The Victorian Infant Hearing Screening Program Dr Melinda Barker VIHSP Co-director Maternal & Child Health Conference, October 2011

The Victorian Infant Hearing Screening Program (VIHSP) - history VIHSP - since 1992 High risk status ascertainment (1992 – present) + behavioural screening via distraction test at 7- 9m (1992 – 2005) VicNIC Pre-discharge AABR screening of all babies in NICU and associated SCNs Program of research into HL in childhood Public Health Hearing Group, Murdoch Childrens Research Institute/Royal Children’s Hospital

VIHSP Newborn Hearing Screening State-wide Rollout Phase & Year Hospitals% of Vic births & 2006 Tertiary maternity hospitals + co- located private hosps + RCH NICU 30% & 2009 Public metro maternity hospitals57% & 2010 Public and private regional maternity hospitals 78% & 2011 (Remaining) private metro hospitals100%

Basic principles of screening a screening test is not diagnostic: it is designed to identify those who are AT HIGHER RISK all screening tests will have a certain number of false positives and false negatives important that a positive result on a screening test results in referral to diagnostic testing condition being screened for should be an important health problem

Why screen for hearing loss in newborns? one in every 1000 babies will be born with a permanent, moderate or greater hearing loss in both ears that can be identified at birth without NHS, PCHI is detected late intervention by 6 months = better communication skills, including spoken language technology to screen neonates is quick, easy, painless diagnosis, early int & support services are available potential to relieve burden of disability caused by language delays and deficits academic delays and disadvantages social impairments economic disadvantages

The VIHSP screening process VIHSP screen #1 Pass result in both ears NFA Refer result in 1 or 2 ears VIHSP screen #2 Pass result in both ears NFA Refer result in 1 or 2 ears Referral to audiology by VIHSP Area Coordinator

Joint Committee on Infant Hearing (2000 & 2007) Benchmarks for key components of the UNHS/EHDI process Age (months) Benchmark 1Screen by 1 month of age 3 Diagnostic audiological evaluation by 3 months for infants at risk (refer result on screen) 6 Enrolment of infants with HI into early intervention by 6 months

A hearing screen is one of the routine health checks babies have soon after birth. This is a quick and simple way to check the hearing of newborn infants. Information brochure ‘Your baby’s hearing screen’ during one of the antenatal visits, in the pre- admission pack, or when the VIHSP screener visits after the baby is born.

Generally, the hearing screen will be done whilst the baby is still in hospital. A hearing screener attends the hospital room and the screen is done at the bedside. The hearing screener will explain the screen and will answer any questions parents might have.

If parents want their baby to have the hearing screen, they will be asked to sign a consent form. The screen is not compulsory, however almost all parents choose to have their baby’s hearing screened. The hearing screen is now the only routine hearing check that babies are offered.

The screen is quick and painless. Most babies are not unsettled by the screen and most stay asleep in their cots whilst the screen is being carried out.

The screener will put a sensor on the baby’s forehead, shoulder and neck. Two ear cups will be put over the baby’s ears and soft clicking sounds will be played to the baby. As the baby hears those sounds, the sensors will send his/her responses to the screening machine.

We can do the hearing screen whilst the baby is being cuddled or breastfed. The screener will give parents the results of the screen straight away.

A pass result means that the baby showed a clear response to the sounds played. Hearing losses can develop at a later time; if parents have concerns about their baby’s hearing they can arrange to have another hearing check at an audiology clinic.

We do not always get a clear response to the first screen. This might be because the baby woke up or became unsettled during the screen there was fluid or debris still in their ears from the delivery there is a hearing loss. If a baby does not pass their first screen, they have a repeat screen either before the baby goes home or as an outpatient.

A refer result means that, during two screens, we did not get a clear response from the baby to the sounds played. This could be because: the baby was unsettled during the screens there is still fluid or another temporary blockage in his/her ears the baby has a hearing loss.

The hearing screen does not diagnose a hearing loss. A refer result does not always mean that the baby has a permanent hearing loss. A refer result simply means that the baby needs to have a full hearing test at an audiology clinic. If the baby needs to have a full hearing test, the VIHSP Area Coordinator at the hospital will arrange this appointment at the audiology centre of the parent’s choice. What happens after a refer result?

Targeted surveillance: checking for risk factors Hearing loss risk factors assessment via universal maternal and child health service. Child Health Record used as the vehicle for targeted surveillance of infants at risk of progressive or acquired loss. Referral details recorded in CHR.

New Child Health Record Birth Details page Some risk factor information is recorded here

New CHR In Birth Details section Screen Results Page 1 Screener records - Results (Pass or Refer) - Date of screen completion

New CHR In Birth Details section Screen Results Page 2 Screener records - Result (Pass or Refer) - any risk factors present at time of screen

New CHR 8m page Targetted surveillance (risk factor follow up)

New VIHSP Referral Form

The VIHSP/MCH partnership n VIHSP recording of results of NHS referral coordination following NHS n MCH Following up on babies who have been referred Assisting to arrange screen for babies who missed it Risk factor ascertainment Screened babies (passed screen): at 8m [“targetted surveillance”] Language promotion Ongoing role in developmental surveillance

Why continue surveillance if a baby has passed the screen? n Hearing can change over time n Risk factors can change over time Therefore, n Regardless of screen result, the MCH nurse should review risk factors at the 6 -8 month visit and refer to audiology if any risk factors are present

Some results to date n Over 230,000 screened since 2005 n 98% capture rate n 97% screened within 30 days n 0.6 – 1.0% referred n Over 223 detected (rate approx 1 per 1000)

Comparing Median Age at Diagnosis (in months) – Victoria

n Screen shot

New website LIVE

For more information: The Victorian Infant Hearing Screening Program C/o Centre For Community Child Health Royal Children’s Hospital Flemington Road Parkville, Vic 3052 T: (03) F: (03) E: W: