Newborn Screening Information for Providers
Hearing Screening in the Hospital
Minnesota state law (Statute 144.966) outlines the following core responsibilities for all birth hospitals in Minnesota:
- Communicate newborn hearing screening information and parental options to parents prior to screening.
- Test all infants for hearing loss prior to discharge unless parents have signed the Parental Refusal of Newborn Screening form (found on the Education Materials and Forms page)
- Document all hearing screening results
- Inform parents, primary care providers, and the Newborn Screening Program of the hearing screening results within 10 days of screening
- Plan for alternative testing strategies when equipment is not working properly
Newborn hearing screening can be performed by volunteers, nurses, midwives, audiological technicians, audiologists, and other trained personnel. Initial training for those who perform newborn hearing screenings, as well as refresher trainings and periodic monitoring of staff performance, are essential to assuring quality screening. Studies have shown that on-going experience with screening is an important factor in maintaining low and accurate REFER rates in hearing screening. Therefore, the Newborn Screening Program recommends designating specific staff members to conduct hearing screens for all newborns at a given facility. A trained screener should be available at all times to ensure that every newborn is screened.
Providers are responsible for educating parents about hearing screening before screening takes place. Education materials to aid in the discussion about hearing screening are available free of charge and can be ordered on the Education Materials and Forms page. For more information on educating parents about newborn screening, including hearing screening, visit the Postnatal Education page.
Initial hearing screening is best performed after 12 hours of age and should be complete prior to discharge. Screening performed prior to 12 hours of age is more likely to yield a false positive result, depending on the equipment used. According to the Minnesota statute, the hospital that discharges the newborn home is responsible for ensuring that newborn hearing screening is complete.
Newborn hearing screening must be performed using objective physiological screening methods that do not require behavioral responses from the infant. Otoacoustic emissions (OAE) and automated auditory brainstem response (AABR) are the two types of technology proven to be effective in screening for hearing loss in newborns.
Each technology has its advantages and disadvantages. Either technology, or a combination of the two, is considered appropriate for newborn screening.
Policies and Procedures
Every nursery performing newborn hearing screening should have a written policy and procedure for staff to follow when screening newborns for hearing loss. A nursery’s policy should address the following topics:
- Screening procedure
- Follow-up for infants with REFER results
- Communication with parents
- Staff training
- Staff re-training
- Result reporting to MDH and primary care
- Plan for equipment failure
- Quality assurance
Newborn Screening Program audiologists are available to assist in developing and revising policies and procedures to fit the needs of individual hospitals. For sample policies and procedures or to arrange a site-visit with an audiologist, please contact the Newborn Screening Program.
In accordance with Minnesota statute, all newborn hearing screening results and follow-up arrangements should be conveyed to the newborn’s parents, the infant’s primary care provider, and the Newborn Screening Program.
Share hearing screening results with parents both verbally and in writing immediately after the screen is performed. If the infant receives a PASS result, give the parent(s) the PASS Result: Hearing Screening Result Notification sheet and explain that changes in hearing can occur at any time. Encourage parents to contact their infant’s primary care provider should concerns arise. If the infant receives a REFER result, give the parent(s) the REFER Result: Hearing Screening Result Notification sheet and discuss a plan for follow-up. Assist parents in scheduling the necessary appointments as soon as possible and encourage them to discuss hearing results with their infant’s primary care provider. Result notification sheets are available to order free-of-charge on the Education Materials and Forms page.
To the Primary Care Provider
Minnesota law requires that final results from the initial newborn hearing screen (regardless of test outcome) and any rescreening results be sent to the Newborn Screening Program. For all infants with REFER results requiring further testing, the Newborn Screening Program should be notified when and where follow-up testing will take place. Hearing screening results and follow- up plans should be communicated to the Newborn Screening Program within 10 days of screening.
The newborn screening cards used for blood spot collection are also designed to facilitate the reporting of hearing screening results to the Newborn Screening Program. Because the blood spots are used to screen for disorders that can be serious or even fatal, submission should never be delayed in order to wait for the newborn hearing screening results.
- If hearing screening is complete BEFORE collection of the blood spots, send the results to the Newborn Screening Program on the newborn screening card. Simply fill in the area in the lower right-hand corner of the card; there is no need to detach the “Hearing Screening Copy” in this situation.
- If hearing screening is not complete until AFTER the blood spots have been collected and submitted but the “Hearing Screening Copy” from the newborn screening card is still available, send results to the Newborn Screening Program separately on that form. Complete the demographic information, fill in the results, and send the form to the Newborn Screening Program using the same courier or transport service used for sending blood spots.
- If hearing screening is not complete until AFTER the blood spots have been collected and submitted and the “Hearing Screening Copy” from the newborn screening card is NOT available, there is no need to use an additional newborn screening card. The hearing screening results can be faxed to the Newborn Screening Program at 651-215-6285 using another form such as a discharge summary or the equipment printout with the infant’s complete identifying information.
Timely follow-up, thorough documentation, and effective communication between the Newborn Screening Program, providers, specialists, and families are key steps in the newborn hearing screening process that help facilitate prompt diagnosis, family support, and implementation of early intervention services.
All newborn hearing screening results should be documented in a hearing screening tracking and management system and in the infant’s medical record. Record keeping is essential for tracking infants who are “missed,” who require rescreening, and who may need to return for screening due to equipment failure. The hearing screening tracking and management system should also serve as a tool for tracking staff performance, for tracking which individuals were notified of the results, and for documenting follow-up plans.
Primary Care Provider
Infants whose final hearing screen result is a PASS do not require immediate follow-up. However, changes in hearing can occur at any time. Primary care providers are expected to continue to monitor hearing and discuss any parental concerns throughout the child’s life.
Infants whose final hearing screen result is a REFER require immediate follow-up. The primary care provider should refer the family to audiology for a diagnostic evaluation as soon as possible but at no later than three months of age.
Newborn Screening Program
Newborn Screening Program staff will contact birth hospitals, primary care providers, and specialists to ensure that every infant born in Minnesota undergoes a hearing screen and receives appropriate follow-up when necessary.
The Minnesota Early Hearing Detection and Intervention (EHDI) website provides many resources for inpatient screening including best practice guidelines, tools for improvement, and free education materials.