minnesota newborn screening program
Homebirths - Hearing Screening
Information for Out-of-Hospital Birth Providers
Minnesota state law (Minnesota Statute 144.966) requires all professionals attending a birth outside of a hospital to provide both verbal and written information to parents about the importance of hearing screening and where they can have their infant screened.
Thanks to a recent collaboration between the Minnesota Department of Health and the Minnesota Council of Certified Professional Midwives (MCCPM), many Minnesota midwives now have access to the necessary equipment to screen infants for hearing loss outside of the hospital. Please see the PDF below for an updated list of MCCPM members offering hearing screening. These midwives also offer newborn hearing screening to families who are not clients in their practice.
Practitioners who are not trained in performing a hearing screening or who do not have access to hearing screening equipment should arrange for a screening with another provider before one month of age. If practitioners are unable to locate hearing screening resources in their communities, they are encouraged to contact the Newborn Screening Program for guidance.
The following article written by a Colorado midwife and her client provides 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 on the Hands & Voices Web site.
Homebirth and Hearing Screening: A Dilemma in Public Health
Talking with Parents about Hearing Screening
Hearing screening equipment and trained personnel can be found in a variety of settings in Minnesota, including hospital nurseries, audiology offices, primary care clinics, public health departments, school districts, and midwife practices. Practitioners should familiarize themselves with the hearing screening resources in the communities where they attend births to help ensure that all newborns have access to early hearing screening and intervention services.
To help facilitate a discussion with families about the importance of newborn hearing screening, please see the handout below.
WHY is newborn hearing screening important?
Every year, about one in every 300 infants in Minnesota is born with a hearing loss that can be detected by newborn screening. Although these infants may startle to sound, they don’t have the hearing ability necessary for the development of speech and language. Identifying these infants 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 two or three years old. Those early years are essential for a child’s development of language and communication. Whether families chose oral, sign, or bimodal communication, early identification and intervention has demonstrated significant improvements in a child’s ability to access language.
WHEN should newborn hearing screening be performed?
Initial screening is best performed as soon as possible after 12 hours of age. The national recommended timeline for hearing screening to be complete is no later than one month of age.
Hearing screening is easiest to perform when the infant sleeps through the test. Since young infants sleep easily and often, the first month is the easiest time to nurse the baby and let it nap during the test.
The sooner the test is performed, the more quickly infants with hearing loss can be identified, and the sooner parents can learn the best way to care for and interact with their infants with hearing loss.
HOW is newborn hearing screening performed?
Newborn hearing screening does not require the infant’s participation. Unlike hearing tests done for older children and adults, infants do not have to raise their hands in response to test sounds. Rather, a computerized system generates a series of tones and the infant’s physiologic responses are measured.
There are two different technologies currently in use for newborn hearing screening – Otoacoustic Emissions (OAE) and Automated Auditory Brainstem Response (AABR). Both are acceptable for screening infants. With OAE, a soft rubber tip is placed in each ear that delivers soft tones and measures an echo that occurs when the ear is functioning normally. With AABR, earphones deliver the test sounds. Sensors placed on the infant’s head and neck measure the infant’s physiologic response to those sounds. For both OAE and AABR, a computer measures whether the result is a PASS or a REFER (not pass).
WHAT do the results mean?
If an infant receives a PASS result, the screening indicates that the infant’s hearing is normal at that time. Because hearing loss can occur at any time throughout a person’s life, parents should be taught to look for missed speech milestones and discuss any concerns with their child’s primary care provider. This vigilance is especially important if the child has a family history of hearing loss, was in the NICU for more than five days, has had multiple ear infections, has a birth defect, or had birth asphyxia. If parents have concerns about their child’s hearing or the child exhibits any of the above risk factors for progressive hearing loss, further testing is recommended.
If an infant receives a REFER result, the screening indicates that the infant needs further testing. MDH encourages providers to schedule the infant’s rescreen within two weeks of life to help facilitate prompt diagnosis and intervention.Updated Monday, 29-Jul-2013 10:47:36 CDT