Advocating for universal newborn hearing screening.

Universal newborn hearing screening and follow-up is an important detection and intervention program promoting childhood development and the acquisition of fundamental language, social, and cognitive skills. These skills provide the basis for later success in school and in society. Nursing has an important role to play in advocating for newborn hearing screening and in supporting families throughout the screening process. In an article titled "A Nurse-Managed Universal Newborn Hearing Screen Program," Brennan (2004) writes, hearing loss directly affects a child's ability to develop normal language skills, impairs his or her ability to communicate with others in the environment, and has been shown to correlate with poor academic performance. However, if hearing loss is detected early and interventions are begun before six months of age, children with hearing loss develop language, cognitive, and speech skills comparable to their non-hearing-impaired peers. (p. 322) The role of the nurse in collaboration with other health care professionals is to promote newborn hearing screening, accompanied by health teaching and counseling to ensure that the infant receives follow-up audiological assessment and that the family receives education and support services if the infant does not pass the initial screening. The definition of screening for purposes of this article is, "the detection of individuals with specific unrecognized health risk factors or disease processes that may be occurring" (Minnesota Department of Health, 2001). Best practices for screening encompass the use of health teaching and counseling in all screening, regardless of whether results are positive or negative. I wish to emphasize the importance of universal newborn hearing screening (UNHS) and identify three actions nurses and other health care professionals can take in promoting health teaching and counseling for families with infants diagnosed with hearing loss. REVIEW OF LITERATURE Meyer et al. (1999) conducted a quantitative study to determine incidence and risk factors for hearing disorders in a selected group of neonates and the feasibility of selective hearing screening. The research enrollment criteria focused on risk factors defined by the Joint Committee on Infant Hearing of the American Academy of Pediatrics (AAP) (2007) : * family history of hearing loss * in-utero infections * craniofacial anomalies * birth weight less than 1500g * critical hyperbilirubinemia * ototoxic medications * bacterial meningitis * postnatal asphyxia * mechanical ventilation less than 5 days * stigmata of syndromes associated with hearing loss The impact of maternal drug use, birth weight less than 10th percentile, persistent pulmonary hypertension, intracranial hemorrhage more than or equal to grade III, and periventricular leukomalacia were also evaluated. Researchers administered auditory brainstem response (ABR) tests to 777 infants. Follow-up examinations of 31 infants revealed persistent hearing loss in 18 infants (13 sensorineural, 5 from mixed disorders, 7 requiring amplification). The authors concluded that hearing screening in high-risk infants revealed a total of 5% of infants with pathologic ABRs (bilateral 2%). Significant risk factors were familial hearing loss, bacterial infections, and craniofacial abnormalities. Stone et al. (2000) conducted a quantitative study to ascertain if new technology has made UNHS an effective tool. They screened 1,002 hospitalized infants at 6 to 72 hours of age. The screening team consisted of a family practice physician, an RN, and two family practice residents. The cost to find one infant with sensory neural hearing loss was $22,114. They concluded that distortion product otoacoustic emissions (DPOAE) could be easily accomplished in a normal newborn nursery when a two-stage approach is used. These findings suggest that while DPOAE is an effective screening tool, there are questions of cost-effectiveness and challenges in effective follow-up with families whose newborns initially failed the DPOAE. …