1. The Newborn Hearing Screening Programs At Inova Hospitals
Ken Henry, Ph.D.
Inova Fairfax Hospital For Women & Children
Falls Church, VA
Inova Fair Oaks Hospital
Fairfax, VA

2. Inova Fairfax NHS Program
Fairfax Hospital Census Approaches 11,000 Newborns Per Year
Average of 30 Per Day /Census Often Exceeds 50 Per Day
Level I NICU (50 Bed)
Fair Oaks Hospital Census Exceeds 3,000 Per Year
The Two Hospitals Represent Nearly 1/6 Of The Annual Birthing Census In The State Of Virginia

3. Inova Fairfax NHS Program
Personnel Considerations
Two Or More Screeners Present Every Day
One Screener Per Floor
Twelve Part-time Screeners (3 Audiologists)
Universal Screening Performed Daily
Three To Five Hours Per Day
Separate Protocols For WBN and NICU

4. Equipment - Fairfax Hospital
2 Automated OAE Systems (EchoCheck)
One Unit Per Floor
One Additional Backup System
2 Clinical OAE Systems (EchoPort ILO 88 TEOAE)
Quickscreen Protocol

5. Inova Fair Oaks NHS Program
Personnel Considerations
Ave. 11 Newborns Per Day
One Screener Daily
Equipment
1 Automated OAE System (EchoCheck)
1 Clinical OAE System (EchoPort ILO 88)
Quickscreen Protocol

6. Inova Fairfax Hospital Protocol
Well Newborn Screening Initially Began With 2 Stage Process
OAE (EchoPort)
AABR (Algo 2e)
AOAE (EchoCheck)
Evolved To A One Stage Screening
Rescreen Clinic – Two Stage Screen
Repeat TEOAE
AABR If Necessary

7. AOAE versus OAE The Efficacy of UNHS Was Well Established Using TEOAEs
We Were “Skeptical” About The Capability Of Automated OAE Technology
247 Newborns Were Assessed With AOAE, OAE and AABR. None Passed The AOAE And Subsequently Failed The OAE or AABR

8. AOAE versus OAE
33 Did Not Pass the AOAE (EchoCheck) But Did Subsequently Pass The OAE and AABR Conducted Immediately After Initial Screen
12 Did Not Pass the AOAE Or OAE But Did Pass The AABR
Implications?

9. The Use Of AABR Some “Unfair” Statistics
804 AABR records
AABR Screenings Were Conducted On Newborns Who Referred On First Stage Screen With TEOAE
Average test time minutes

10. Inova Fairfax Hospital For Children Multi-Stage Assessment

11. Inova Fairfax Hospital Multi-Stage Screen - TEOAE and AABR

12. Inova Fairfax Hospital TEOAE ONLY

13. Inova Fairfax Hospital Protocol
Separate Protocol For Screening Well Newborns and NICU Newborns
Active Level I Nursery
Clinical TEOAE and ABR Depending On Medical Status

14. NICU Protocol For Diagnostic ABR
Birthweight = OR <1000 Grams
Birthweight Grams (look at vent use & stability of baby- if “rocky” course- ABR
if very stable- OAE
TORCH
APGAR score at 5min. equal to or less than 6
Severe asphyxia, hypoxic ischemia, encephalopathy protracted seizures
Craniofacial anomalies
Chromosomal Abnormalities
CNS Abnormalities
IVH (Grade 2 or above)
PVL
hydrocephalus
malformations
meningitis
PPHN
Hyperbilirubinemia requiring exchange transfusions

15. Neonatal Screening Program For Inova Hospitals (Well Baby Nursery)

16. When Do You Refer For Diagnostic Audiology and/or Medical Evaluation?
JCIH 2000 recommendations for EDHI states: “ All infants who do not pass the birth admission screen and any subsequent rescreening begin appropriate audiological and medical evaluations to confirm the presence of hearing loss before 3 months of age”

17. OUTPATIENT RESCREEN CLINIC

18. SUMMARY OF EHDI PROCESS

19. “Summary”
Newborn Census and Personnel Will Dictate Choice in Equipment/Technology
Time-Cost Analysis Of Protocol
Final Outcome
Impact On The Community
Follow-Up
Personnel Resources
Parental Considerations
Insurance Considerations