Newborn Screening Information for Providers:
Hearing Screening Out of Hospital Births
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.
For infants born outside of a birthing hospital, there are several options available to ensure that newborn hearing screening is performed before one month of age. There are many midwives throughout the state of Minnesota with access to screening equipment who have been trained by Newborn Screening Program audiologists to perform newborn hearing screening. The Minnesota Council of Professional Midwives (MCCPM), for example, has distributed hearing screening equipment to trained members practicing across the state to screen newborns for hearing loss. MCCPM members also offer newborn hearing screening to families who are not clients in their practice. Please see the PDF below for a list of MCCPM members offering hearing screening.
Midwives who do not have access to hearing screening equipment should educate parents about newborn hearing screening and set up a hearing screening appointment with another provider before the infant is one month of age. Midwives who refer families to other providers for hearing screenings are encouraged to fill out the Notification of Newborn Hearing Screening Appointment form and fax or mail it to the Newborn Screening Program. Copies of this form can be ordered free-of-charge on the Education Materials and Forms page.
The Newborn Screening Program can provide assistance in locating hearing screening resources in the community.
Screening may be performed by anyone who has been properly trained. Initial training for those who perform newborn hearing screening, as well as refresher trainings and periodic monitoring of staff performance, are essential to ensuring quality screening. Resources for training may include experienced screeners; local, licensed clinical and educational audiologists; MDH audiologists; hearing screening equipment manufacturers; and other online resources as recommended by the Newborn Screening Program. Midwives may select appropriate staff to carry out hearing screening and related duties.
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.
The initial hearing screen is best performed after 12 hours of age but at no later than three days postpartum. The screen may be performed before 12 hours of age if needed; however, early screens have a higher REFER (not pass) rate due to residual birthing debris in the ear canal. Infants who do not pass the initial hearing screen should be rescreened at the two-week postpartum check or at no later than one month of age.
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 advantages and disadvantages. Either technology, or a combination of the two, is considered appropriate for newborn screening.
Policies and Procedures
Every midwife practice and out-of-hospital birth center performing newborn hearing screening should have a written policy and procedure to follow when screening newborns for hearing loss. The 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 these policies and procedures. 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 you or 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 (if applicable)
Final results and any scheduled follow-up arrangements should be communicated in writing to the infant’s primary care provider within 10 days of screening. Results can be sent using a copy of the Hearing PASS Sheet or Hearing REFER Sheet that was given to the infant’s parent(s). Alternatively, results stored in the infant’s medical record can be faxed directly to the infant’s primary care provider.
To the Newborn Screening Program
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 blood spots are used to screen for disorders that can be serious or even fatal, submission of the newborn screening card should never be delayed to wait for hearing screening results.
- If hearing screening is complete BEFORE the collection of 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 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 mail the form to the Newborn Screening Program using the address on the bottom of the card.
- If hearing screening is not complete until AFTER 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 mailed or faxed to the Newborn Screening Program using another form 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 health record. Record keeping is essential for tracking infants who are “missed” or who require rescreening because of an initial REFER result or a screening equipment malfunction. The hearing screening tracking and management system should also serve as a tool for tracking staff performance, for tracking who is notified of results, and for documenting follow-up plans.
Infants whose final hearing screen result is a PASS do not require immediate follow-up. However, changes in hearing can occur at any time. The child’s hearing should continue to be monitored and any parental concerns should be discussed throughout the child’s life.
Infants whose final hearing screen result is a REFER require immediate follow-up. A diagnostic audiology appointment should be scheduled for the family as soon as possible but at no later than three months of age. The primary care provider (if applicable) and the Newborn Screening Program should be promptly notified of the date and time of the diagnostic audiology appointment to help facilitate timely services.
Newborn Screening Program
Newborn Screening Program staff will contact midwives/out-of-hospital birth centers, primary care providers, and specialists as needed to ensure that every infant born in Minnesota undergoes a hearing screen and receives appropriate follow-up when necessary.