Newborn Screening

Universal Newborn Hearing Screening (UNHS)

It has long been recognized that unidentified hearing loss at birth can adversely affect speech and language development as well as academic achievement and social-emotional development. Historically, moderate-to-severe hearing loss in young children was not detected until well beyond the newborn period, and it was not unusual for diagnosis of milder hearing loss and unilateral hearing loss to be delayed until children reached school age.

Universal newborn hearing screening (UNHS) is widely recognized as the standard of care for newborns nationwide.  Universal newborn hearing screening is the first step in the early hearing detection and intervention (EHDI) process.  A screening is not a diagnostic evaluation but is a critical component of early hearing detection and intervention.  Without effective newborn hearing screening, detection of hearing loss is delayed resulting in delayed speech and language development that affects children into adulthood.

Universal newborn hearing screening (UNHS) has been mandated in Texas since 1999, with the goal being early identification of infants with hearing loss.  Successful implementation of UNHS requires cooperation between providers and coordination of services across multiple sites to ensure infants with potential hearing loss receive timely diagnostic evaluations and appropriately early intervention services.  Each step in the process is crucial to ensuring every infant at risk for hearing loss receive the services necessary to reach his or her fullest potential.

For Universal Hearing Screening Staff and Program Managers

As outlined in Joint Committee on Infant Hearing Year 2007 Position Statement, teams of professionals, including audiologists, physicians (neonatologists, pediatricians, other primary health care physicians, otolaryngologists), and nursing personnel, are traditionally involved in establishing the UNHS component of Early Hearing Detection and Intervention (EHDI) systems.  It is recommended that an audiologist be involved in each component of the universal newborn hearing screening program, particularly at the level of statewide implementation and, whenever possible, at the individual hospital level.  It is also recommended that hospitals and agencies designate a physician to oversee the medical aspects of the program.  All team members are to work together to ensure that screening programs are of high quality and are successful.

Physiologic measures must be used to screen newborns and infants for hearing loss.  These measures include Otoacoustic Emissions testing (OAE) and Auditory Brainstem Response (ABR), also referred to as Automated Auditory Brainstem Response (AABR).  Both OAE and ABR technologies provide noninvasive recordings of physiologic activity underlying normal auditory function, both are easily performed in newborns and infants and both have been successfully used for UNHS.  However there are important differences between the two measures. 

OAE measurements are obtained from the ear canal by using a sensitive microphone within a probe assembly that records cochlear responses to acoustic stimuli.  It requires little or no cooperation from the child, which makes it an especially accessioble test for infants, very young children, or children with multiple involvements who are not otherwise able to make noticeable responses to sound.  The child can be awake or asleep but has to be still and quiet.  The testing needs to be conducted in a quiet room.  OAEs reveal the status of the peripheral auditory system extending to the cochlear outer hair cells. 

In contrast, ABR measurements are obtained by placing surface electrodes on the child's head to measure neural activity generated from the cochlea, auditory nerve and brainstem.  These measures are recorded in response to acoustic stimuli delivered through an ear phone.  The child must be relaxed so that there is no muscle tension in the neck since this tension can mask test results.  Newborn's natural sleep state is very deep, therefore they can often be tested by ABR techniques while sleeping.  Older infants and children, however, often must be mildly sedated (and perhaps even sleep deprived prior to testing) so that they can go into a deep sleep for the duration of the test.  ABR measurements reveal the status of the peripheral auditory system, the eighth nerve, and the brainstem auditory pathway.

In Texas, Universal Newborn Hearing Screening is overseen by the Texas Early Hearing Detection and Intervention Program, Department of State Health Services.  The information below outlines important informtation for Texas EHDI professionals involved in the UNHS process.

What is the Texas Early Hearing Detection and Intervention Program?

The Texas Early Hearing Detection and Intervention Program's (TEHDI Program) purpose is to ensure all children who have hearing loss as newborn infants or young children are identified early and provided appropriate intervention services needed to prevent delays in communication and cognitive development.  The Texas Newborn Hearing Screening (NBHS) Program was established in 1999 through the passage of House Bill 714, and is currently being implemented in Texas facilities.  The Texas Department of State Health Services (DSHS) is the oversight agency.  The overall TEHDI goals are:

• Screen all newborns for hearing loss before 1 month of age, preferably before hospital discharge.
• Provide all infants who screen positive to have a diagnostic audiologic evaluation before 3 months of age.
• Provide all infants identified with a hearing loss to receive appropriate early intervention services before 6 months of age.

For more information, please visit: http://www.dshs.state.tx.us/tehdi/

Educational Materials

The TEHDI Program has developed educational materials for parents and providers. To view those materials, please click below or schedule a face to face presentation with one of the TEHDI Program educators:

• Sounds of Texas Brochure: https://secure.thstepsproducts.com/pdf/TEHDI1-324_0311.pdf
• Information For Parents to Be Brochure: https://secure.thstepsproducts.com/pdf/TEHDI1-325_0311.pdf
• Hearing Checklist for Parents: https://secure.thstepsproducts.com/pdf/TEHDI1-323_0311.pdf
• Did Not Pass for Parents: https://secure.thstepsproducts.com/pdf/TEHDI1-322_0311.pdf

To order the brochures above, please go to: https://secure.thstepsproducts.com/default.asp#newborn

• 1-3-6 Guide

To view the above brochure go to:  http://www.dshs.state.tx.us/tehdi/Audiology-Services-Information-for-Health-Professionals.aspx

To order, please contact the TEHDI Program at 512/776-6616.

Training Opportunities

The TEHDI Program offers online trainings, webinars, and face to face presentations.  There are several online trainings specific to UNHS and the Texas EHDI process.  These can be accessed at the following:

ü  Online CEU accredited training  https://secure.thstepsproducts.com/default.asp

ü  Online TEHDI Program specific training  http://www.tehditraining.com/UNHS/

ü  For face to face trainings that offer standard curriculum from a trained educator, please contact the TEHDI Coordinator at 512/776-7726.