Newborn Hearing Screening - GOV.UK

Newborn Hearing ScreeningPaediatrics > Screening > Newborn Hearing Screening

Published: 18-Mar-2015 Valid until: 31-Mar-2016 Printed on: 26-Jun-2015 © Map of Medicine Ltd This care map was published by England. A printed version of this document is not controlled so may not be up-to-date with the latest clinicalinformation.

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Newborn hearingscreening

Neonatal intensivecare unit (NICU) orspecial care baby unit(SCBU) screeningprotocol

Well baby screeningprotocol

Hospital basedscreening service

Community basedscreening service

Provide informationand take consent

Check eligibility

Consider referral forearly audiologicalassessment

Eligible for screening Not eligible forscreening

Refer for earlyaudiologicalassessment

Go to NICU/SCBUProtocol

Consider risk factorsfor hearing loss

Go to Well BabyProtocol

This document is excluded from the Open Government Licence. Images and content are subject to copyright; All rights reserved ©Map of Medicine Limited 2015 and © Public Health England 2015.



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1 Newborn hearing screening

Quick info:Scope:

• screening for hearing impairment in newborn babies

• the target condition for the screen is bilateral, permanent hearing impairment (sensorineural or permanent conductive)averaging 40dB or more in the better ear

• this pathway summarises guidelines developed by the NHS Newborn Hearing Screening Programme (NHSP) inEngland; more information about NHSP and supporting materials for these pathways can be found on the NHSPwebsite (hearing.screening.nhs.uk)

• Screening may be attempted up to 3 months corrected age (corrected age is the age a premature baby would be if born on theirdue date). In exceptional circumstances such as, when a baby is too poorly to screen at 3 months, screening may be carriedout at up to 6 months (corrected) age

• where screening has not been possible by 6 months (corrected) age a referral to audiology should be made.

Protocol:

• a multistage screening protocol is used, with two types of test:

• automated oto-acoustic emission (AOAE)

• automated auditory brainstem response (AABR)

• there are two versions of the protocol:

• one for well babies and the other for babies who have been in a neonatal intensive care unit (NICU) or special care baby unit(SCBU)

• the protocols are different due to NICU or SCBU babies having a higher risk of auditory neuropathy or auditory dyssynchronyor other neurological problems that are more likely to be picked up by AABR rather than AOAE testing

• NHSP uses the terms 'clear response' and 'no clear response' rather than 'pass' and 'fail' as these are more family friendly.

Prevalence:

• The estimated prevalence of moderate, severe or profound bilateral hearing loss is 1-2 per 1000 babies. This increasesin babies with risk factors and is about ten times higher (1 per 100 babies) in the NICU/SCBU population. http://hearing.screening.nhs.uk/surveillanceguidelines

Prognosis:

• newborn hearing screening results in earlier diagnosis and treatment of hearing loss; this leads to better outcomes for childrenand their families in terms of

• speech

• language

• social development.

2 Check eligibility

Quick info:Babies with certain conditions are ineligible for screening as they are at high risk of a hearing impairment.These babies should bereferred directly for early audiological assessment by the treating paediatrician or NHSP manager.

• microtia/external canal atresia – where there is no patent ear canal in one or both ears – these provide unequivocal evidence ofhearing loss of some degree

• confirmed or strongly suspected neonatal bacterial meningitis (any organism) or meningococcal septicaemia – 1 in 10 patientsdevelop sensorineural hearing loss (SNHL) as a sequela:

• urgent hearing evaluation by tertiary audiology centre is required; these children may be at risk of developing labyrinthitisossificans and may need to be referred urgently to a cochlear implant centre.

5 Consider risk factors for hearing loss


http://hearing.screening.nhs.uk

http://hearing.screening.nhs.uk/surveillanceguidelines




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Quick info:

• some factors appear to be risks for late onset or progressive deafness − for these the surveillance guidelines recommendfollow-up in audiology at age 7-12 months even if the screen is clear

• in some cases the paediatrician may decide to refer for earlier assessment

• information on risk factors can be found on the Newborn Hearing Screening Programme (NHSP) website in the document“Guidelines for surveillance and audiological monitoring of infants and children following the newborn hearing screen”.

6 Consider referral for early audiological assessment

Quick info:

• referral should be made immediately

• aim to start the assessment process within 4 weeks of screen completion or by 44 weeks gestational age

• assessment guidelines are detailed on the BSA website http://www.thebsa.org.uk/resources/ in the document “Guidelines forthe early audiological assessment and management of babies referred from the Newborn Hearing Screening Programme”

• the assessment will generally include auditory brainstem response (ABR) and should be at the specialist centre where there arefull audiology facilities, not at 'tier 2' or intermediate or community audiology clinics.

7 Provide information and take consent

Quick info:Pregnant women are given the NHS information booklet ‘Screening tests for you and your baby’ at their booking appointment.Newborn screening is discussed toward the end of pregnancy and postnatally before screening. The booklet should be used as aguide for discussing the screening test and is available at http://screening.nhs.uk/annbpublicationsConsent and reference to the provision of written information must be recorded by the healthcare professional in the maternity/babyrecords, eSP and Personal Child Health Record (sometimes referred to as the ‘Red book’). Written consent is not required. Parent(s) or guardians of babies to be screened under the NICU protocol should be given the explanatory NICU screen leaflet. Take consent:

• obtain informed consent (or decline)

• this should be performed by the screener or trained individual

• arrange a suitable time for screening − best practice is for parents to be present while screening takes place

• guidance on the consent process can be obtained from the NHSP programme.

9 Neonatal intensive care unit (NICU) or special care baby unit (SCBU) screening protocol

Quick info:Criteria:

• all babies resident in the neonatal intensive care unit (NICU) or special care baby unit (SCBU) for more than 48 hourscontinuously should be screened using the NICU/SCBU protocol

• those in 'transitional care' admitted to the NICU for less than 48 hours should follow the well baby protocol

Timing:

• ideally complete screening as close to discharge as possible while the baby is in hospital

• wherever possible, the baby should be well and any major medical or drug treatment completed

• if the process is not completed in hospital, an outpatient appointment or home visit is required to complete the process, usuallywithin one visit

• aim to complete screening by 44 weeks gestational age

• screening should not be performed on babies less than 34 weeks gestational age.



http://www.thebsa.org.uk/resources/

http://screening.nhs.uk/annbpublications



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10 Well baby screening protocol

Quick info:Well baby screening protocol:

• all babies who do not fall into the neonatal intensive care unit (NICU) or special care baby unit (SCBU) screening protocolcriteria should be screened using the well baby protocol, ie. all babies not resident in the NICU or SCBU for more than 48 hourscontinuously

• there are two models of the screening protocol:

• hospital based services

• community based services

11 Hospital based screening service

Quick info:Timing of hospital based screening:

• to complete screening prior to discharge from hospital

• if the process is not completed in hospital, an outpatient appointment or home visit is required to complete the process, usuallywithin one visit

• aim to complete screening by (corrected) 4 weeks of age

• screening should not be performed on babies at less than 34 weeks gestational age.

12 Community based screening service

Quick info:Timing of community based screening:

• the first screen usually takes place at the new birth visit by the health visitor at approximately 10 days of age

• any subsequent screening required should be completed by (corrected) 5 weeks of age.


Provenance: Newborn Hearing Screening

Provenance

It is important that each care map is referenced in line with Map of Medicine guidelines.

Classification

When creating or updating each care map you will need to use the following classification,

please note not all classification may be applicable;

[G] – guideline [M] – meta – analysis [S] – systematic review [A] – randomised controlled trail [B] – non-randomised prospective study [C] – retrospective study [Q] – cost or decision analysis [P] – performance measures or policy documents [E] – practice based information (expert opinion)

References

Davis A, Bamford J, Wilson I. A critical review of the role of neonatal hearing screening in the

detection of congenital hearing impairment. Health Technology Assessment Review 1997; 1 (10). [S]

Kennedy CR. Language Ability after Early Detection of Permanent Childhood Hearing Impairment.

The New England journal of medicine 2006; 354(20): 2131. [C]

Guidelines for the early audiological assessment and management of babies referred from the

Newborn Hearing Screening Programme. 2013. Available from

http://hearing.screening.nhs.uk/audiology [G]

Guidelines for surveillance and audiological monitoring of infants and children following the newborn

hearing screen. 2012. Available from http://hearing.screening.nhs.uk/surveillance. [G]


http://hearing.screening.nhs.uk/audiology

http://hearing.screening.nhs.uk/surveillance

Wood, S.A., Davis, A.C. Sutton, G.J. 2013. Effectiveness of targeted surveillance to identify moderate to

profound permanent childhood hearing impairment in babies with risk factors who pass newborn screening. Int J

Audiol, 52,394-399. [B] Contributors

The following individuals have contributed to this care map:

Name of Screening Programme: NHSP

Contributor Name Job Title Conflicts of Interest

Sally Wood

Consultant Clinical Scientist

(Audiology), Clinical Advisor

to NHS Newborn Hearing

Screening Programme

None

Jane Hibbert Programme Manager – NHS

Newborn Hearing Screening

Programme

NHS Screening Programmes

None


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