by Margaret Lanier, early education hearing detection and intervention coordinator,
Alaska Department of Health and Social Services
Each year in Alaska, approximately 10,000 babies are born and 30 to 40 are likely
to have some type of congenital hearing loss. Hearing loss is the most common
birth defect in newborns, with a higher incidence than cerebral palsy, Down
Syndrome, and severe mental retardation.
The most important period for speech and language development is from birth
to age three, making early identification of hearing loss critical. This is
why implementing newborn hearing screening in birthing facilities is so important.
Through the screening, infants with hearing loss can be identified at birth,
and be enrolled into early intervention immediately. Such intervention includes
diagnostic screening with an audiologist, the use of assistive technology, and/or
introduction to sign language if appropriate, again from a very young age.
Unfortunately, the average age of identification of hearing loss in children
in the absence of newborn hearing screening is two to three years of age. This
delay in diagnosis can impair a child’s language, speech, psychosocial,
and cognitive development.
A generic newborn hearing screening protocol at a birthing facility or hospital
might look something like this; upon admittance to the facility and ideally,
throughout the prenatal period, parents receive information on newborn hearing
screening. Parents who do not wish their infants to be screened can refuse.
However, most hospitals ask parents who refuse to sign a waiver because of liability
issues. If the parents sign a waiver, they may be given some information on
hearing milestones when sent home.
Most other babies will be screened prior to discharge from the nursery/NICU.
The screening results are either pass or refer (no pass). If a baby passes,
parents will be given a congratulations card and information on hearing milestones.
A “refer” will appear if the baby did not pass in one ear or both
ears. If a baby “refers” on the first screening, most hospitals
attempt to do at least one more screen prior to discharge. If the baby does
not pass the second screen he/she is referred for diagnostic testing to an audiologist.
Once a hearing loss is confirmed, the baby and family are referred to their
pediatrician and to appropriate local early interventions and other needed services.
A third possibility, one that is not common but does happen, is that a baby
is missed and does not receive screening before being sent home. If the baby
is missed in the nursery, the hospital calls the parents to schedule an outpatient
screening within an allotted amount of time. This is a major challenge in Alaska,
particularly in the rural communities, where many mothers come into the hub
town weeks before the due date. It is extremely difficult to get them to fly
back in from the village for a recheck if missed or for further diagnostic testing
if needed.
In April of 2000, the Alaska Department of Health and Social Services, Division
of Public Health, Section of Maternal Child & Family Health was awarded
a four year grant to plan and develop an Early Hearing Detection & Intervention
(EHDI) program. Program goals included:
1) Establishing a statewide advisory committee to assist in
program development and implementation. Stakeholders include physicians, public
and private insurance representatives, audiologists, public health nurses, early
interventionists, parents and persons who experience hearing loss.
2) Ensuring that babies born in Alaska have newborn hearing
screening prior to hospital discharge.
3) Ensuring that all newborns who fail hearing screening receive
an audiological evaluation by three months of age.
4) Ensuring that infants diagnosed with hearing loss are referred
to, and enrolled in, appropriate early intervention and other needed services
by six months of age.
In addition, the Alaska EHDI program received a grant from the Centers for Disease
Control & Prevention (CDC) to develop an electronic data tracking and surveillance
system to facilitate the follow-up process and ensure smooth transitions through
services.
Currently, 12 hospitals in Alaska have implemented newborn hearing screening
and approximately 60% of all babies born in the state receive the screening.
Please contact Margaret Lanier Kossler, EHDI Program Manager, at (907) 269-3466
if you have additional questions about the program.
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