Rescreening and Follow-Up Procedures
Infants failing hospital newborn hearing screening may be screened in the medical home.
Waiting interval: Rescreening should not be delayed for longer than one month after hospital discharge even if transient middle ear pathology is suspected or is being treated.
Choice of screening test: Rescreening should consist of either Otoacoustic Emissions Screening (OAE) or Automated Auditory Brainstem Response (AABR) screening testing. The choice of test should be determined by the type of test used for the initial hospital screening:
Although rare, auditory neuropathy spectrum disorder has been diagnosed more frequently in the NICU population, and may have implications for the infant's speech and language development. These children may pass an OAE screening test but will continue to fail the AABR.
OTOACOUSTIC EMISSION TESTING: Use of either Transient (TEOAE) or Distortion Product (DPOAE) testing devices is acceptable. Both ears should be screened even if the child only failed one ear. Make sure to set your screening unit to pass 3 out of 3 frequencies.
Pass Criterion: AT LEAST THREE FREQUENCIES IN EACH EAR MUST PASS
AUDITORY BRAINSTEM EVOKED RESPONSE (ABR): Air-conducted clicks should be presented through insert earphones or specialized infant earphones. Both ears should be screened even if the child only failed one ear.
Pass Criterion: Screening AABR is typically preset to pass if Wave V is present at 35 dB.
INFANT FOLLOW-UP PROCEDURES
WHAT TO DO WHEN AN INFANT FAILS THE RECREENING TEST:
The infant should be referred to a licensed audiologist for a diagnostic audiological assessment as soon as possible. Repeated attempts at rescreening will only delay the determination of hearing status.
A delay will also increase the likelihood that sedation will be required for the diagnostic ABR testing procedure and will delay appropriate intervention. (Infants older than 6 months usually need to be sedated for the diagnostic testing.)
If a middle ear problem is suspected, diagnostic audiological studies can be completed while medical management is taking place.
Each professional should have written information in the parent's native language to assist the parents in obtaining the diagnostic testing. Brochures and other useful information is available on the DHH website: www.ehdi.dhh.la.gov
WHAT TO DO WHEN AN INFANT PASSES THE RECREENING TEST:
The primary care physician is responsible for developmental surveillance at every well child check-up. Monitoring for speech/ language developmental milestones, auditory skills, and parental concerns should continue.
WHAT TO DO WHEN AN INFANT HAS A RISK FACTOR FOR DELAYED-ONSET HEARING LOSS:
The physician should review every infant's medical and family history for the presence of risk factors that require monitoring of delayed-onset or progressive hearing loss.
Children with risk indicators that are highly associated with delayed-onset hearing loss, such as family history of deafness, having received ECMO, or having CMV infection, should have diagnostic assessment by an audiologist at least annually. All infants with a lower risk indicator for hearing loss (such as NICU stay for over 5 days) should be referred for a diagnostic audiological assessment at least once by 24 to 30 months of age.