The following is the text of a presentation made at a workshop on early hearing detection and intervention (EHDI) in Atlanta, Georgia on October 22, 1997. The workshop was sponsored by the Centers for Disease Control and Prevention (CDC). Participants represented various academic disciplines and areas of responsibility and experience related to identifying and providing intervention to very young children with congenital hearing loss. This presentation was invited to set the context for the remainder of the workshop. The text of the presentation, along with the slides, are included here. In addition, you may also download the text and the slides of the presentation.
There are two important things about the way in which this meeting has been organized. First is the diversity of the people who are participating and will have an opportunity to comment about issues related to early identification of hearing loss. In spite of the fact that most of us spend a good deal of our time thinking about issues related to newborn hearing screening, I am sure we will hear different points of view today than what we typically hear. The second point is that the meeting has been structured to encourage a free-flowing discussion of the important issues related to early identification of hearing loss.
To help you follow the large amount of material I will be presenting very rapidly, I have included in your packet copies of all the slides I will use, plus some additional slides, notes, and references. Some of the work I will cite is unpublished and should not be cited further without permission from the authors.
I have been asked to summarize the scientific evidence related to whether we should be doing universal newborn hearing screening as a way of identifying congenital hearing loss. To set the context for that discussion, slide #2 is a picture of two babies identified with congenital sensorineural hearing loss at Woman's Hospital in Baton Rouge, Louisiana when they were less than six weeks old. They were fitted with hearing aids by the time they were three months old. Virtually everyone agrees that this is the kind of picture we should see more frequently.
Slide #3 shows a baby being screened for hearing loss prior to being discharged from the hospital. Some people are very enthusiastic about the fact that we are seeing such pictures more frequently, but other people have deep concerns about it. In my presentation, I will summarize some of the most pertinent data on both sides of that issue. My purpose is not to convince you of a particular point of view, but rather to present evidence in a way that will lead to further discussion and analysis.
As shown in slide #4, there has been a rapid increase in the number of universal newborn hearing screening (UNHS) programs which have been implemented in the U.S. since the NIH Consensus Development Conference on Early Identification of Hearing Loss held in 1993. At that time, there were only 11 hospitals screening more than 90 percent of their babies. Now, based on a survey which our Center does each year, there are almost 400 such programs. In other words, there has been an almost forty-fold increase during the last four and a half years.
That increase in the number of operational programs has been supported by a variety of different governmental and professional groups which have endorsed the concept of early detection of hearing loss and have recommended hospital-based universal newborn hearing screening as the most feasible method to identify hearing loss early (see slide #5). As shown in slide #6, more and more states are also using legislative actions to address this issue. Five states now have legislative mandates requiring all babies to be screened for hearing before they are discharged from the hospital. Three of those mandates were passed in 1997. At least eight other states will be considering similar legislation during 1998.
The focus of this presentation as shown in slide #7 is whether the picture on the left (hospital-based universal newborn hearing screening) is the best way to achieve the picture on the right (detection of and intervention for hearing loss in babies before six months of age). Even though the focus is on the scientific evidence related to whether hospital-based newborn hearing screening should be the method of choice for early detection of hearing loss, it is useful to consider that evidence in the context of recent legislative activity and the rapid expansion of hospital-based newborn hearing screening programs.
Although there are obviously many people who believe that hospital-based universal newborn hearing screening is the solution, there are other very important groups who have considered the evidence and concluded that more work is needed (slide #8). For example, the U.S. Preventive Services Task Force Guide to Clinical Preventive Services, published in 1996 (see slide #9), concluded that even though "congenital hearing loss is a serious health problem associated with developmental delay in speech and language function, there is little evidence to support the use of routine, universal screening for all neonates." The Task Force Guide went on to say that universal newborn hearing screening programs would result in a substantial number of infants being misclassified, the costs and feasibility for UNHS programs are not fully known, and the evidence for the efficacy of early intervention with infants identified in such programs is incomplete.
To address the issue of whether we should be implementing UNHS programs or whether we should be considering other methods for early detection of hearing loss, information will be presented and organized according to six issues (slide #10). The purpose is to provide a common foundation for those who come from different perspectives to further discuss some of these important issues. After presenting the most relevant evidence related to each of those issues, the remainder of this meeting will be devoted to discussing where the evidence is inadequate and how CDC or other groups might proceed to gather evidence to address the existing gaps. The six issues to be discussed (slide #11) include:
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