Universal Newborn Hearing Screening

Universal Newborn Hearing Screening - Baby FlunkedUniversal Newborn Hearing Screening is the term for state public health programs which test every newborn baby for hearing loss. All screening take place prior to initial discharge from the hospital.

A highly-cited article in the Journal of the American Medical Association [full-text pdf] provides the best discussion of the Universal Newborn Hearing Screening programs.

In states with universal newborn hearing screening programs, all newborn babies are screening for hearing loss before they leave the hospital or birth center. Newborns who fail this initial screening are referred to a specialized audiology clinic for a follow-up newborn hearing test. [update: see link for Arya's results]

My baby daughter flunked her newborn hearing screening which was conducted two days after her difficult birth. In our state, the Department of Public Health provides a limited brochure [pdf] and links to a state website with information about the program.

The website lists basic data on the Massachusetts Universal Newborn Hearing Screening program and further links to an odd Facebook page which seems to be a waste of some government employee’s time. Neither the initial pages of the website nor the pointless Facebook page offer much information beyond the basic data in the brochure.

Useful data about the Massachusetts newborn hearing screening program is buried in a link for researchers. In 2009 [pdf], the most recent year for which data is available, 74,835 newborns were screened (99.5% of total live births). Of these, 1311 (1.8%) failed the screening. This puts my baby in scary territory as I view her as being in the bottom 2 percent in terms of hearing screening.

However, of the 1311 who failed the screening, only 213 (16.2%) were subsequently diagnosed with hearing loss. Organizing the data differently, 213 out of 74,835 newborns (0.28%) were diagnosed with hearing loss through the Massachusetts Universal Newborn Hearing Screening program in 2009.

More interestingly to me is that of the 1311 newborns who failed the screening, only 16.2% were subsequently diagnosed with hearing loss.

The Massachusetts data is not unusual. The American Academy of Family Physicians, UCLA Medical School, and multiple academic articles note the high rate of false-positives throughout universal newborn hearing screening programs. The U.S. Department of Health and Human Services, Agency For Healthcare Research and Quality explicitly states:

“The evidence is insufficient to recommend for or against routine screening of newborns for hearing loss during the postpartum hospitalization”

Published evidence shows that the high false-positive rate could be reduced by adding a second routine newborn hearing screening to all infants who fail the first hospital screen. Since the comprehensive newborn hearing test requires a specialized audiologist and takes over one hour longer than the basic screening, eliminating false positives through the use of a second routine hearing screening would almost certainly save money for the healthcare system.

Universal Newborn Hearing Screening - Covering My EarsFrom my individual perspective, I prefer having to go to the newborn hearing test in six weeks. Due to our insurance coverage, the hearing test costs nothing and knowing for sure whether our baby has hearing loss that our baby does not have hearing loss is worth the two hours of my time. [update: see results of newborn hearing test].

Having large numbers of false-positives is also good for the hospital which houses the specialized audiology center that conducts the newborn hearing test. As the hospital receives insurance company reimbursement for our upcoming visit there is a benefit for the hospital so long as the audiology clinic is not running at full capacity. For the healthcare system as a whole the high number of false-positives drives up costs with no corresponding benefit.