Programs
Birthing Hospitals and Facilities
Hospitals and birth centers perform hearing screenings on newborns before discharge. If a newborn does not pass the hearing screening, a follow-up screening is performed before discharge or as an outpatient. It is the responsibility of the hospital, birth center, or midwife to have a hearing screening performed on newborns and a follow-up screening performed on newborns that do not pass the initial hearing screening no later than one month of age.
Our staff will contact midwives/out-of-hospital birth centers, primary care providers (PCPs), and specialists as needed to ensure that every infant born in Kansas has a hearing screen and receives appropriate follow-up when necessary.
Kansas state law (Statute KSA 65-1,157a) outlines the following core responsibilities for all birthing health care professionals in Kansas.
- Educate parents on newborn hearing screening information and parental options before screening. Education materials to aid in the discussion are available free of charge and can be ordered from our Newborn Hearing Screening Online Resources page (link to 4.2).
- Perform screening on all infants before discharge unless parents have signed the Parental Refusal or Delay of Newborn Screening (PDF) form.
- Document the results of all hearing screenings.
- Communicate results to parents, PCPs, and the Newborn Screening Program within 7 days of screening.
- Plan for alternative testing strategies when equipment is not working properly.
Scheduling outpatient follow-up within 1-2 weeks is highly recommended for infants who do not pass. While it is not a statutory requirement, this protocol does ensure better outcomes for babies.
Every nursery performing newborn hearing screening should have a written policy and procedure for staff to follow when screening newborns for hearing loss. A nursery’s policy should address the following topics:
- Screening procedure
- Equipment
- Follow-up for infants with REFER results
- Communication with parents
- Staff training
- Staff re-training
- Documentation
- Reporting results to the Kansas Department of Health and Environment as well as the baby’s PCP
- Plan for equipment failure
- Quality assurance
Our audiologists are available to assist in developing and revising policies and procedures to fit the needs of individual hospitals. For sample policies and procedures or to arrange a site visit with an audiologist, please contact the Newborn Hearing Screening Program (link to main Contact page).
Timely follow-up is key to the newborn screening process, including thorough documentation and effective communication between the Newborn Screening Program, health care professionals, specialists, and families.
Final inpatient newborn hearing screening results should be documented in the infant’s medical record. If the birth facility does not schedule outpatient follow-up for a child who is referred for additional screening, the PCP should schedule follow-up as soon as possible. All screening/rescreening should be completed by one month of age with diagnosis completed no later than three months of age.
Hearing Screening in the Neonatal Intensive Care Unit (NICU)
It is reported that the risk of hearing loss is 10 times greater among infants in the NICU, compared to infants in the Well-Baby Nursery. This means special attention must be given when screening infants in the NICU to ensure proper screening.
Infants in the NICU for more than five days (who are presumed to be at increased risk for neural hearing loss), must have automated auditory brainstem response (AABR) included as part
of their hearing screening. Hearing screens may be “missed” when newborns are transferred from one hospital/unit to another. Unless a different process has been established with the facility, the transferring hospital is responsible for reporting the hearing screen to the Kansas Department of Health and Environment (KDHE). By state law, NICU hearing screens must be reported within 7 days of the screen.
Infants in the NICU who do not PASS prior to discharge are sent directly to a pediatric audiologist for further evaluation. It is the responsibility of the hospital staff that discharges the baby to make sure that hearing screening is complete and that results are reported to KDHE.
Hearing Screening for Out-of-Hospital Births and Midwives
Kansas state law (Statute KSA 65-1,157a) requires all professionals attending a birth outside of a hospital to provide both verbal and written information to parents about the importance of hearing screening and where they can have their infant screened.
Many midwives throughout Kansas have trained with our program’s audiologists to perform newborn hearing screening and have access to the necessary screening equipment. Every midwife practice and out-of-hospital birth center performing newborn hearing screening should have a written policy and procedure to follow when screening newborns for hearing loss. The policy should address the following topics:
- Screening procedure
- Equipment
- Follow-up for infants with REFER results
- Communication with parents
- Staff training
- Staff re-training
- Documentation
- Reporting results to the Kansas Department of Health and Environment as well as the baby’s PCP
- Plan for equipment failure
- Quality assurance
Midwives who do not have access to hearing screening equipment should educate parents about newborn hearing screening and set up a hearing screening appointment with an appropriate health care professional before the infant is one month old.
Our program’s audiologist is available to assist in developing and revising these policies and procedures. Please contact our staff for sample policies and procedures or to arrange a site visit with an audiologist.
All newborn hearing screening and rescreening results (regardless of outcome) completed by the midwife provider will be transmitted to the Newborn Screening Program through the electronic birth certificate or via fax to the Kansas Newborn Hearing screening program. Kansas law requires all newborn hearing screen results to be sent within 7 days of the screening.
Audiologists
Audiologists must report all follow-ups on newborn screening referrals, including all newly confirmed permanent hearing loss through age eight, to the Kansas Department of Health and Environment (KDHE). Prompt report submission helps ensure timely follow-up so that infants with confirmed hearing loss can receive intervention services as soon as possible.
Signed, written consent from parents for submitting results to KDHE’s Newborn Screening Program (KSNBS) is not necessary under the mandatory hearing screening law. Audiologists have two options for reporting hearing screening results. We prefer that audiologists complete a written report with the infant’s screening results and hearing diagnosis then fax it to the KSNBS Program as soon as possible at 785-559-4240.
Audiologists who have access to the Kansas Newborn Hearing Screening database manually enter the results into the infant’s electronic chart and upload the written report into the Share Document section of the Hearing Screening database. Audiologists also enter scheduled follow-up appointments, which keeps the KSNBS staff informed of future appointments.
Physicians
The PCP, in cooperation with the audiologist, directs and coordinates the evaluation and referral process within the child’s medical home by:
- Referring a newborn that does not pass a hearing screening to a pediatric audiologist for a diagnostic audiologic evaluation if the baby has not already been referred.
- Providing 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.
- Referring a baby diagnosed with hearing loss to appropriate agencies capable of providing intervention services and to appropriate medical specialists (i.e., otolaryngologist and geneticist) as may be indicated by the diagnostic audiologic evaluation.
- Monitoring individual cases to assure that the diagnostic audiologic evaluation was completed, and facilitating the infant’s receipt of amplification if needed and linkage to Early Intervention services.
- Providing updates regarding the infant’s hearing status to KDHE upon request.
- Providing ongoing monitoring and surveillance of all children, especially those with risk factors for late-onset and early childhood hearing loss (such as babies who spent at least five days in the NICU). Approximately 2 to 3 babies per 1,000 are born with a hearing loss. Of babies with hearing loss, about 90% are born to hearing parents.
Hearing Screening Results
PASS Results
A “PASS” result means that the newborn exhibited normal hearing function in both ears during screening. Both ears must pass a single screening to be considered an overall passing result. Combining passing results in opposite ears on successive screens does not constitute a passing result.
Since hearing loss can occur at any time throughout a person’s life, health care professionals should continually monitor the following risk factors in all children who pass the newborn hearing screen:
- Family history of childhood hearing loss
- Exposure to infection before or after birth (e.g., cytomegalovirus or bacterial meningitis)
- Spending more than five days in the neonatal intensive care unit (NICU)
- Presence of other congenital and/or craniofacial anomalies
- Exposure to ototoxic medications
- Speech delay
REFER Results
A “REFER” result means that the newborn did not pass the hearing screen in one or both ears. A REFER result does not definitively mean that the newborn has hearing loss, but rather that additional testing is needed. Because newborn hearing screening is not a diagnostic test, some newborns may receive a REFER result but later be found to have normal hearing. Although false positives do occur, it is crucial that all REFER results receive attention and appropriate, timely follow-up.
Like all screening tests, newborn hearing screening inherently generates false positive results to avoid missing infants with hearing loss. Health care professionals should take the following action for every REFER result:
- Review information from the hospital
- Schedule rescreening or further evaluation by an audiologist as soon as possible (if not already scheduled by birthing facility)
- Contact the family and encourage prompt follow-up
- If hearing loss is confirmed, refer to early intervention, parental support, and specialty services
Comparison of OAE and AABR Measures
- Several studies have demonstrated that both OAE and AABR measurements can be used in UNHS programs to accurately identify infants with hearing loss.
- Both techniques can be implemented with automatic response-detection algorithms. This means that the personnel performing either test to screen newborns for hearing loss do not require extensive special training.
- OAE tests tend to be quicker and less expensive because they do not require the use of electrodes. Costs for AABR electrodes vary, but many health-care organizations require the use of disposable electrodes in efforts related to infectious-disease control.
- The accuracy of OAE measurements depends on the status of the external and middle ear. More infants fail OAE screenings compared to AABR tests primarily because of middle ear the presence of fluid in the middle ear or vernix in the ear canal at birth.
- AABR tests typically require more time than OAE tests and tend to be more expensive.
- AABRs are less susceptible to the status of the middle ear, and are more sensitive than OAEs to disorders such as auditory neuropathy or other neural problems.
- AABRs typically are elicited by clicks, which result in excitation of wide cochlear regions. Thus, a hearing loss restricted to a narrow range of frequencies might be missed if an AABR response is generated from other cochlear regions where function is normal.
- OAE tests, even those using clicks as stimuli, provide a more frequency-specific response than click-evoked AABR screening measures.
- Both OAE and AABR tests tend to identify mid-to-high frequency hearing losses with greater accuracy than hearing loss affecting lower frequencies. As the majority of permanent hearing losses affect mid-to-high frequencies, this should not be considered a major limitation of either test.
Risk Indicators
The Joint Committee on Infant Hearing (JCIH) recommends 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.
The 2007 JCIH Risk Indicators Associated with Permanent Early Onset and or Late Progressive Hearing Loss in Childhood:
- Parent, caregiver or PCP concern regarding hearing, speech, language or developmental delay.
- Family history of permanent childhood hearing loss.
- Neonatal intensive care stay greater than 5 days, which may include extracorporeal membrane oxygenation (ECMO) assisted ventilation, exposure to ototoxic medications (gentamicin and tobramycin) or loop diuretics (furosemide/lasix), and hyperbilirubinemia requiring exchange transfusion.
- In-utero infections such as cytomegalovirus, herpes, rubella, syphilis, and toxoplasmosis.
- Craniofacial anomalies, including those involving the pinna, ear canal, ear tags, ear pits, and temporal bone anomalies.
- Physical findings such as white forelock, can be associated with one of many syndromes (Waardenburg, Usher, Pendred) known to include sensorineural or permanent conductive hearing loss.
- Syndromes associated with hearing loss or progressive or late onset hearing loss such as neurofibromatosis, osteopetrosis, and Usher syndrome. Other frequently identified syndromes include Waardenburg, Alport, Pendred, and Jervell and Lange-Nielson.
- Neurodegenerative disorders, such as Hunter syndrome, or sensory-motor neuropathies, such as Friedreich’s ataxia and Charcot-Marie-Tooth syndrome.
- Culture-positive postnatal infections associated with sensorineural hearing loss, including confirmed bacterial and viral (especially herpes and varicella) meningitis.
- Head trauma, especially basal skull/temporal bone fracture requiring hospitalization.
- Chemotherapy.
Physician Resources
Helpful Documents
- Kansas Hearing Screening Guidelines (PDF)
- EHDI Patient Checklist for Pediatric Medical Home Providers (PDF)
- EHDI Care Coordination Plan (PDF)
- Facts about Pediatric Hearing Loss (PDF)
- Kansas Protocol for Newborn Hearing Screening (PDF)
- List of Pediatric Audiologists in Kansas (PDF)
- Cultural Competence Health Practitioner Assessment
- Joint Committee on Infant Hearing Position Statements
- Parent Education & Information
- Hearing Loss, Genetics and Your Child Brochure (PDF)
- Causes of Hearing Loss Basic Genetics
- Unilateral and Mild Hearing Loss
- Guidelines for Audiologists Providing Informational and Adjustment Counseling to Families of Infants