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 (printable) page)
- Document all hearing screening results
- Inform parents, primary care providers, and the Newborn Screening Program of the hearing screening results within 7 days of screening
- Plan for alternative testing strategies when equipment is not working properly
- Schedule outpatient follow-up within 1-2 weeks for infants who do not pass (not a statutory requirement, but highly recommended for quality assurance)
Performing Newborn Hearing Screening
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, we recommend 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 in the well-baby nursery. Infants in the NICU must have AABR included as part of their 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
Our 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 our program staff.
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 Newborn Screening Program and Primary Care Providers
As of January 2017, all hospital submitters now complete secure electronic submission of newborn hearing screen results to the Newborn Screening Program directly from their hearing screening devices. All inpatient results (regardless of outcome) and any outpatient rescreening results completed by the nursery unit will be transmitted to the Newborn Screening Program in this way through MNScreen. Previously, hearing screening results could be reported in a section of the newborn screening card used for blood spot collection. This section will no longer be available for reporting of hearing screening results. Midwives who provide newborn hearing screening will also be transitioning to electronic submission of results during 2017.
Minnesota law also requires that final results from the inpatient newborn hearing screen (regardless of test outcome), and any outpatient rescreening results completed by the nursery unit, be sent to the infant's primary care provider. For all infants with REFER results requiring further testing, please notify the program and the primary care provider of when and where follow-up testing will take place. Hearing screening results and follow-up plans should be communicated to the primary care clinic within 10 days of screening.
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.
Final inpatient newborn hearing screening results should be documented in the infant’s medical record. If the birth facility did not schedule outpatient follow-up for a child who referred, the primary care provider should schedule follow-up as soon as possible. All screening/rescreening should be completed by one month of age, and diagnosis completed no later than three months of age.
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 and schedule the infant for follow-up as soon as possible. All screening/rescreening should be completed by one month of age, and diagnosis completed no later than three months of age.
Newborn Screening Program
Our 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.