Early Intervention and Newborn Screening

According to the World Health Organization (WHO), approximately 0.5–5 of every 1,000 infants are born with congenital or prelingual deafness, often classified within the severe to profound category. In the United States, screening newborns for auditory impairment is currently a standard of care. Each state has implemented its own Early Hearing Detection and Intervention (EHDI) program, of which 43 states have passed legislation relating to screening for hearing loss.

Two governing bodies, namely the U.S. Preventive Services Task Force and the Joint Committee on Infant Hearing, have acted on specific tasks that would ultimately establish universal programs for screening newborns. These efforts have thus resulted in the following national targets that should be utilized in assessing the performance of each EHDI system in every state: All newborns within the age of 1 month should undergo screening; a diagnostic test should be conducted in infants who do not pass the screening test before the age of 3 months; and children who have been diagnosed to be deaf or have difficulties in hearing will be immediately admitted into an early intervention program as soon as possible, possibly before they are more than 6 months old.

Approximately 95 percent of babies born in the United States undergo screening tests for deafness at birth. These nationwide activities have identified approximately 76,000 infants, accounting for 2 percent of infants who have undergone screening, as positive for hearing problems. These infants are then endorsed to undergo further evaluation, which could be either a rescreening for hearing loss or a diagnostic evaluation for auditory disorders. National statistics gathered in 2007 show that almost half of these babies do not have any documentation of their diagnosis and a majority are often “lost to follow-up,” or that further documentation of the infant has been stopped. Approximately 33 percent of the infants who have been diagnosed as having permanent hearing issues do not have documentation that they have received any services relating to early intervention.

The EHDI has thus been designed and implemented in every state in order to standardize and ensure that a hearing condition in infants is immediately detected and addressed. The process of EHDI is rather straightforward, consisting of phases that include screening, followed by diagnostic testing, and then referral to a specialist for early intervention. The initial phase of screening is generally performed within the hospital, soon after the birth of an infant. Rescreening is usually conducted after the infant has been discharged from the hospital; either the procedure is conducted in the same hospital when the infant is born, or the infant is [Page 334]referred to another facility. Due to the scarcity in pediatric audiologists, families residing in rural areas have to drive for hours to the nearest center for audiologic testing, which often consists of multiple sessions.

Children who have been positively diagnosed with permanent hearing conditions are then referred to a specialist, known as an otorhinolaryngologist, before further etiologic assessments are performed. A pediatric audiologist conducts the fitting of a hearing aid, which usually requires an appointment in a separate facility. Receiving services related to early intervention thus involves a progression from the health care system to the educational system, which then entails the inputs of audiologists, the child’s pediatrician, the instructors of the deaf, and therapists for speech perception, as well as educators.

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