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Task Force recommends screening for hearing loss in all newborns

All newborn infants should be screened for congenital hearing loss that is present at birth, according to a new recommendation from the U.S. Preventive Services Task Force. The recommendation and the accompanying summary of evidence appear in the July 7 issue of Pediatrics.

Children whose hearing is impaired at birth, during infancy, or in early childhood can have problems with verbal and nonverbal communication and social skills, increased behavioral problems, and lower academic achievement compared with children with normal hearing. Infants at high risk for hearing loss include those who have spent more than 2 days in a neonatal intensive care unit; those diagnosed with certain syndromes, such as Waardenburg or Usher syndrome; and those with a family history of childhood hearing loss.

Because half of infants with hearing loss have no identifiable risk factors, the Task Force proposes universal screening, rather than targeted screening. Detecting and treating infants for hearing loss, rather than detecting it at a later age, provides better chances for positive outcomes such as stronger language skills.

For every 1,000 infants born in the United States, congenital hearing loss occurs in between 1 and 3 infants. Congenital hearing loss happens more frequently than other conditions typically screened for as part of a health care evaluation. Infants should be screened before they are 1 month old; those who do not pass the screening should receive further hearing and medical evaluation before they are 3 months old.

Thirty-nine States have enacted legislation related to universal newborn hearing screening. Laws differ on whether screening is mandated or encouraged, how results are reported, and how screening is funded.

The Task Force recommends screening using a two-step screening process that includes otoacoustic emissions followed by auditory brainstem response in those infants who fail the first test. Otoacoustic emissions check the inner ear response to sound and are measured by placing a very sensitive microphone in the ear canal to measure the ear's response. The auditory brainstem response checks the brain's response to sound and is measured by placing electrodes on the infant's head to record the brain's response to sound.

Good evidence was found that newborn hearing screening testing is highly accurate and leads to earlier identification and treatment of infants with hearing loss. Good evidence was also found demonstrating that early detection and treatment improve language outcomes.

The Task Force is the leading independent panel of experts in prevention and primary care. The Task Force, which is supported by the Agency for Healthcare Research and Quality (AHRQ), conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. Its recommendations are considered the gold standard for clinical preventive services. The Task Force based its conclusions on a report from a research team led by Heidi Nelson, M.D., at AHRQ's Evidence-based Practice Center at the Oregon Health & Science University in Portland.

The recommendations and materials for clinicians are available on the AHRQ Web site at http://www.ahrq.gov/clinic/uspstf/uspsnbhr.htm. Previous Task Force recommendations, summaries of the evidence, and related materials are available from the AHRQ Publications Clearinghouse.

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