Universal Newborn Hearing Test Endorsed by AAP.
Despite arguments by skeptics that such screening has not yet been shown to be cost effective, the AAP has endorsed nationwide implementation of the approach in a new policy statement.
The AAP policy states that up to 3 per 1,000 newborns in the well-baby nursery and up to 4 per 100 in intensive care have significant hearing loss in both ears.
Newborn screening implemented under guidelines set forth in the policy would seek to identify 100% of hearing loss prior to hospital discharge (Pediatrics 103:527-30, 1999).
Support for universal screening has been growing. Twelve states--Colorado, Connecticut, Hawaii, Indiana, Kansas, Maryland, Massachusetts, Mississippi, Rhode Island, Utah, Virginia, and West Virginia--already mandate it, said Karl White, Ph.D., director of the National Center for Hearing Assessment and Management and professor of psychology and special education at Utah State University, Logan.
Ten states have less extensive laws related to newborn hearing screening: Arizona, Arkansas, California, Florida, Georgia, Kentucky, Louisiana, New Jersey, Ohio, Oklahoma, Dr. White said.
But the American Academy of Family Physicians is not yet convinced. "We have found insufficient evidence at this time to recommend that newborn hearing screening be routine," said Dr. Herbert F. Young, director of the AAFP's scientific activities division.
in communities and health care systems that have started universal screening, AAFP members have seen high false-positive rates that increase costs, Dr. Young said in a telephone interview.
"We will continue to monitor this issue, and we look forward to an evidence-based review of the literature being done by the U.S. Preventive Services Task Force," he added.
Another skeptic is Dr. Jack L. Paradise, who argued in a commentary that universal screening is not the only, the best, or the most cost-effective way to achieve the goal of detecting sensori-neural hearing loss early (Pediatrics 103:670-72, 1999).
Other approaches have not been studied, but a widespread public education campaign focusing on parental awareness of signs of hearing loss might be equally effective, said Dr. Paradise of the University of Pittsburgh.
He also objected to screening of presumably normal infants because false positives exceed 90%. The possibility of adverse events related to these false positives has not been investigated.
Dr. Paradise cited the U.S. Preventive Services Task Force's 1995 statement that there is little evidence to support the use of routine, universal screening for all neonates. (The task force plans to review the recommendation.)
The main goal set forth in the AAP policy, and also in a 1994 statement of the Joint Committee on Infant Hearing, is detection of hearing loss in infants prior to age 3 months--preferably before discharge from the hospital--and appropriate intervention by age 6 months.
Early identification will prevent the impairment of speech, language, and cognitive development that is common in babies whose hearing loss is detected later; 14 months is currently the average age of detection of significant hearing loss, according to the AAP policy statement.
The AAP does not endorse any particular screening method. Two methods are currently available: Evoked otoacoustic emissions testing is based on the measurement of sound waves generated in the cochlea in response to clicks or tone bursts; automated auditory brain stem response testing uses scalp electrodes to measure electroencephalographic waves generated in response to clicks. The two can be used together to improve diagnostic accuracy.
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|Title Annotation:||American Academy of Pediatrics|
|Publication:||Family Practice News|
|Date:||Jun 1, 1999|
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