hospital for follow up
Records
 Report screening results on
every baby

11. How Do We Test Babies?
?????

12. How Do We Test Babies?

13. How Do We Test Babies?
Two types of tests can be done on newborns:
 Auditory Brainstem Response (ABR)
 Tests the infant’s ability to hear soft sound
through miniature earphones
 Sensors measure baby’s brainwaves to determine
if the sounds are heard normally
 Otoacoustic Emissions (OAE)
 Measured directly with a miniature microphone
 Measures response coming from inner hair cells

14. Goals of EHDI
1–3-6
 Screen by 1 month old
 Confirmed diagnosis by 3 months old
 In Early Intervention by 6 months old

15. How Are We Doing?
Screening Rate
100% 99%
98%
98% 97% 97% 97% 97% 97%
96% 96%
96% 95%
94% 93%
92%
90%
AAP 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

16. How Are We Doing?
Confirmed HL
120
106
100
85 82
74 77 75
80 68
62 58
60
40
40
20
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

17. How Are We Doing?
EI by 6 mos old
120%
100%
100% 88%
80%
63% 60%
58%
60% 51% 49% 53%
43%
38%
40%
20%
0%
AAP 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

18. How Are We Doing?
Lost to Follow-Up/Documentation
50%
43%
40% 38% 37%
32% 33%
29%
30%
21% 23% 23%
20%
10%
0%
2003 2004 2005 2006 2007 2008 2009 2010 2011

19. Things to Celebrate
 100% labor and delivery hospitals conduct screenings
 More than 55,000 babies are screened each year prior to
discharge
 Data reporting system linked to vital records

20. Things to Improve
 Follow up rates for failed screen
 Data reporting
 Parent support

21. Collaboration Opportunities
 Home Visitation & ECHO Programs
Report
Screening
Results
Verification
of Screening Report
Results Diagnostic
Results
Report Need
Audiology
for Further
Resource
Follow Up

22. FIRST SOUND
Questions?
Tara Carroll, MCD, CCC/A
First Sound Program Manager/Audiologist
803-898-0708
carroltp@dhec.sc.gov