Should Newborn Hearing Screening be the Standard of Care in the United States

1
The Status of Early Hearing Detection and
Intervention in the United States
2
Blindness separates people from things. Deafness
separates people from people. --- Helen Keller
3
Improvements in Hearing Screening Equipment
4
Number of Hospitals Doing Universal Newborn
Hearing Screening
Number of Programs
5
Endorsements for Universal Newborn Screening

• National Institutes of Health
• American Academy of Pediatrics
• Maternal and Child Health Bureau
• Centers for Disease Control Prevention
• Joint Committee on Infant Hearing
• American Academy of Audiology
• American Speech-Language-Hearing Association
• National Association of the Deaf

6
Why is Early Identification of Hearing Loss so
Important?

• Hearing loss is the most frequent birth defect.

7
Rate Per 1000 of Permanent Childhood Hearing Loss
in UNHS Programs

• Sample Prevalence
• Site Size Per 1000
• Rhode Island (3/93 - 6/94) 16,395 1.71
• Colorado (1/92 - 12/96) 41,976 2.56
• New York (1/95 - 12/97) 69,761 1.95
• Texas (1/94 - 6/97) 52,508 2.15
• Hawaii (1/96 - 12/96) 9,605 4.15
• New Jersey (1/93 - 12/95) 15,749 3.30

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Incidence per 10,000 of Congenital
Defects/Diseases
9
Why is Early Identification of Hearing Loss so
Important?

• Hearing loss is the most frequent birth defect.
• Undetected hearing loss has serious negative
  consequences.

10
Reading Comprehension Scores of Hearing and Deaf
Students
Grade Equivalents
Age in Years
Schildroth, A. N., Karchmer, M. A. (1986). Deaf
children in America, San Diego College Hill
Press.
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Effects of Unilateral Hearing Loss
Normal Hearing
Unilateral Hearing Loss
Math
Keller Bundy (1980)
(n 26 age 12 yrs)
Language
Math
Peterson (1981)
(n 48 age 7.5 yrs)
Language
Social
Bess Thorpe (1984)
(n 50 age 10 yrs)
Math
Blair, Peterson Viehweg (1985)
Language
(n 16 age 7.5 yrs)
Math
Culbertson Gilbert (1986)
Language
(n 50 age 10 yrs)
Social
Average Results
0th
10th
20th
30th
40th
50th
60th
Math 30th percentile
Percentile Rank
Language 25th percentile
Social 32nd percentile
12
Why is Early Identification of Hearing Loss so
Important?

• Hearing loss is the most frequent birth defect.
• Undetected hearing loss has serious negative
  consequences.
• There are dramatic benefits associated with early
  identification of hearing loss.

13
Boys Town National Research Hospital Study of
Earlier vs. Later
129 deaf and hard-of-hearing children assessed 2x
each year.
)
Assessments done by trained diagnostician as
normal part of early intervention program.
)
6
Identified lt6 mos (n 25)
5
Identified gt6 mos (n 104)
4
3
Language Age (yrs)
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_at_boystown.org
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Tremendous ProgressDuring the Last Decade

• Less than 30 hospitals with UNHS in 1993
  compared with more than 2000 today
• More than 2 million babies are screened every
  year prior to discharge
• 34 states have passed legislation related to
  newborn hearing screening

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The Other Side of the Coin . . . .

• 2,200 hospitals are not yet screening for hearing
  loss
• Almost 2 million babies are NOT screened every
  year prior to discharge
• Existing legislation is of variable quality
• Only 9 states (accounting for 7 of the births)
  have implemented reasonable statewide programs
• Follow-up rates are often alarmingly low
• Some hospitals have unacceptably high referral
  rates

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Implementing Effective EHDI Programs
out
Then a
miracle
occurs
Start
Good work,
but I think we might
need just a little
more detail right here.
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Status of EHDI Programs in the United States

• Universal Newborn Hearing Screening
• Effective Tracking and Follow-up as a part of the
  Public Health System
• Appropriate and Timely Diagnosis of the Hearing
  Loss
• Prompt Enrollment in Appropriate Early
  Intervention
• A Medical Home for all Newborns
• Culturally Competent Family Support
• Elimination of geographic and financial barriers
  to service access

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Goal of Workshop

• As a result of this workshop, participants will
• Develop a plan for implementing an effective
  statewide UNSHI program
• Outline the contents of the grant application to
  be submitted June 15th
• Understand how grant applications will be
  reviewed so that critical components can be
  included

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Resources are available to help
www.infanthearing.org