Summary of Recommendation

The U.S. Preventive Services Task Force (USPSTF) recommends screening for hearing loss in all newborn infants (Table 1). B recommendation.

Rationale

Importance.Children with hearing loss have increased difficulties with verbal and nonverbal communication skills, increased behavioral problems, decreased psychosocial well-being, and lower educational attainment compared with children with normal hearing.

Detection.Because one half of children with hearing loss have no identifiable risk factors, universal screening (instead of targeted screening) has been proposed to detect children with permanent congenital hearing loss. There is good evidence that newborn hearing screening testing is highly accurate and leads to earlier identification and treatment of infants with hearing loss.

Benefits of detection and early treatment.Good-quality evidence shows that early detection improves language outcomes.

Harms of detection and early treatment.There is limited evidence about the harms of screening, with conflicting research findings regarding anxiety associated with false-positive test results. There is limited information about the harms of treatment. Complications of cochlear implant surgery include increased risk of meningitis; however, the overall risks of complications of screening and treatment are estimated to be small.

USPSTF assessment.The USPSTF concludes that there is moderate certainty that the net benefit of screening all newborn infants for hearing loss is moderate.

Clinical Considerations

• Patient population. This recommendation applies to all newborn infants.

• Assessment of risk. Risk factors associated with a higher incidence of permanent bilateral congenital hearing loss include neonatal intensive care unit admission for two or more days, several congenital syndromes, a family history of hereditary childhood sensorineural hearing loss, craniofacial abnormalities, and certain congenital infections. However, approximately 50 percent of infants with permanent bilateral congenital hearing loss do not have any known risk factors.

• Screening tests. Screening programs should be conducted using a one- or two-step validated protocol. One frequently used protocol requires a two-step screening process, which includes otoacoustic emissions followed by auditory brain stem response in those who do not pass the first test. Equipment should be well maintained; staff should be thoroughly trained; and quality control programs should be in place to reduce avoidable false-positive test results. Screening programs should develop protocols to ensure that infants with positive screening test results receive appropriate audiologic evaluation and follow-up after discharge. Newborns delivered at home, at birthing centers, or at hospitals without hearing screening facilities should have some mechanism for referral for newborn hearing screening, including tracking of follow-up.

• Treatment. Early intervention services for infants with hearing impairment should be designed to meet the individualized needs of the infant and family, including acquisition of communication competence, social skills, emotional well-being, and positive self-esteem. Early intervention includes evaluation for amplification or sensory devices, surgical and medical evaluation, and communication assessment and therapy. In recent years, cochlear implants have become more available for appropriate candidates; this surgery is usually considered in children with severe-to-profound hearing loss only after inadequate response to hearing aids.

• Screening intervals. All infants should be screened for hearing loss before one month of age. Infants who do not pass the newborn screening should undergo audiologic and medical evaluation before three months of age for confirmatory testing. Because of the elevated risk of hearing loss in infants with risk indicators, an expert panel has recommended that these children undergo periodic monitoring for three years.¹