2002 Annual Meeting on Successful Statewide
Early Hearing Detection and Intervention Programs
- Roundtable Summaries -

Roundtable Topic: What concerns do primary care physicians have about EHDI programs?
Session: 4:15 PM
Moderator: .

Summary

In February, 1999, the American Academy of Pediatrics (AAP) issued a policy statement endorsing the "implementation of universal newborn hearing screening." Consistent with this statement, most primary care physicians agree with the importance of identifying congenital hearing loss as early as possible.

According to the AAP statement, at least the following 5 criteria must be met in order to justify the implementation of universal newborn hearing screening programs:

1. An easy-to-use test that possesses a high degree of sensitivity and specificity to minimize referral for additional assessment is available.
2. The condition being screened for is otherwise not detectable by clinical parameters.
3. Interventions are available to correct the conditions detected by screening.
4. Early screening, detection, and intervention result in improved outcome.
5. The screening program is documented to be in an acceptable cost-effective range.

Although there are now enough data to show that all five of these criteria are achievable by effective universal newborn hearing screening programs, it is clear that not all programs are functioning this well. Experiences of the past five years with Early Hearing Detection and Intervention (EHDI) programs have also raised a number of other issues about which primary care physicians have expressed concern.

Issues

• Inappropriately high refer rates. Although many programs have low refer rates, it is not unusual to hear of programs in which 10-20% of newborns are referred for diagnostic testing.
• Poor follow-up. Many published reports of EHDI programs report that they are unable to confirm the presence of diagnostic results for 30% to 60% of referred children.
• Parental anxiety and stress. Although preliminary studies are encouraging, more research is needed about whether newborn hearing screening programs could result in negative side effects for the family.
• Reimbursement. Much newborn hearing screening legislation has been an "unfunded mandate." This may result in a financial burden for parents and unreimbursed services for physicians.
• Physician education. Because hearing loss is a relatively rare occurrence, many physicians are not "up-to-date" on how they can assist most effectively in diagnosis and treatment.
• Access to services. Finding well-qualified and experienced pediatric audiologists, ophthalmologists, and geneticists to whom they can refer patients is often a challenge.

American Academy of Pediatrics (1999). Newborn and infant hearing loss: Detection and intervention. Pediatrics, 103(2), 527-530.

www.babyhearing.org (this recently-announced website from Boys Town National Research Hospital contains a wealth of information which every primary care physician and parent should know)

American Academy of Pediatrics (2002). Principles and guidelines for early hearing detection and intervention programs (Joint Committee on Infant Hearing - Year 2000 Position Statement). www.aap.org/policy/infanthear.html

American Academy of Pediatrics (2001). More must be done to diagnose hearing loss early. AAP News, 18, 197.

American Academy of Pediatrics (2000). Pediatricians vital in coordinating care: Standardized newborn screening urged. AAP News, 17, 41.

Bachmann, K. R., & Arvedson, J. C. (1998). Early identification and intervention for children who are hearing impaired. Pediatrics in Review, 19, 155-165.

Mehl, A. L., & Thomson, V. (2002). The Colorado newborn hearing screening project, 1992-1999: On the threshold of effective population-based universal newborn hearing screening. Pediatrics, 109.

Finitzo, T., Albright, K., & O'Neal, J. (1998). The newborn with hearing loss: Detection in the nursery. Pediatrics, 102, 1452-1460.

Clemens, C. J., & Davis, S. A. (2001). Minimizing false-positives in universal newborn hearing screening: A simple solution. Pediatrics, 107.

Weichbold, V., & Welzl-Mueller, K. (2001). Maternal concern about positive test results in universal newborn hearing screening. Pediatrics, 108, 1111-1116.