1 figure, 1 table omitted
Hearing loss (HL) occurs in one to three of 1,000 live births annually1,2 and, when left undetected, can result in developmental delays.3,4 To promote communication from birth, Early Hearing Detection and
Intervention (EHDI) programs support early identification of infants with
HL. Without EHDI programs, the average age of identification for HL is age
1.5-3.0 years,2,5,6 which is past the start of the critical period
for optimal language acquisition.7,8 In 2001, a total of 48 states/areas
with EHDI tracking and surveillance systems (30 funded by CDC) reported the
percentage of newborns screened for HL. This report summarizes the results
of an analysis of surveillance data for 1999-2001, which indicate that more
infants were screened for HL, received diagnostic audiologic evaluations,
and were enrolled in early intervention services in 2001 than in 1999 and
2000. Continued development of EHDI surveillance systems should assist states/areas
in providing needed services to children with HL.
Benchmarks for the key components of the EHDI process include hearing
screening before age 1 month, diagnostic audiologic evaluation before age
3 months for infants who do not pass the screening, and enrollment of infants
identified with HL in early intervention services before age 6 months. These
benchmarks form the basis of the "1-3-6" plan that state/area EHDI programs
are implementing. States/areas with EHDI programs are collecting data on the
numbers of infants screened, evaluated, and enrolled in intervention services.
In collaboration with Directors of Speech and Hearing Programs in State Health
and Welfare Agencies, CDC requested data for 1999-2001 from the 50 states,
the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands.
Responses were received from 22 states/areas in 1999, from 46 in 2000, and
from 52 in 2001.
In 1999, a total of 726 (49%) hospitals and birthing centers in the
22 reporting states/areas were classified as universal newborn hearing screening
(UNHS) facilities (i.e., facilities in which the majority of infants were
screened). The percentage of infants screened needed to achieve UNHS classification
varied. The 22 states/areas reported that 660,639 (46.1%; range: 7.3%-99.8%)
of 1,433,780 newborns were screened for HL. In addition, 12 jurisdictions
reported referral rates (i.e., percentage of screened newborns referred for
audiologic evaluation). An average of 4.0% (range: 0.2%-14.5%) of screened
infants were reported to have been referred for audiologic evaluation; eight
states/areas reported that 4,221 (51.8%; range: 1.3%-75.5%) of 8,145 referred
infants received an audiologic evaluation.
In 2000, a total of 46 states/areas reported that 1,976 (59.7%) of 3,312
hospitals and birthing centers were classified as UNHS facilities, and 44
reported that 1,496,014 (52.1%; range: 10.9%-99.9%) of 2,872,869 newborns
were screened for HL. In 2001, a total of 52 states/areas reported that 2,656
(73.2%) of 3,628 hospitals and birthing centers were classified as UNHS facilities,
48 reported that 2,115,869 (65.4%; (range: 1.3%-99.8%) of 3,232,914 newborns
were screened for HL, 40 reported an average referral rate of 2.1% (range:
0.4%-11.5%), and 27 reported that 11,901 (55.7%; range: 3.2%-100%) of 21,377
newborns referred for screening received an audiologic evaluation.
In the 21 states/areas that reported screening data for both 1999 and
2001, the number of newborns who received a hearing screening during this
period increased by an estimated 35%. For the 10 states/areas that reported
data on infants referred for audiologic evaluation for 1999 and 2001, referral
rates were low,* decreasing from 4.0% in 1999 to 2.0% in 2001. These rates
are consistent with the National EHDI and Joint Committee on Infant Hearing
goal of referring ≤4.0% (objective nos. 1.79 and 5[a]210) of children tested. Eight states/areas reported audiologic evaluation
data in both 1999 and 2001; the number of infants receiving an evaluation
increased by approximately 9% during this period.
For 1999, five states/areas reported that 179 infants were identified
with HL; 108 (60.3%) were enrolled in early intervention programs by age 6
months. In 2001, 25 states/areas reported that 1,354 infants were identified
with HL; 879 (64.9%) were enrolled in early intervention programs. Of these
879 enrolled infants, 627 (71.3%) reportedly were enrolled by age 6 months.
M Gaffney, M Gamble, MPH, P Costa, MS, J Holstrum, PhD, C Boyle, PhD,
Div of Human Development and Disability, National Center on Birth Defects
and Developmental Disabilities, CDC.
In 2001, approximately three times as many infants were reported to
have been screened for HL and to have received audiologic evaluations than
were reported in 1999. However, the number of infants evaluated and enrolled
in intervention services was low. In 2001, nearly half of the infants referred
for audiologic evaluation reportedly did not receive an audiologic evaluation,
and approximately one third of infants identified with HL were not reported
to be enrolled in intervention services. Although this finding is attributable
in part to loss to follow-up and differing reporting requirements, the data
indicate the need to strengthen EHDI programs. Continuing to develop tracking
and surveillance systems, ensuring that such systems are linked to diagnostic
and intervention services, including medical home, and implementing consistent
methods for reporting by health-care providers should enable states/areas
to capture EHDI-related data for all newborns.
The variation in reported rates is attributable to several factors.
States/areas began implementing EHDI programs at different times. Certain
states/areas have mandated screening, but requirements vary. Although 22 states/areas
indicated that newborn hearing screening legislation was passed or implemented
by 2000, not all require reporting of data to the respective EHDI program.
In addition, in 20 (40%) of 50 states/areas reporting in 2001, ≥10% of
hospitals and birthing facilities were not designated as UNHS facilities,
which affected the number of children screened. The reasons for not screening
all newborns include financial constraints and policy issues (e.g., hospitals
with fewer annual births not being required to screen). In addition, large
annual birth populations, geographic barriers, and differing eligibility requirements
for receiving services might affect the ability to provide EHDI-related services.
The findings in this report are subject to at least five limitations.
First, certain states/areas (31 in 1999, seven in 2000, and two in 2001) did
not have the requested data or did not respond. Second, some states/areas
that reported data were unable to determine if infants had been screened or
evaluated before the recommended age intervals. Third, three states/areas
in 2001 were able to report only partial data or data from a limited number
of hospitals. Fourth, data for the 3 reporting years were too limited to report
the age of identification, severity of HL, or whether the HL was detected
in one or both ears. Finally, although states/areas were requested to provide
actual data, some might have submitted estimates.
The findings in this report underscore the need for EHDI programs to
ensure that infants with HL are detected rapidly and enrolled in early intervention
services. Surveillance data can help in assessing polices and procedures and
ensuring that infants with HL are identified as early as possible and enrolled
in appropriate intervention programs. These activities will help children
with HL develop communication skills commensurate with their cognitive abilities.
This report is based on data provided by Directors of Speech and Hearing
Programs in State and Health Welfare Agencies in Alabama, Alaska, Arizona,
Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Guam,
Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine,
Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana,
Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina,
North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, South
Dakota, Tennessee, Texas, U.S. Virgin Islands, Utah, Vermont, Virginia, Washington,
West Virginia, Wisconsin, and Wyoming.
References: 10 available
*Low referral rates are an indication that screenings are being performed
correctly and are important in maintaining both public and professional confidence
in the accuracy of screening results.
Infants Tested for Hearing Loss—United States, 1999-2001. JAMA. 2003;290(18):2399-2400. doi:10.1001/jama.290.18.2399