The importance of having your baby's hearing tested

An investigative report on a Universal Newborn Hearing Screening (UNHS) program that was implemented at a private health care facility in South Africa showed that the UNHS program did not achieve the benchmark standard of 95% coverage, which is recommended by the Health Professions Council of South Africa (HPCSA).   

Veruschka Naidoo, a client relations executive at Oticon South Africa sites negative economic factors, a lack of staff training and poor public awareness as factors that attribute to the low coverage rate.  “One example of a shortfall in public awareness is the performance of the UNHS program in the Neo-natal Intensive Care Unit, which presented with a significantly lower coverage rate,” explains Naidoo.

The parents of children in the Neo-natal Intensive Care Unit are often in a fragile frame of mind and are very anxious.  “Their concern lies with the immediate well-being of their child and as a result they perceive the hearing screen as an additional test that could cause further distress to their infant.  They often don’t realise that some healthcare procedures may actually cause a hearing loss, which effectively means that they are making an uninformed decision about the care of their child,” says Naidoo.

Infants should be tested before 6 months

The HPCSA recommends that infants hearing be tested before the age of six months.  “If a hearing loss is identified after the age of six months, the child may already be experiencing a language development delay,” explains Naidoo.

Recommended screening technologies include oto-acoustic emissions (OAE), which assess cochlear (inner ear) functioning, and auditory brainstem responses (ABR), which record neural activity in response to sounds.  The tests are accurate and take one to three minutes to perform; and has the same sensation as simply putting a finger in the infant’s ear.

The report found that the age at which an infant was tested had a significant impact on the referral rate.  Screenings at the private health care facility, where the research was conducted were only offered from Monday to Friday, which played a role.  The discharge of an infant before they were three days old was an additional factor; or the latter, where an infant is screened before they were 2.8 days old.  

“At such a young age, the infant could fail the screening test because they may still have *vernix or amniotic fluid in the ear canal.  It is not something that you can remove with an ear bud as the baby’s body will naturally do so.  Such a blockage is more prevalent in babies that were delivered via a C-section in addition to micro preemie babies whose ear canals are still too small,” explains Naidoo.  The older the infants were when tested, resulted in a lower referral rate in the UNHS program.  

Naidoo’s analysis of the data further revealed that only 32% of the infants that failed the initial screening test had their hearing re-screened.  “This highlights the need for better tracking methods to ensure that more infants attend the re-screen,” she says.  “During a re-screen, the exact same test is performed, which will take a minimal amount of time.  The effort is well worth knowing what your child’s hearing status is and to provide the means to intervene, should it be needed.”

The prevalence of hearing loss in the selected sample was found to be 1.65 per thousand infants born.  “Four of the infants who were re-screened required further diagnostic testing,” says Naidoo.  “One of the infants presented with unilateral hearing loss, which validates the need for a bilateral pass criterion in UNHS programs.  Additionally, one of the two infants who were diagnosed with hearing loss had no high-risk factors that are commonly associated with hearing loss,” she adds.

Some high-risk factors that could flag a possible hearing loss:

  • family history of permanent childhood sensorineural hearing loss,
  • in-utero infections (rubella, toxoplasmosis, syphilis, cytomegalovirus) 
  • craniofacial anomalies, 
  • hyperbilirubinemia requiring transfusion, 
  • postnatal infections (otitis media, meningitis) 
  • stigmata associated with syndromes known to include sensorineural hearing loss (Downes, CHARGE, Waardenburg)  
  • syndromes associated with progressive hearing loss (neurofibromatosis, osteopetrosis, and Usher' s syndrome 
  • neurodegenerative disorders (Hunter Syndrome) and/or head trauma.

Some hearing milestones a child should reach in the first year of life:

  • Most newborn babies startle or "jump" with sudden loud noises.
  • By three months, a baby usually recognises a parent's or caregiver’s voice. 
  • By six months, an infant can usually turn his or her eyes or head towards a sound. 
  • By 12 months, a child can usually imitate some sounds and produce a few words, such as "Mama" or "bye-bye."

“The need to have a hearing screen test performed on your baby is essential.  It certainly warrants an evaluation of the costs of screening tests in addition to addressing staff training concerns.  More importantly, we need to create public awareness of the matter,” concludes Naidoo.

(* vernix:  The waxy or cheese-like white substance found coating the skin of newborn babies)

(Oticon press release)

(Picture: doctor examining baby from Shutterstock)

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