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Complete Health Indicator Report of Newborn Hearing Screening

Definition

Utah has had mandated screening for hearing loss for newborn infants since 1998. Because half of the children with hearing loss have no identifiable risk factors, universal screening (instead of targeted screening) is done to detect children with permanent congenital hearing loss (PCHL). There is good evidence that newborn hearing screening testing is highly accurate and leads to earlier identification and treatment of infants with hearing loss. Healthy People 2020 Objectives addressed in this report include: * HP 2020 ENT-VSL-1.1 Percentage of newborns who are screened for hearing loss no later than age 1 month. * HP 2020 ENT-VSL-1.2 Percentage of infants who did not pass hearing screening who received audiologic evaluation by age 3 months. * HP 2020 ENT-VSL-1.3 Percentage of infants with confirmed hearing loss enrolled in intervention services no later than age 6 months.

Numerator

ENT-VSL-1.1 Number of newborns screened for hearing loss by one month of age[[br]] ENT-VSL-1.2 Number of newborns who received an audiologic evaluation following failed hearing screening[[br]] ENT-VSL-1.3 Number of infants with confirmed hearing loss enrolled in Early Intervention

Denominator

ENT-VSL-1.1 Number of occurrent births in Utah[[br]] ENT-VSL-1.2 Number of infants referred for audiologic evaluation[[br]] ENT-VSL-1.3 Number of infants with confirmed permanent hearing loss

Why Is This Important?

It is extremely important for hearing loss to be detected early to optimize speech and language development. The most effective method to implement early identification of hearing loss is to screen all babies before they leave the birthing hospital or by one month of age, diagnose permanent hearing loss quickly, and begin intervention as soon as possible.

Healthy People Objective ENT-VSL-1:

Increase the proportion of newborns who are screened for hearing loss by no later than age 1 month, have audiologic evaluation by age 3 months, and are enrolled in appropriate intervention services no later than age 6 months
U.S. Target: Not applicable, see subobjectives in this category

Other Objectives

Healthy People 2020 sub-objectives and targets for ENT-VSL-1: {{style color:#003366 ENT-VSL-1.1:}} Increase the proportion of newborns who are screened for hearing loss no later than age 1 month * '''U.S. Target:''' 90.2 percent * '''Utah Target:''' 97.0 percent[[br]] [[br]] {{style color:#003366 ENT-VSL-1.2:}} Increase the proportion of newborns who receive audiologic evaluation no later than age 3 months for infants who did not pass the hearing screening * '''U.S. Target:''' 72.6 percent * '''Utah Target:''' 72.6 percent[[br]] [[br]] {{style color:#003366 ENT-VSL-1.3:}} Increase the proportion of infants with confirmed hearing loss who are enrolled for intervention services no later than age 6 months * '''U.S. Target:''' 55.0 percent * '''Utah Target:''' 70.0 percent

How Are We Doing?

The Utah Early Hearing Detection and Intervention (EHDI) Program within the Utah Department of Health oversees newborn hearing screening in Utah and documents hearing screening on over 98% of newborns. In 2015, 98% of infants with documented screening results were screened by one month of age (as reported to the CDC Survey), an increase from 96.2% reported for 2011 births. Many of the infants with screening delayed past one month are NICU (newborn intensive care unit) babies where screening may not be indicated until discharge (often after one month of age), or home births who may not have access to screening before one month. Babies in diagnostic process may receive confirmation of hearing loss after the optimal 3 month "window" although they received one or more diagnostic evaluations within that time. (e.g. Utah diagnostic percentages historically included COMPLETED diagnoses only - for 2011, 66% of infants in the diagnostic process had had one audiologic evaluation, but diagnosis was still incomplete before 3 months of age.) After closely reviewing the recommendations from the Joint Committee on Infant Hearing we updated our reporting process beginning with 2013 data to report infants who have had an initial diagnostic exam prior to 3 months of age. For 2015 reported data, of those who received a diagnostic exam, 74.6% were completed prior to 3 months of age.

How Do We Compare With the U.S.?

In 2014, Centers for Disease Control and Prevention (CDC) data showed that 97.9% of newborns in the United States (50 states, 5 territories, and the District of Columbia) were screened for hearing loss, with 96.1% screened by one month of age. Of those babies not passing the hearing screening, 57.6% had a diagnostic evaluation; 71.3% were diagnosed as either having or not having a hearing loss before 3 months of age. 2015 National data has not yet been published. Of infants "referred for evaluation"* in 2014: * % with no loss ** U.S.: 47.9% ** Utah: 52.0% [[br]] *% with hearing loss ** U.S.: 9.7% ** Utah: 20.6%* ''* For data tracking and reporting purposes, those "referred for evaluation" include all infants who did not pass their final hearing screening. While Utah is a 2-stage screening state, this number includes all infants who did not pass both inpatient and outpatient screens and were referred for diagnostic audiology, as well as those infants who did not pass inpatient screening and did not return for outpatient screening.''[[br]] [[br]] *% still pending (loss to follow-up/documentation/unknown) ** U.S.: 34.4% ** Utah: 13.9%[[br]] [[br]] National Early Hearing Detection and Intervention (EHDI) data shows the percent of infants born in 2014 with hearing loss receiving EI (Early Intervention) services by 6 months of age at 64.9%; Utah showed a 77% enrollment success rate by 6 months of age for 2014.[[br]] [[br]] ---- Data source: [http://www.cdc.gov/ncbddd/hearingloss/2014-data/2014_ehdi_hsfs_summary_h.pdf CDC] Published October 2016

What Is Being Done?

State legislation requires that ALL newborns, including those born at home, must have their hearing screened by one month of age and results reported to the Utah Department of Health. Increased efforts have been focused on providing screening equipment, support, and training for local midwives who collectively birth over 1,000 babies per year. The Utah Newborn Hearing Screening office supports tracking efforts and provides resource information to hospitals, local programs, and families. Improvements in the EHDI tracking surveillance system and decreasing loss to follow-up/documentation has been a priority for 2013-2015. Implementation of the Birth Certificate Alert Program, in collaboration with local health departments, began statewide in 2014. 26 of 29 local health departments are now participating. Alerts to parents applying for their child's birth certificate are generated if their infant has not yet completed the newborn hearing screening process. The Newborn Hearing Screening Committee endorses Healthy People 2020 goals and assesses progress quarterly.

Available Services

Resource information on screening and diagnostic providers, hearing loss, and intervention services along with related handouts are available through the Utah Department of Health (UDOH) Early Hearing Detection and Intervention (EHDI) Program. Statewide hearing screening and audiology diagnostic providers can be found at: [http://ehdipals.org EHDI-PALS] Families of infants identified with permanent hearing loss are offered targeted services for hearing impaired infants through the UDOH Baby Watch Early Intervention Program and the Utah Schools for the Deaf and Blind Parent Infant Program.


Related Indicators

Relevant Population Characteristics

All hospitals and birth attendants are required to participate in newborn hearing screening by legislative mandate. Hospital programs have screening equipment on site and do a very good job of screening babies prior to discharge. For babies who require follow-up, completion rates are dependent upon individual hospital commitment, location, and patient demographics. Actual screening rates for home births reflect local availability, cost, and convenience for families. Home birth hearing projects have increased out-of-hospital screening rates from 23% in 2007 to more than 81% in 2013.

Related Relevant Population Characteristics Indicators:


Health Care System Factors

All hospitals are required to participate in newborn hearing screening by legislative mandate. However, actual screening rates and timelines are dependent upon individual hospital commitment, regardless of demographics.

Related Health Care System Factors Indicators:


Risk Factors

The National Joint Committee on Infant Hearing, Year 2007 Position Statement lists hearing risk factors which are addressed by Utah newborn hearing programs. [http://www.cdc.gov/ncbddd/hearingloss/documents/JCIH_2007.pdf] Appendix 2, Page 24.

Related Risk Factors Indicators:


Health Status Outcomes

The critical age for initiating habilitation for hearing loss is prior to six months of age. Most infants receiving intervention by this age develop language and social skills approximating their normal hearing peers by kindergarten enrollment. Intervention delayed beyond six months has been shown to have less successful outcomes.



Graphical Data Views

Newborn Hearing Screening ENT-VSL-1.1: Screening for Hearing Loss No Later Than Age 1 Month, Utah, 2010-2015

::chart - missing::

Screening for hearing loss is completed by hospital staff prior to discharge or for infants born outside a hospital setting by the attending midwife or local audiologist. Screening includes an A-ABR or OAE as recommended by Joint Committee on Infant Hearing (JCIH, 2007).
Hearing ScreeningYearPercentage of Newborns
Record Count: 18
By 1 Month201096.2%
By 1 Month201196.3%
By 1 Month201296.2%
By 1 Month201396.7%
By 1 Month201497.0%
By 1 Month201597.1%
After 1 Month20102.4%
After 1 Month20112.5%
After 1 Month20122.6%
After 1 Month20132.2%
After 1 Month20141.9%
After 1 Month20151.9%
Not Screened20101.4%
Not Screened20111.2%
Not Screened20121.2%
Not Screened20131.1%
Not Screened20141.1%
Not Screened20150.9%

Data Notes

New hearing screening objectives adopted in 2010 therefore trend data begins in 2010. Infants should be screened by 1 month of age. Infants not screened include infants who are deceased, refused screening, or lost to follow-up.

Data Source

NBHS - HI*TRACK Hearing Screening Tracking and Data Management (C) HI*TRACK, Utah State University


Newborn Hearing Screening ENT-VSL-1.2: Infants Receiving Audiologic Evaluation Following Failed Hearing Screening, Utah, 2010-2015

::chart - missing::

When an infant does not pass newborn hearing screening the infant is referred to an audiologist to perform diagnostic testing. The diagnostic testing should be performed by 3 months of age.
Timely Diagnostic EvaluationYearPercentage of Infants with Diagnostic Evaluation
Record Count: 18
By 3 Months201014.0%
By 3 Months201119.2%
By 3 Months201219.7%
By 3 Months201348.0%
By 3 Months201458.9%
By 3 Months201558.8%
After 3 Months201011.2%
After 3 Months201114.6%
After 3 Months201215.1%
After 3 Months201313.6%
After 3 Months201413.7%
After 3 Months201520.0%
No Diagnostics201074.8%
No Diagnostics201166.2%
No Diagnostics201265.2%
No Diagnostics201338.4%
No Diagnostics201427.4%
No Diagnostics201521.1%

Data Notes

New hearing screening objectives adopted in 2010 therefore trend data begins in 2010. Approximately 2% of all Utah births do not pass newborn hearing screening and require diagnostic follow-up. The Joint Committee on Infant Hearing (JCIH, 2007) recommends a diagnostic exam by 3 months but Utah numbers reflect a CONFIRMED hearing status by 3 months thus Utah's percent receiving a diagnostic evaluation are substantially lower due to the current tracking mechanism. This should increase in future years as now the system will track the first diagnosis whether confirmed or not. Not showing on this graph is that Utah's lost to follow-up rate has also decreased: *2010: 67.03% *2011: 55.21% *2012: 54.74% *2013: 31.1% *2014: 13.9%/3.4% removing "parent contacted unresponsive" (pcu) *2015: 12.2%/3.4% removing "pcu" [[br]] [[br]] Reasons for not having a diagnostic exam are broken out in [[a href="indicator/view/NewHearScr.EvalReas.html" ENT-VSL-1.2 (Part 2): Reasons for No Diagnosis]].

Data Source

NBHS - HI*TRACK Hearing Screening Tracking and Data Management (C) HI*TRACK, Utah State University


Newborn Hearing Screening ENT-VSL-1.2 (Part 2): Reasons for No Diagnosis, Utah, 2010-2015

::chart - missing::

Utah's Lost to Follow-Up number consists of those children who are "Contacted Unresponsive", "Unable to Contact", and "Unknown", however there are many reasons that families do not follow-up for services. Those "Other" include: in process (need tubes, cleft palate repair, etc.), non-resident, moved out of jurisdiction, unable to receive due to medical reasons, PCP did not refer, infant died, or the family declined. In 2014 the CDC gave states the option to remove "contacted but unresponsive" from their lost to follow-up numbers. For 2015, this would give Utah a lost to follow-up rate of ~3%.
Reasons for No DiagnosisYearNumber of Infants
Record Count: 24
Contacted Unresponsive201083
Contacted Unresponsive2011143
Contacted Unresponsive2012113
Contacted Unresponsive201388
Contacted Unresponsive201453
Contacted Unresponsive201543
Unable to Contact201029
Unable to Contact201176
Unable to Contact2012121
Unable to Contact201341
Unable to Contact201417
Unable to Contact201516
Unknown2010313
Unknown2011173
Unknown2012147
Unknown201324
Unknown20140
Unknown20151
Other201049
Other201178
Other201273
Other2013124
Other201468
Other20150

Data Notes

New hearing screening objectives adopted in 2010 therefore trend data begins in 2010.

Data Source

NBHS - HI*TRACK Hearing Screening Tracking and Data Management (C) HI*TRACK, Utah State University


Newborn Hearing Screening ENT-VSL-1.3: Infants With Confirmed Hearing Loss Enrolled for Intervention Services, Utah, 2010-2015

::chart - missing::

Infants with confirmed hearing loss should be enrolled in Early Intervention by 6 months of age to begin communication development as soon as possible.
Timely EnrollmentYearPercentage of Infants with Confirmed Hearing Loss
Record Count: 18
By 6 Months201044.6%
By 6 Months201154.8%
By 6 Months201257.0%
By 6 Months201352.0%
By 6 Months201454.8%
By 6 Months201557.1%
After 6 Months201035.4%
After 6 Months201128.8%
After 6 Months201213.0%
After 6 Months201319.0%
After 6 Months201416.3%
After 6 Months201518.4%
Not Enrolled201020.0%
Not Enrolled201116.4%
Not Enrolled201230.0%
Not Enrolled201328.9%
Not Enrolled201428.8%
Not Enrolled201521.4%

Data Notes

New hearing screening objectives adopted in 2010 therefore trend data begins in 2010. Infants not enrolled in Early Intervention (EI) may have opted-out when contacted by program staff for services or have been lost to follow-up. OVER 90% OF ALL CHILDREN WITH CONFIRMED HEARING LOSS ARE REFERRED TO EARLY INTERVENTION. Reasons for no EI enrollment are shown in [[a href="indicator/view/NewHearScr.EnrReas.html" ENT-VSL-1.3 (Part 2)]]. Lost to follow-up for Early Intervention has decreased since 2010: *2010: 10.8% *2011: 12.5% *2012: 19.0% *2013: 4.1% *2014: 8.7% *2015: 7.14% [[br]] [[br]] In 2012 reporting requirements changed to include the date of the Individualized Family Service Plan (IFSP), which was not readily available to Utah EHDI. If the original IFSP date was not reported, the CDC counted those children as "not enrolled". For 2015 data, 3 children are receiving monitoring services only.

Data Source

NBHS - HI*TRACK Hearing Screening Tracking and Data Management (C) HI*TRACK, Utah State University


Newborn Hearing Screening ENT-VSL-1.3 (Part 2): Reasons for No Early Intervention Enrollment, Utah, 2013-2015

::chart - missing::

Documented reasons for not being enrolled in EI services include: not eligible for Part C, non-resident, moved out of jurisdiction, infant died, family declined, contacted but unresponsive, unable to contact, and unknown.
Reasons for No EnrollmentYearNumber of Infants
Record Count: 24
Not Eligible for Part C20131
Not Eligible for Part C20141
Not Eligible for Part C20150
Non-resident20131
Non-resident20140
Non-resident20150
Moved out of Jurisdiction20136
Moved out of Jurisdiction20143
Moved out of Jurisdiction20154
Infant Died20132
Infant Died20142
Infant Died20153
Family Declined201320
Family Declined201415
Family Declined20157
Contacted but Unresponsive20131
Contacted but Unresponsive20145
Contacted but Unresponsive20154
Unable to Contact20130
Unable to Contact20140
Unable to Contact20151
Unknown20134
Unknown20144
Unknown20152

Data Notes

Reasons for no Early Intervention enrollment were not collected on CDC HSFS prior to 2013.

Data Source

NBHS - HI*TRACK Hearing Screening Tracking and Data Management (C) HI*TRACK, Utah State University


Newborn Hearing Screening: Number of Children with Diagnosed Hearing Loss, by Birth Year, Utah, 2010-2015

::chart - missing::

YearNumber of Children
Record Count: 6
201065
2011104
2012100
2013121
2014104
201598

Data Source

NBHS - HI*TRACK Hearing Screening Tracking and Data Management (C) HI*TRACK, Utah State University

References and Community Resources

For an extensive list of Newborn Hearing Screening related links, please see the Utah Medical Home Portal website at: [http://www.medicalhomeportal.org/newborn/hearing-loss-and-deafness]. National and local links are also available at: [http://www.cdc.gov/ncbddd/hearingloss/index.html] and [http://infanthearing.org]. Local Audiology resources can be found at: [http://www.ehdi-pals.org] and [http://www.infanthearing.org/statematerials/referred/UT-2012-Guide-to-Ped-Audio.pdf].

More Resources and Links

Evidence-based community health improvement ideas and interventions may be found at the following sites:

Additional indicator data by state and county may be found on these Websites:

Medical literature can be queried at the PubMed website.

For an on-line medical dictionary, click on this Dictionary link.

Page Content Updated On 10/05/2017, Published on 12/18/2017
The information provided above is from the Department of Health's Center for Health Data IBIS-PH web site (http://ibis.health.state.gov). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Tue, 23 October 2018 20:27:14 from Department of Health, Center for Health Data, Indicator-Based Information System for Public Health Web site: http://ibis.health.state.gov ".

Content updated: Mon, 18 Dec 2017 16:17:28 MST