Universal Screening of Newborns: The Promise and The Reality

It has been a long dream of our profession to screen the hearing of newborns based on the assumption that early detection and early intervention can and will minimize the negative consequences of childhood deafness. With the advent of automated ABR and OAE testing, the dream could technologically become a reality. Our national associations have become enthusiastic advocates of legislation promoting the establishment of universal screenings for all newborns.

Bess and Paradise (1994) suggested that despite our technologic abilities -- our profession was not ready to manage the consequences of universal screenings. Bess and Paradise were additionally concerned about high false positive rates and the lack of trained personnel available to manage families of the newly identified infants.

The N.I.H. Consensus Statement (1993) which gave sanction to the screening of newborns was also careful to state that screening programs should not be instituted unless a good management program was in place.

In 2000, nearly seven years later, we now have accumulated data regarding results of the early screening programs which clearly indicate that Bess and Paradise were prophetic and indeed, the admonition of the N.I.H. panel was not heeded.

Recent studies have indicated:

1. False positive rates hover between 50 and 90 percent (Mehl and Thomson, 1998, Mason & Hermann, 1998) Clearly these false positives are significant and can be the source of tremendous familial anxiety, fear and tension.
2. Additionally, Arehart et. al. (1998) determined that of 16 states with newborn screening programs, only fifteen percent of the sites reported the average age of confirmation (of the hearing loss) to be within the first three months of life. Further, only fifteen percent of the sites reported the average age of intervention to be within the first six months of life.

The above studies indicate we are sending home large numbers of newborns and parents with the mistaken notion that they have a deaf child. Further, of the families that actually do have a deaf child, eighty-five percent of those are not getting intervention prior to age six months.

Therefore, I wonder if we have actually done more damage through a large number of false positive identifications - or more good through a small number of early interventions? This is clearly a failure of management. Are hearing impaired and deaf children better off since the advent of universal screening? It hardly seems so.

The cost of universal screenings in both monetary and emotional terms are substantial, while the "real world" benefits have, as of yet, to be determined. It is likely that some families are actually harmed emotionally due to the significant high false positive rates and the lengthy period of time between true identification and intervention. Additionally, some people may lose faith in medical and audiological professionals as a result of the early, often inaccurate introduction to our professions.

I believe that at this time, it would be better for our profession to focus our energies on developing management components of universal screening programs, rather than promoting universal screenings in the absence of well established, outcomes-based, clinical and emotional management protocols.

Once we have the management team trained and available, we can then realize both the dream and the promise of universal screenings.

REFERENCES:

Bess, F. and Paradise, J. (1994) Universal Screenings for Hearing Impairment: Not so Simple, Not Risk Free, Not Necessarily Beneficial and Not Presently Justified. Pediatrics, 93 (2) 330-334.

Mehl and Thomson, V. (1998) Newborn Hearing Screening: The Great Omission. Pediatrics (97) 101-103

Arehart, K et. al. (1998) State of the States: The Status of Universal Newborn Hearing Screening, Assessment and Intervention Systems in 16 States. American J. Audiology 77 (2) 101-114.

National Institutes of Health Consensus Statement (1993) Early Identification of Hearing Impairment in Infants and Young Children.

Mason, J. and Hermann, K. (1998) Universal Infant Screening by Automated Auditory Brainstem response Measurement Pediatrics 101 (2) 221-228.