Early Hearing Detection and Intervention (EHDI)

Office of Children with Special Health Care Needs

The Early Hearing Detection and Intervention (EHDI) Program provides oversight to healthcare practitioners to ensure all newborns receive early screening, diagnosis and intervention for hearing loss.

Hearing loss is one of the most common birth conditions, occurring in 1 in every 500 newborns. The first months and years of life are a critical period for brain development needed for communication, social and emotional development, and even academic success. Early identification of hearing loss and appropriate intervention ensures a child will have the opportunity to reach their full potential.

Utah Early Hearing Detection and Intervention (EHDI) Program goals:

  • All newborns receive hearing screening before discharge or before 10 days of age if born out of hospital.
  • For infants who fail the screening, a repeat screening should be conducted before 10 days of age.
  • If an infant fails the 2nd hearing screening:
    1. Test for congenital Cytomegalovirus (CMV) infection before 21 days of age.
    2. Complete a diagnostic hearing evaluation by a pediatric audiologist with expertise in testing infants before 3 months of age.
  • If an infant is diagnosed as deaf or hard of hearing (DHH)
    1. Enroll infant into early intervention services before 6 months of age.
    2. Refer family to EHDI parent to parent support services

Parents

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Physicians

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Hospitals

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Midwives

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Audiologists

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Parents

Many babies with hearing loss will react to loud sounds, cry, and babble. The only way to know if your baby has typical hearing is to have a screening done with special equipment.

Initial Newborn Hearing Screening
All babies born in Utah will have a hearing screening before they leave the hospital. If your baby was born out of hospital, your baby should have their hearing screened before 10 days of age.

Be sure to know the results of your baby’s hearing screening. The results will be a “pass” or a “fail”.

Physicians

All newborns should receive a hearing screening before discharge or if born out of the hospital, no later than 10 days of age. If the baby fails, a rescreen should be completed before 10 days of age. If the baby fails the second hearing screening, please confirm the CMV testing has been completed (the birth facility typically facilitates this process) and your patient has been referred to a Pediatric Audiologist opens in a new tab for diagnostic hearing assessment.

Utah is a two-stage hearing screening state. This means that a baby may be tested twice (stage 1= inpatient and stage 2 = outpatient) before further diagnostic hearing testing is required. 90% of infants who fail the inpatient screening will go on to pass the outpatient screening. The other 10% are at a higher risk for permanent hearing loss.

Do not minimize the importance of hearing screening by saying that it is likely just fluid. Any child that does not pass a hearing screening is at higher risk for a hearing loss; there is a possibility of hearing loss even in the presence of fluid and further testing is needed.

Hospitals

Guidelines for conducting well-baby hearing screenings

  • Test no sooner than 12 hours after birth or as close to discharge as possible.
  • Test when infant is quiet or sleeping.
  • Ensure a quiet environment for testing, away from background noise.

If a newborn does not pass the screening it is acceptable to repeat the screening no more than two times during the same session.

Guidelines for conducting hearing screenings in the NICU

Newborns who have been in the NICU must have an Automated ABR to rule out a neural hearing loss. (Utah Newborn Hearing Screening Standards opens in a new tab and JCIH Recommendations)

Communicating hearing screening results to families

  • Provide results of the screening, whether the newborn passed or did not pass the hearing screening, and explain what the results mean. Follow EHDI Screener Guidelines and Scripts opens in a new tab.
  • Results should be conveyed verbally and in writing to the parents.
  • If the infant did not pass the initial screening, do not minimize the importance of the rescreen.
  • Schedule the repeat hearing screening appointment prior to discharge if an infant does not pass the initial screening.
  • If the initial screening was not completed (the baby was missed or results were incomplete) prior to discharge, it is the birth facility's responsibility to follow-up with the family and schedule outpatient screening.
  • Provide all parents with information on milestones opens in a new tab of normal auditory, speech and language development in children.

CMV Mandate Responsibility

  • It is the hospital screening program’s responsibility to report newborn hearing screening results to the primary care provider (PCP), the family and the State EHDI program.
  • If the baby does not pass inpatient screening, the PCP must be notified of the failed screening.
  • If the baby returns and does not pass their outpatient screening, complete the CMV and ABR Testing Order Form opens in a new tab and assist the family to the hospital lab for testing. Notify the PCP of failed screening and need for CMV testing. Notify the the EHDI Program at email [email protected].

Midwives

Birth attendants are required by law to assure initial hearing screening occurs no later than 7 days of age. If a newborn fails the hearing screening, a follow-up screening should be performed no later than 14 days of age.

If the newborn fails their initial hearing screen and the screen was performed more than 14 days after birth OR if the newborn fails their rescreen, the newborn should immediately be referred for congenital Cytomegalovirus (CMV) testing. **Note: The midwife can collect the speciment (urine or saliva only) and send directly to their preferred lab. Specimen kits are available to order direclty from labs.

A CMV and ABR Testing Order Form opens in a new tab should be completed and the family should be directed to a lab for CMV testing. Notify the primary care provider (PCP) (if known) and Utah EHDI at email [email protected] or fax to (801) 536-0492.

CMV testing is time-sensitive and must be completed before 21 days of age in order to rule-out congenital vs. acquired CMV. CMV testing is simple and painless, and is accomplished using a urine or saliva sample (the inside of your baby’s cheek is swabbed).

Reporting newborn hearing screening results to the EHDI Program is mandated opens in a new tab and must be done within 7 days of the screening. Reporting can be done via email at email [email protected], fax to (801) 536-0492, direct entry into EHDI database (HiTrack), or other approved methods.

Audiologists

As an Audiologist, you play a key role in the EHDI Process:

  • Confirm CMV testing results and document them in your diagnostic report. If CMV testing has not been completed, please recommend to the family the importance of completing testing and assist them (if possible) to a hospital lab. .
  • Complete diagnostic audiologic evaluation prior to 3 months of age. (JCIH Recommendations opens in a new tab) This should Include:
    • ABR (suprathreshold click AND frequency-specific stimuli)
    • OAEs
    • Tympanometry
    • Bone-conduction (as indicated)
  • Report the results to the child's Primary Care Physician (PCP) and Fax to (801) 536-0492 (Utah EHDI Program)
  • Make a referral to USDB Parent Infant Program opens in a new tab.