Audiology Screening

Congenital hearing loss affects approximately 1 to 3 infants per 1000 live births. At least 37 states and the District of Columbia have legislatively mandated universal newborn hearing screening programs in the United States (National Center for Hearing Assessment and Management [NCHAM], 2005). In a 2008 update, USPSTF changed its recommendation on newborn hearing screening to a B recommendation, indicating that the evidence shows moderate certainty that there is a moderate net benefit to universal newborn hearing screening.

There are three acceptable screening tests to detect congenital hearing loss: automated auditory brainstem response (AABR), transient evoked otoacoustic emissions (TEOAE), and distortion product otoacoustic emissions (DPOAE) (Hayes, 2002; NCHAM, 2006). The AABR is a more expensive test but has a lower audiology referral rate than testing for TEOAE or DPOAE. TEOAE might have higher false-negative results in particularly vulnerable populations such as premature infants

Box 22-4 Examination Technique for the New Ballard Score

Neuromuscular maturity

Posture: Assign score when infant is relaxed and quiet.

Square window: Measure the angle of the wrist in flexion, between the hypothenar eminence and the forearm.

Arm recoil: Score the position of the arm after flexing the forearms for

5 seconds, fully extending the arm and releasing quickly.

Popliteal angle: Measure the angle of the popliteal fossil with the hip fully flexed and the knee extended with gentle pressure.

Scarf sign: Maneuver arm over opposite shoulder keeping scapulae on the exam table.

Heel to ear: Keeping the pelvis on the exam table and without forcing the leg, move the infant's foot toward the head.

Physical maturity

Skin: With increasing gestational age, the skin becomes thicker, tougher, and less transparent.

Lanugo: Describe the fine, downy lanugo hair as seen over the infant's back and scapulae.

Plantar surface of foot: Measure from the tip of great toe to the back of the heel.

Breast tissue: Describe nipple size, stage of development, and amount of breast tissue.

Eye/ear: Loosely fused eyelids open with gentle traction; the pinna in a term infant is well formed and quickly recoils after bending. Genitalia: Describe the development of the external genitalia.

Modified from Thureen PJ, Deacon J, Hernandez JA, Hall DM. Assessment and Care of the Well Newborn. 2nd ed. Philadelphia, Saunders, 2005.

or those hospitalized in the intensive care unit (Hayes, 2002). Many screening programs using TEOAE or DPOAE employ a two-stage screening program, where an infant who fails the initial screen will be tested with AABR before discharge (NCHAM, 2006). Infants who fail a hearing screening program should be promptly referred to a pediatric audiologist for further diagnostic testing.

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