Newborn Hearing Screening

By Ronald L. Scott
rscott@central.uh.edu

A number of states, including Texas, are considering legislation that would mandate newborn or infant hearing screening, and require health insurance plans to pay for such screening.

Early hearing loss detection and intervention enjoys wide support in the medical, scientific, and public health communities. The federal Centers for Disease Control and Prevention (CDC) estimates that every day, approximately four infants are born with bilateral hearing impairments that will not be diagnosed in time to prevent significant, lifelong communication disabilities. CDC notes that without early detection programs, the current average age at which children are identified as having hearing impairment is two and one-half years. See www.cdc.gov. The National Center for Hearing Assessment and Management at Utah State University (NCHAM) cites even more startling figures. NCHAM found that 33 babies are born each day in the United States with permanent hearing loss, i.e. 12,000 annually, and with three of every 1,000 births having a hearing loss, it is the most frequently occurring birth defect. See www.usu.edu/~ncham/index.html. In the United States, the average age of identification of hearing impairment is 31 months, compared to an average of six to seven months in countries such as England and Israel.

Newborns only a few hours old can be tested for hearing loss, and babies as young as three months can be fitted with hearing aids. Most children diagnosed with hearing losses prior to three months of age, with appropriate interventions by six months of age, do not suffer developmental delays experienced by children whose diagnosis is delayed. See Self Help for Hard of Hearing People, Inc. (SHHH) at www.shhh.org.

Cost estimates for hospital-based universal newborn hearing screening range from $10 to $60 per baby according to NCHAM, depending on the protocol and technology used. NCHAM notes that the cost per child identified with congenital hearing loss is about one-tenth the cost per child identified with PKU, hypothyroidism, or sickle cell anemia in screening programs for such conditions, and that screening for these disorders is required in every state. Some advocates for universal screening such as SHHH argue that early screening and intervention make more sense than spending large sums (up to $1,000,000) per case of unidentified hearing loss.

Two national panels have endorsed universal screening. The National Institutes of Health (NIH) held a consensus conference in 1993 to address the advantages of early identification of hearing impairment, the consequences of late identification of hearing impairment, and the issue of which children should be screened for hearing impairment and when. The panel concluded that universal screening should be implemented for all infants within the first three months of life. See http://text.nlm.nih.gov/nih/cdc/www/92txt.html. Also, the Joint Committee on Infant Hearing, whose members represent the major professional organizations that care for children with hearing loss, including the American Academy of Pediatrics, the American Academy of Otolaryngology, the American Academy of Audiology, the American Speech-Language-Hearing Association, the Directors of Speech and Hearing Programs in State Health and Welfare Agencies, and the Council for the Education of the Deaf reached a similar conclusion in 1994. The committee endorsed the goal of universal detection of infants with hearing impairment by 3 months of age, with intervention by 6 months of age. See www.aap.org/policy/00619.html.

Critics of mandated health insurance benefits legislation believe that mandates lead to an increase in the cost of premiums, ultimately increasing the number of uninsured individuals. Proponents of such legislation argue that they are necessary to ensure adequate benefits for consumers. A December 1998 report to the Texas Legislature by the Texas Department of Insurance addressed the impact of mandated health benefits and found that a number of studies conclude that factors other than mandated benefits are mainly responsible for increasing uninsured rates.

At least ten states have enacted legislation mandating some form of newborn or infant hearing screening, including California, Colorado, Connecticut, Hawaii, Massachusetts, Mississippi, Rhode Island, Utah, Virginia and West Virginia. Some states such as Utah mandate universal screening (see Testing of newborn infants, Utah Statute § 26-10-6), while others such as California require only screening of infants at high risk for deafness (see Newborn and Infant Hearing Screening, Tracking and Intervention Act, Calif. Health & Safety Code § 124115 et. seq.).

Model legislation for state legislatures to consider in establishing infant screening guidelines (The Model Universal Newborn/ Infant Hearing Screening, Tracking, and Intervention Bill) was prepared with input from: the American Speech-Language-Hearing Association (ASHA); the American Academy of Audiology; the American Academy of Otolaryngology-Head and Neck Surgery; and the Alexander Graham Bell Association for the Deaf, Inc. The model legislation is available at http://www.asha.org.

03/08/99