minnesota newborn screening program
Homebirths - Hearing Screening
Information for Homebirth attendants
Minnesota state law (Minnesota Statute 144.966) requires all professionals attending a birth outside of a hospital to provide information orally and in writing to parents regarding places where the parents may have their infants’ hearing screened and the importance of screening.
While it is unlikely that Minnesota midwives will perform hearing screening, they can be a vital source of information about the importance of hearing screening for families and may even learn to provide hearing screening themselves. The following article written by a Colorado midwife and her client provide an excellent beginning to a dialogue with families.
Welcome to your first few days of parenting a newborn!
We are writing to tell you the story of our daughter who was born at home. Our third child had a picture-perfect birth on the last day of summer. She received a thorough examination by our wonderful midwife at birth and at the many follow up visits, and also at one week by our physician. She was a very alert, “vocal” baby, who seemed so conscious of the people, sounds, and movement around her.
As Maddie began to crawl and venture further from her parent's laps, we noticed she didn't always turn to her name or look at us when we called. We did the classic parent test: dropping pans behind her head. She seemed to pass another examination at the doctor's office but this wise woman referred us to an ENT. We were stunned to learn that Maddie had a severe to profound loss and couldn't possibly have heard our speech. When tested at 16 months, she had the expressive and receptive abilities of a six-month-old or younger. We had no idea that deaf children might respond to some sounds, but not speech.
Imagine our grief that our beautiful baby girl had not heard a single lullaby, an "I love you", or even the names of her siblings - ever. We wondered if she would ever be able to talk or understand speech, to write, and to be able to support herself.
Since 1999, a simple hearing screening is available to all Colorado newborns. The babies sleep through the test, and it is over in a matter of minutes. Some midwives have training and equipment to do this screening, and most birthing hospitals can screen on an outpatient basis. This outing was our first trip out of the house with our next born daughter.
We hoped that sharing our personal story would encourage you to have your baby tested as a newborn. Hearing loss occurs far more frequently than PKU, hypothyroidism, cystic fibrosis, and other conditions routinely screened. Some types of hearing loss are entirely correctable if identified early. Homebirth families choose homebirth because of the quality care they receive – this screening is part of the newborn evaluation.
Life with a new baby is wonderful and crazy – the lack of sleep, the wonder, the worry. You may be tempted to put off the hearing screening. Please don’t. Hearing loss is invisible and can’t be tested without equipment. As babies grow older and are awake longer, sedation is needed for the test. Our daughter could have had access to communication at birth if we had known sooner that she couldn't hear. For the sake of your own baby, we hope you will take the time to educate yourselves on this issue.
For our daughter, deafness is a part of who she is forever. Today, Maddie is a skilled sign language user and has developed understandable speech. She's one of the lucky ones: many late identified children stay behind their peers in language development. The average age of children identified after birth without the hearing screening is 2½ years. Your midwife or the state office listed below can tell you where to get the screening, and you’ll know for sure that your baby can hear each “I love you.”
Sara and her midwife tell more of Maddie's story at Hands & Voices Web site.
Talking with Parents about Hearing Screening
The equipment and trained personnel to perform hearing screening can be found in a variety of settings in Minnesota, including: hospital nurseries, audiology offices, primary care clinics, public health departments, and school districts. Practitioners should familiarize themselves with the resources for hearing screening in the communities where they attend births. It is preferable to offer families several options. As you learn from families about their experiences with hearing screening in the different settings, you can refine the list you provide to future clients. If you are unable to locate resources for hearing screening in your community, please feel free to contact the newborn screening program for suggestions.
The following handout is designed to familiarize homebirth families with the importance of early hearing screening. Practitioners can list local resources on the form so parents can arrange for hearing screening. There is also a brief discussion of the value of newborn hearing screening to help guide the dialogue between parents and birth attendants.
WHY is newborn hearing screening done
Every year, about one in every 300 babies in Minnesota is born with a hearing loss that can be found by newborn screening. Although these babies may startle to sound, they don’t have the hearing necessary for development of speech and language. Finding these babies early and offering education, family support, and intervention before they fall behind in language development can make a big difference.
Without newborn screening, hearing loss often remains undetected until a child is 2 or 3 years old. Those early years are essential for a child’s development of language and family communication. When hearing loss is undetected, language development is usually delayed and children face frustration in school and life-long economic consequences.
Early identification of hearing loss in the frequencies needed to understand speech allows for early family education and intervention. New developments including infant education, hearing aids that can be fit for babies, and cochlear implants, offer parents a variety of ways to help their children learn spoken language.
WHEN should newborn hearing screening be done?
Screening should be done as soon as possible and screening is best completed before the infant is one month old.
Hearing screening is easiest to perform when the infant sleeps through the test. Since young infants sleep easily and often (although maybe not for as long as their parents would like), the first month is the easiest time to nurse the baby and let it nap during the test.
The sooner the test is done, the more quickly infants with hearing loss can be identified, and the sooner parents can learn the best way to care and interact with their babies with hearing loss.
HOW is newborn hearing screening done?
Newborn hearing screening does not require the infant’s participation. Unlike the hearing tests done with older children and adults, the babies do not have to raise their hands in response to a beep. Rather, a computerized system generates a series of tones and the infant’s physiologic responses are measured. The testing has been simplified so that it does not need to be done in a soundproof room, and a variety of individuals with different training can effectively screen babies. The testing is not painful or even uncomfortable.
There are two different technologies currently in use for newborn hearing screening - OAE and AABR. Both are acceptable for screening infants. OAE stands for Otoacoustic Emissions. With an OAE, the tester inserts a small probe into the baby’s ears The probe looks like the earbuds often used to listen to music. Soft tones are played through the speakers in the probe and the probe then measures the tones as they bounce back from the different parts of an infant’s ear. The computer attached to the small probe then determines whether the result is a PASS or a REFER.
AABR stands for Automated Auditory Brainstem Response. Sounds are played to the baby through earphones while the baby’s physiologic response to the tones is measured by small sensors placed on the skin. Again, the computer measures whether the result is a PASS or a REFER.
WHAT do the results mean?
If a baby has a PASS result, the screening indicates that the baby’s hearing is normal at that time. Parents should be be taught to look for certain developmental lags that could indicate that the child may have lost hearing as he or she got older. This vigilance is especially needed if the child has any of the risk factors that could lead to progressive hearing loss (see below).
If the baby has a REFER result, the screening indicates that the baby needs to be referred for further testing. Many children with REFER results have normal hearing when re-tested. These false positive results can be caused by many factors including: debris or fluid in the baby’s ear; a baby who didn’t settle down well during the test; and poor fit of the probes. It is important to get the re-testing done quickly so children with false positive results can be separated from those babies who truly have hearing loss.
Risk Factors for Hearing Loss that Require Further Testing
- Parental concern that child can't hear
- Family History of permanent childhood hearing loss
- Transfer to NICU and admission for > 5 days
- Multiple ear infections
- Birth defects
- Birth asphyxia