Why follow-up care is crucial when a newborn refers on hearing screening
Our baby will receive many tests and treatments in their first days of life, from Apgar scoring to measure their reflexes and eye drops that eliminate germs to their first series of vaccinations.
Among the most important of these is the newborn hearing screening. From birth, babies use information from their surroundings to access early language – the foundation for a lifetime of communication.
Babies who are born deaf or hard of hearing need additional support to access language. Knowing early whether a newborn has hearing loss gives families the best chance to improve their hearing and language development.
There are two types of hearing screenings for newborns. Both are painless and work by introducing sound into the baby’s ear and analyzing the ear’s function:
Otoacoustic emissions (OAE) – the standard that many hospitals use. OAE measures activity from the hair cells in the inner ear that bring sound vibrations to the cochlea, a structure that transforms the vibrations into signals that travel up the brainstem.
Auditory brainstem response (ABR) – an advanced technology that UT Southwestern and Parkland Health use. ABR assesses more of the auditory pathway, recording neural impulses from the cochlea and all the way through the upper levels of the brainstem.
OAE screening is sufficient for most newborns, but ABR screening reduces the number of vulnerable babies who might get left behind. For example, preemies may have underdeveloped auditory nerves, causing hearing loss. Babies with auditory neuropathy spectrum disorder may have a cochlear response, but sound vibrations don’t make it to their brains.
Using ABR offers parents two layers of confidence in their newborn’s results. A trained technician performs the screening. At some institutions, including Parkland Hospital, if the baby does not pass, they get a second ABR with an audiologist – a doctor who specializes in hearing – before they go home from the hospital.
Angela Shoup, Ph.D., previously Chief of the Division of Communicative and Vestibular Disorders at UT Southwestern Medical Center, and now Executive Director of the Callier Center for Communication Disorders, Professor at UT Dallas and Clinical Professor at UT Southwestern was a champion in developing this advanced process. Learn more below about Dr. Shoup’s 25-year passion for universal newborn hearing screening.
Newborns that do not pass the hospital hearing screening may have acute or chronic hearing loss. These babies need advanced follow-up within two weeks. At that visit, we can determine whether the problem is temporary or chronic – and what the baby needs in order to access early language development.
What causes babies to fail their hearing screening?
Deafness and hearing loss can be caused by genetic abnormalities, birth defects, or maternal infections during pregnancy. In some cases, the baby will immediately show signs of hearing loss, such as not responding to sounds or failing their hearing screening.
Rarely, a baby who can hear and process sound might nonetheless fail their newborn hearing screening. Some of these include babies who:
Stayed in the NICU: Babies go to the neonatal intensive care unit (NICU) for high-risk health issues, some of which can damage hearing. For example, serious breathing problems can decrease oxygen to the brain, resulting in inner ear or auditory nerve damage. Maternal health complications such as diabetes or substance use disorder can also negatively impact hearing.
Had fluid in their ears: Some newborns get fluid in their middle or inner ears during the birth process, and it can take a few days for the fluid to clear. Approximately 10 percent of babies with fluid in their ears may develop lasting hearing loss that requires treatment, according to the American Academy of Otolaryngology – Head and Neck Surgery Foundation [PDF].
Had jaundice: Jaundice is a temporary condition that causes approximately 60 percent of newborns to temporarily have yellowed skin and eyes. The baby’s liver must adapt to filtering out the chemical bilirubin – which is handled by the mother’s liver during pregnancy. Short-term elevations of bilirubin levels, as well as severe and untreated jaundice, can cause hearing loss.
Had a CMV infection: Congenital cytomegalovirus (CMV) is a viral infection that can cause severe disease if a baby is infected before birth. In the U.S., 0.5-0.7 percent of babies are born with CMV, and approximately 90 percent of those have no symptoms at birth. However, 10-15 percent of asymptomatic babies develop hearing loss over time. Visit the National CMV Foundation to learn more.
Aspirated meconium: Occasionally, a baby swallows their own feces (poop) during birth. With quick treatment, breathing complications generally resolve quickly. However, some antibiotics used to treat meconium-related infections, such as gentamicin, can damage the sense organ of hearing.
If your baby experienced these issues and passed their newborn hearing screening, they still will likely need follow-up screenings throughout childhood. Hearing loss can develop over time, and your baby may need close monitoring and screening for hearing loss through young adulthood.
If the baby did not pass the newborn hearing screening, it’s important that the baby receive an advanced follow-up screening within 10-12 days for the best chance at receiving early intervention and unlocking their early language development.
