Universal Newborn Hearing Screening Programs
Shulman et al report their survey of 55 state and territorial Universal Newborn Hearing Screening and Intervention (UNHSI) programs (including eight site visits). Significant and beneficial strides have been made with regard to screening infants at birth for permanent hearing loss. However, for children failing the hearing screening, “loss to
follow-up” remains a significant problem.
The authors identified four areas presenting barriers to follow-up (paraphrased below):
- Lack of service-system capacity. In many locations, there is insufficient screening equipment, a shortage of pediatric audiologists, inadequate early intervention services for identified children and a lack of family support programs.
- Lack of provider knowledge. Hospital staff, pediatricians and audiologists need new knowledge and skills to support increasing numbers of identified children. Most screeners are nurses and newborn care staff with little formal training in NHS. Indeed, most people performing screenings were trained by other screeners or manufacturers. Only one-third of the programs reported their screeners were trained with regard to how to present information to parents. Many pediatricians have a “wait and see” approach to hearing loss.
- Challenges to families in obtaining services. These challenges include lack of transportation and lack of insurance (i.e., cost) for services. Other challenges include language differences between the family and the provider.
- Information gaps. Gaps include poor communication among staff and providers, data systems that are not ideal and are often inaccessible to providers, and privacy-sharing laws and restrictions can confound the flow of information.
Shulman et al identified five key areas for improvement (paraphrased below):
- Improving data systems.
- Assuring all infants a medical home.
- Building capacity beyond identified providers.
- Developing family support services.
- Promoting early detection.
Thus, despite clear and obvious benefits from development and implementation of Universal Newborn Hearing Screening Programs, significant loss to follow-up is still occurring.
For More Information, References, and Recommendations
Shulman S, Besculides M, Saltzman A, Irelys H, White KR. (2010) Evaluation of the universal newborn hearing screening and intervention program. Pediatrics 126(1). Accessed from www.pediatrics.org and Pediatrics 2010;126,S19-S27, DOI: 10.1542/peds.2010-0354F.