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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 family history of deafness or hearing loss, universal screening is conducted to detect children with permanent congenital hearing loss (PCHL) as soon as possible. There is good evidence that newborn hearing screening 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 communication 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 two weeks of age to 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:''' 98.0 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:''' 86 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:''' 64.0 percent* *Utah Target based on CDC-EHDI Grant goals for 2017.

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 2016, 98% of infants with documented screening results were screened by one month of age (as reported to the CDC EHDI Hearing Screening and Follow-up Survey [HSFS]), an increase from 97.4% 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 the 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. 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 i.e., not "confirmed" 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 2016 reported data, of those who received a diagnostic exam, 82.5% were completed prior to 3 months of age (an increase of 7.9% from 2015).

How Do We Compare With the U.S.?

In 2016, Centers for Disease Control and Prevention (CDC) EHDI data showed that 98% of newborns in the United States (49 states, 7 territories) were screened for hearing loss, with 94.8% screened by one month of age. Of those babies not passing the hearing screening, 62.7% had a diagnostic evaluation; 75.9% were diagnosed as either having or not having a hearing loss before 3 months of age. ''* 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]] Of infants "referred for evaluation"* in 2016: * % with no loss ** U.S.: 52.9% ** Utah: 55.7% [[br]] *% with hearing loss ** U.S.: 9.7% ** Utah: 23.4%* [[br]] *% still pending (overall loss to follow-up) ** U.S.: 25.4% ** Utah: 14.5% [[br]] *% still pending (loss to follow-up due to Unable to Contact/Unknown) ** U.S.: 18.1% ** Utah: 2.0%[[br]] [[br]] *% still pending (loss to follow-up due to Contacted Unresponsive) ** U.S.: 7.2% ** Utah: 12.5%[[br]] [[br]] National Early Hearing Detection and Intervention (EHDI) data shows the percent of infants born in 2016 with hearing loss receiving EI (Early Intervention) services by 6 months of age at 67.3%; Utah showed a 81.6% enrollment success rate by 6 months of age for 2016.[[br]] [[br]] ---- Data source: [https://www.cdc.gov/ncbddd/hearingloss/2016-data/01-2016-HSFS-Data-Summary-h.pdf] Published May 2018

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/EHDI Program supports tracking efforts and provides resource information to hospitals, midwives, medical providers, local programs, and families. Improvements in the EHDI tracking surveillance system and decreasing loss to follow-up/documentation has been a priority, as well as matching EHDI data across other state programs (Utah Birth Defects Network, CCHD, Vital Records, etc.) 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

Resources for families and providers on deafness and hearing loss, state requirements, intervention services, and related handouts are available at [https://health.utah.gov/cshcn/programs/ehdi.html]. Statewide hearing screening and audiology diagnostic providers can be found at: [https://health.utah.gov/cshcn/programs/map.html]. Families of infants identified with permanent hearing loss are offered targeted services for deaf and hard of hearing children birth through 3 years of age through the UDOH Baby Watch Early Intervention Program ([https://health.utah.gov/cshcn/programs/babywatch.html BWEI]) and the Utah School for the Deaf Parent Infant Program ([https://www.usdb.org/programs/deaf-and-hard-of-hearing/ USDB]). Families in need of parent to parent support upon initial diagnosis or at any point throughout the EHDI process may contact EHDIparents@utah.gov. For up to date resources and community happenings, interested parties can follow the Utah EHDI Family Support and Information Facebook page (@UtahEHDI). Topics of interest to deaf and hard of hearing families are presented live monthly through the Utah EHDI WebinEARS series and are recorded and available on the Facebook page. The Utah Children's Hearing Aid Program (CHAP) provides access to hearing aids to children under 6 years of age for financially eligible families. For more information and/or to apply, visit [https://health.utah.gov/cshcn/programs/chap.html]


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 90% in 2016.

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, 2010-2016

::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 other community provider. Screening is accomplished through automated auditory brainstem response (A-ABR) or otoacoustic emissions (OAE) in accordance with the Joint Committee on Infant Hearing (JCIH, 2007).
Hearing ScreeningYearPercentage of Newborns
Record Count: 21
By 1 Month201096.2%
By 1 Month201196.3%
By 1 Month201296.2%
By 1 Month201396.7%
By 1 Month201497.0%
By 1 Month201597.1%
By 1 Month201697.2%
After 1 Month20102.4%
After 1 Month20112.5%
After 1 Month20122.6%
After 1 Month20132.2%
After 1 Month20141.9%
After 1 Month20151.9%
After 1 Month20162.0%
Not Screened20101.4%
Not Screened20111.2%
Not Screened20121.2%
Not Screened20131.1%
Not Screened20141.1%
Not Screened20150.9%
Not Screened20160.8%

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, 2010-2016

::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: 21
By 3 Months201014.0%
By 3 Months201119.2%
By 3 Months201219.7%
By 3 Months201348.0%
By 3 Months201458.9%
By 3 Months201558.8%
By 3 Months201665.3%
After 3 Months201011.2%
After 3 Months201114.6%
After 3 Months201215.1%
After 3 Months201313.6%
After 3 Months201413.7%
After 3 Months201520.0%
After 3 Months201613.8%
No Diagnostics201074.8%
No Diagnostics201166.2%
No Diagnostics201265.2%
No Diagnostics201338.4%
No Diagnostics201427.4%
No Diagnostics201521.1%
No Diagnostics201620.9%

Data Notes

New hearing screening objectives adopted in 2010 therefore trend data begins in 2010. Approximately 2% of all Utah births require diagnostic follow-up for not passing the newborn hearing screening 2-stage process. Not showing on this graph is that Utah's lost to follow-up rate has also decreased from 67.03% in 2010 to 2.0% in 2016.[[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, 2010-2016

::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 2016, this would give Utah a lost to follow-up rate of approximately 2%. The CDC defines lost to follow-up categories as follows: "Contacted Unresponsive" - "a documented two-way conversation or written communication with the child's legal parent or guardian in which they have acknowledged awareness and have nevertheless not obtained the recommended service"; "Unable to Contact" - "the parents or family were not able to be contacted because the EHDI program/hospital/provider did not have any current/correct contact information"; "Unknown" - "there is no documentation that they received any follow-up testing and there has been no documented contact with the parents". Not showing on this graph is that Utah's lost to follow-up rate has decreased: *2010: 67.03% *2011: 55.21% *2012: 54.74% *2013: 31.10% *2014: 13.9%/3.4% removing "parent contacted unresponsive" *2015: 12.2%/3.4% removing "parent contacted unresponsive" *2016: 14.5%/2.0% removing "parent contacted unresponsive"[[br]] [[br]]
Reasons for No DiagnosisYearNumber of Infants
Record Count: 28
Contacted Unresponsive201083
Contacted Unresponsive2011143
Contacted Unresponsive2012113
Contacted Unresponsive201388
Contacted Unresponsive201453
Contacted Unresponsive201543
Contacted Unresponsive201656
Unable to Contact201029
Unable to Contact201176
Unable to Contact2012121
Unable to Contact201341
Unable to Contact201417
Unable to Contact201516
Unable to Contact20169
Unknown2010313
Unknown2011173
Unknown2012147
Unknown201324
Unknown20140
Unknown20151
Unknown20160
Other201049
Other201178
Other201273
Other2013124
Other201468
Other201544
Other201629

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, 2010-2016

::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: 21
By 6 Months201044.6%
By 6 Months201154.8%
By 6 Months201257.0%
By 6 Months201352.0%
By 6 Months201454.8%
By 6 Months201557.1%
By 6 Months201659.0%
After 6 Months201035.4%
After 6 Months201128.8%
After 6 Months201213.0%
After 6 Months201319.0%
After 6 Months201416.3%
After 6 Months201518.4%
After 6 Months201613.3%
Not Enrolled201020.0%
Not Enrolled201116.4%
Not Enrolled201230.0%
Not Enrolled201328.9%
Not Enrolled201428.8%
Not Enrolled201521.4%
Not Enrolled201627.6%

Data Notes

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 95% 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%/3.1% removing "parent contacted unresponsive" *2016: 3.8%/0% removing "parent contacted unresponsive"[[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 there were 3 children receiving only monitoring services so 100% of children are not accounted for in the graph.

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, 2013-2016

::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. A goal of Utah EHDI for 2018 is to determine reasons families decline Early Intervention services. This will guide future Quality Improvement initiatives.
Reasons for No EnrollmentYearNumber of Infants
Record Count: 32
Not Eligible for Part C20131
Not Eligible for Part C20141
Not Eligible for Part C20150
Not Eligible for Part C20160
Non-resident20131
Non-resident20140
Non-resident20150
Non-resident20160
Moved out of Jurisdiction20136
Moved out of Jurisdiction20143
Moved out of Jurisdiction20154
Moved out of Jurisdiction20165
Infant Died20132
Infant Died20142
Infant Died20153
Infant Died20160
Family Declined201320
Family Declined201415
Family Declined20157
Family Declined201620
Contacted but Unresponsive20131
Contacted but Unresponsive20145
Contacted but Unresponsive20154
Contacted but Unresponsive20160
Unable to Contact20130
Unable to Contact20140
Unable to Contact20151
Unable to Contact20163
Unknown20134
Unknown20144
Unknown20152
Unknown20160

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, 2010-2016

::chart - missing::

YearNumber of Children
Record Count: 7
201065
2011104
2012100
2013121
2014104
201598
2016105

Data Notes

For 2010 data HiTrack calculations for hearing loss were deemed to be inaccurate and under-represented the true number of children with hearing loss. For 2013 data calculations for hearing loss were deemed to be inaccurate and over-represented the true number of children with hearing loss. Incidence of permanent congenital hearing loss in Utah generally remains at 2 per thousand births.

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 newborn hearing screening and Audiology resources can be found at: [https://health.utah.gov/cshcn/programs/map.html] Or by calling the Utah EHDI Program at 801-584-8215.

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.

Page Content Updated On 10/15/2018, Published on 11/05/2018
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 Sat, 24 August 2019 20:47:11 from Department of Health, Center for Health Data, Indicator-Based Information System for Public Health Web site: http://ibis.health.state.gov ".

Content updated: Thu, 20 Jun 2019 13:03:28 MDT