ContextEach year, approximately 5000 infants are born in the United States
with moderate-to-profound, bilateral permanent hearing loss (PHL). Universal
newborn hearing screening (UNHS) has been proposed as a means to speed diagnosis
and treatment and thereby improve language outcomes in these children.ObjectivesTo identify strengths, weaknesses, and gaps in the evidence supporting
UNHS and to compare the additional benefits and harms of UNHS with those of
selective screening of high-risk newborns.Data SourcesWe searched the MEDLINE, CINAHL, and PsychINFO databases for relevant
articles published from 1994 to August 2001, using terms for hearing disorders,
infants or newborns, screening, and relevant treatments. We contacted experts
and reviewed reference lists to identify additional articles, including those
published before 1994.Study SelectionWe included controlled and observational studies of (1) the accuracy,
yield, and harms of screening using otoacoustic emissions (OAEs), auditory
brainstem response (ABR), or both in the general newborn population and (2)
the effects of screening or early identification and treatment on language
outcomes. Of an original 340 articles identified, 19 articles, including 1
controlled trial, met these inclusion criteria.Data ExtractionData on population, test performance, outcomes, and methodological quality
were extracted by 2 authors (D.C.T., H.M.) using prespecified criteria developed
by the US Preventive Services Task Force. We queried authors when information
needed to assess study quality was missing.Data SynthesisGood-quality studies show that from 2041 to 2794 low-risk and 86 to
208 high-risk newborns were screened to find 1 case of moderate-to-profound
PHL. The best estimate of positive predictive value was 6.7%. Six percent
to 15% of infants who are missed by the screening tests are subsequently diagnosed
with bilateral PHL. In a trial of UNHS vs clinical screening at age 8 months,
UNHS increased the proportion of infants with moderate-to-severe hearing loss
diagnosed by age 10 months (57% vs 14%) but did not reduce the rate of diagnosis
after age 18 months. No good-quality controlled study has compared UNHS with
selective screening of high-risk newborns. In fair- to poor-quality cohort
studies, intervention before age 6 months was associated with improved language
and communication skills by ages 2 to 5 years. These studies had unclear criteria
for selecting subjects, and none compared an inception cohort of low-risk
newborns identified by screening with those identified in usual care, making
it impossible to exclude selection bias as an explanation for the results.
In a mathematical model based on the literature review, we estimated that
extending screening to low-risk infants would detect 1 additional case before
age 10 months for every 1441 low-risk infants screened, and result in treatment
before 10 months of 1 additional case for every 2401 low-risk infants screened.
With UNHS, 254 newborns would be referred for audiological evaluation because
of false-positive second-stage screening test results vs 48 for selective
screening.ConclusionsModern screening tests for hearing impairment can improve identification
of newborns with PHL, but the efficacy of UNHS to improve long-term language
outcomes remains uncertain.

Universal newborn hearing screening: summary of evidence

The Rhode Island Hearing Assessment Program: Experience with statewide hearing screening (1993-1996)

Background. Early detection of hearing loss coupled with appropriate early intervention is critical to speech, language, and cognitive development. These competencies serve as the foundation for later academic skills. For these reasons, many states are undertaking aggressive efforts to screen all newborns before hospital discharge. Universal detection of hearing loss in newborns is a three-stage process composed of 1) the birth admission screen, 2) follow-up and diagnosis, and 3) intervention services. Breakdown at any stage jeopardizes the entire effort. The goals of this research are to examine the birth admission screen by reviewing outcome measurements for 54 228 Texas newborns and to evaluate factors that impact outcomes positively or negatively. Methodology. All newborns were screened for hearing loss using a physiologic test of auditory function; either screening auditory brainstem responses or transient evoked otoacoustic emissions. Screening occurred in the newborn and intensive care nurseries, before hospital discharge in 9 sites as part of the nursery protocol. Patients. A total of 54 228 newborns were available for screening. Outcome Measures. Four measures were evaluated and are reported: the number of births screened, the number of newborns who passed the screen before discharge, the number of infants who returned for follow-up, and the number of infants identified with hearing loss. A Birth Screening Performance Index is also calculated. Results. Results are reported for calendar years 1994, 1995, 1996, and through June 1997. A total of 54 228 newborns were available for screening; 52 508 were screened before hospital discharge during their birth admission and 50 721 passed this screen. Infants returning for follow-up screen as outpatients numbered 1224. Over this 3½-year span, 113 infants who failed the birth admission screening had hearing loss that was sensorineural in nature. From these data, the estimated incidence of hearing loss is 3.14/1000 infants. Conclusions. Screening in the nursery with low false-positive rates can be achieved when three elements are present: audiology involvement, hospital support, and automated data and information management. Follow-up measures need improvement. Better tracking methods may help assure that at-risk newborns are connected to services.

The newborn with hearing loss: detection in the nursery

A diverse panel of experts convened in Bad Ischl, Austria, in June of 2012 for the purpose of coming to consensus on essential principles that guide family-centered early intervention with children who are deaf or hard of hearing (D/HH). The consensus panel included parents, deaf professionals, early intervention program leaders, early intervention specialists, and researchers from 10 nations. All participants had expertise in working with families of children who are D/HH, and focus was placed on identifying family-centered practice principles that are specific to partnering with these families. Panel members reported that the implementation of family-centered principles was uneven or inconsistent in their respective nations. During the consensus meeting, they identified 10 agreed-upon foundational principles. Following the conference, they worked to refine the principles and to develop a document that described the principles themselves, related program and provider behaviors, and evidence supporting their use (drawing upon studies from multiple disciplines and nations). The goal of this effort was to promote widespread implementation of validated, evidence-based principles for family-centered early intervention with children who are deaf and hard of hearing and their families.

/pdf/best-practices-in-family-centered-early-intervention-for-11ga0y1x2y.pdf

Best practices in family-centered early intervention for children who are deaf or hard of hearing: an international consensus statement.

EI services represent the purpose and goal of the entire EHDI process. Screening and confirmation that a child is D/HH are largely meaningless without appropriate, individualized, targeted and high-quality intervention. For the infant or young child who is D/HH to reach his or her full potential, carefully designed individualized intervention must be implemented promptly, utilizing service providers with optimal knowledge and skill levels and providing services on the basis of research, best practices, and proven models. The delivery of EI services is complex and requires individualization to meet the identified needs of the child and family. Because of the diverse needs of the population of children who are D/HH and their families, well-controlled intervention studies are challenging. At this time, few comparative effectiveness studies have been conducted. Randomized controlled trials are particularly difficult for ethical reasons, making it challenging to establish causal links between interventions and outcomes. EI systems must partner with colleagues in research to document what works for children and families and to strengthen the evidence base supporting practices.

https://pediatrics.aappublications.org/content/pediatrics/early/2013/03/18/peds.2013-0008.full.pdf

Supplement to the JCIH 2007 Position Statement: Principles and Guidelines for Early Intervention After Confirmation That a Child Is Deaf or Hard of Hearing

The use of telehealth as a service delivery method for early intervention (EI) is in its infancy and few studies have examined its use within the context of a statewide program. The focus of this report was to determine the factors that influence providers' utilization of telehealth in Colorado's Part C Early Intervention program (EI Colorado). This report presents information that was gathered through surveys sent to Part C program administrators, service coordinators, providers, and caregivers. Surveys were used to understand perceptions of telehealth, actual experiences with telehealth, and perceived benefits and challenges using this service delivery method. Follow-up focus groups were conducted with program administrators and family members to gather more nuanced information. Participants identified several benefits associated with telehealth including its flexibility, access to providers, and more family engagement. The primary barriers included access to high speed internet and the opinion that telehealth was not as effective as in-person treatment. The results in the report served to identify next steps in the implementation of telehealth in Colorado's Part C EI program.

/pdf/report-on-the-use-of-telehealth-in-early-intervention-in-1wfakdhzvi.pdf

Report on the Use of Telehealth in Early Intervention in Colorado: Strengths and Challenges with Telehealth as a Service Delivery Method.

/pdf/expanding-use-of-telepractice-in-speech-language-pathology-2hutf9rpmj.pdf

Expanding Use of Telepractice in Speech-Language Pathology and Audiology

/pdf/a-model-of-early-intervention-for-children-with-hearing-loss-51w136bhdm.pdf

Arlene Stredler-Brown

Papers

Best practices in family-centered early intervention for children who are deaf or hard of hearing: an international consensus statement.

Report on the Use of Telehealth in Early Intervention in Colorado: Strengths and Challenges with Telehealth as a Service Delivery Method.

Expanding Use of Telepractice in Speech-Language Pathology and Audiology

A Model of Early Intervention for Children with Hearing Loss Provided through Telepractice.

Learning to Communicate: Babies with Hearing Impairments Make Their Needs Known.