Early Hearing Detection and Intervention Program
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This page is geared toward healthcare providers, birth facilities, nurse midwives, audiologists, otolaryngologists, primary care providers, Medical Homes, Children and Youth with Special Healthcare Needs networks, community-based screening programs, and early intervention providers who work with infants or children who are deaf or hard of hearing.
Universal newborn hearing screening was passed into law in Connecticut in 2000 to ensure that all babies are screened at birth to identify potential hearing loss. Subsequent legislation was passed in 2016 requiring babies who do not pass their newborn hearing screening to also be screened for congenital Cytomegalovirus (cCMV). In Connecticut, institutions caring for newborns are required to report hearing screening and cCMV results to the Department of Public (DPH) under the Early Hearing Detection and Intervention (EHDI) Program.
Why is Early Hearing Detection and Intervention so important?
According to the Centers for Disease Control and Prevention (CDC), 1.7 per 1000 children have a hearing loss. The earlier a child who is deaf or hard of hearing starts getting services, the more likely the child’s speech, language, and social skills will reach their full potential.
What is the 1-3-6 model in the Early Hearing Detection and Intervention (EHDI) Program?
Barring medical concerns, the Connecticut Early Hearing Detection and Intervention (EHDI) Program’s goals are:
All newborns receive a hearing screening before facility discharge, or no later than 1 month of age;
Those newborns who do not pass their hearing screening should also receive a cCMV screening before 21 days of age;
A diagnostic audiological evaluation no later than 3 months of age for babies who do not pass the newborn hearing screening; and
Enrolment into early intervention supports, Birth to Three, no later than 6 months of age for babies who are identified with a hearing loss.
What are the recommended technologies for screening newborns for hearing loss?
The Automated Auditory Brain Response (AABR/ABR) and the Otoacoustic Emissions (OAE) are the two technologies used by birthing facilities for universal newborn hearing screening. Although both ABR and OAE screening tests have a high sensitivity and specificity, both tests can miss some mild hearing losses or unusual configurations. It is important to remember that hearing loss can occur at any age, especially for those newborns with risk factors.
What are some of the risk factors for delayed or late onset hearing loss?
Risk factors account for the majority of delayed or late onset hearing losses in newborns and children. Children with risk factors should be monitored regularly by a pediatric audiologist. A child may be “at risk” for hearing loss if any of the following apply:
Congenital cytomegalovirus (cCMV)
Cultural Positive Postnatal Infections
NICU >5 days
A child who has one or more risk factors, should be referred for follow up audiology monitoring. For more information about Risk Factors & Genetics, click here.
How do birth facilities support the EHDI Program?
The birth facilities perform newborn hearing screenings on all newborns before discharge or no later than 1 month of age. If a newborn does not pass the initial hearing screening, either in one or both ears, a second screening should be performed using an ABR. Both ears should be tested again using the ABR.
Newborn hearing screening results should be reported to DPH through the electronic database or on the Newborn Hearing Screening Paper Reporting Form and shared with the parents and pediatrician. Babies who were not born in a Connecticut birth facility can report the newborn hearing screening results on the Home Birth, Out of Hospital or Out of State Birth Notification Form.
For those children who do not pass the newborn hearing screening, either in one or both ears, the birth facility should:
Report the hearing screening results to the parents, pediatrician, and DPH.
Per law, screen the infant for cCMV prior to discharge, and report results to the parents, pediatrician, and DPH.
Make a pediatric audiology referral or appointment prior to discharge.
For more information, click the Early Hearing Detection & Intervention Program Guidelines for Infant Hearing Screening or the Birth Facility Flow Chart for: Newborn Hearing Screening (NBHS) and congenital Cytomegalovirus (cCMV) Testing.
The Can Your Baby Hear? A Parent Guide to Newborn Hearing Screening brochure should be given to all families prior to testing to inform them about the newborn hearing screening program. Click here for the Spanish version of this brochure.
Families may refuse the universal newborn hearing screen when it conflicts with their religious tenets and practice. These families are required to complete the Newborn Hearing Refusal Waiver.
For children who didn’t pass their newborn hearing screening, it is recommended that the facility enters the screening results on the Family Plan of Care for Infants\Children Who are Deaf or Hard of Hearing (Family Plan of Care) and gives it to the parent. The Family Plan of Care is meant to keep all hearing related medical information and results in one place to facilitate sharing with audiologists and the pediatrician. Additionally, it may help parents and providers improve outcomes, and help the parents better understand and adhere to the recommended timelines.
How do pediatric audiologists support the EHDI Program?
Pediatric audiologists determine whether a baby has a hearing loss using a diagnostic hearing evaluation. This comprehensive battery of tests is the only way to determine if a there is a hearing loss or not. The EHDI program goal is to complete the diagnostic audiological evaluation no later than 3 months of age, if medically able.
Audiologists report the results of the diagnostic hearing evaluation to the baby’s parents, pediatrician, and the DPH using the Diagnostic Audiology Reporting Form.
For those babies that have a hearing loss, Connecticut General Statutes, Section 17a-248d requires that a referral be made to the Connecticut Birth to Three for early intervention supports no later than seven days after the date of completed diagnosis. Referrals can be made by calling Child Development Infoline at 1-800-505-7000 or by using the on-line referral system at www.birth23.org.
For more information, click the Early Hearing Detection & Intervention Program Guidelines for Infant Hearing Screening.
For children who have been diagnosed with a hearing loss, it is recommended that the pediatric audiologist either updates the existing Family Plan of Care with the diagnosis or give the parents a new one. The Family Plan of Care is meant to keep all hearing related medical information and results in one place to facilitate sharing amongst providers, improve outcomes, and to help the parents better understand and adhere to the recommended timelines.
How do early intervention providers support the EHDI Program?
Connecticut Birth to Three early intervention providers offer hearing specialty supports to families with children who are deaf or hard of hearing. They work with the family to help develop their child’s language and social skill, access appropriate technology, and support transition from Birth to Three to a school district at age three.
Audiological hearing evaluations can be reported to DPH on the Birth to Three\Early Hearing Detection & Intervention (EHDI) Fax-Back Form.
How do pediatricians support the EHDI Program?
The pediatrician works in conjunction with the birth facilities, audiologists, and other specialists to coordinate timely screening, diagnosis, and early intervention supports for their patients. Pediatricians should make sure newborns in their care receive a newborn hearing screening at birth. If a baby in their care did not receive a hearing screening, or a completed hearing screening, it is recommended that they refer the baby to a pediatric audiologist for the screening, especially if there are risk factors present.
Babies who did not pass the newborn hearing screening should be referred to a pediatric audiologist for a diagnostic hearing evaluation. Some birth facilities will schedule appointments for the infant prior to discharge, or a pediatrician can make the referral for the family. Click here for Connecticut Infant Diagnostic Testing Locations or search for a pediatric audiology facility at http://ehdipals.org/.
Pediatricians should also make sure that babies who did not pass the newborn hearing screening were also tested for CMV at the birth facility. In order to determine whether CMV is congenital, CMV testing must be done prior to 21 days of age. Click here for more information about CMV Screening and Follow-up Recommendations and Monitoring.
For those children who are diagnosed with a hearing loss, the pediatrician initiates and/or monitors referrals to other medical specialties, like ophthalmology or genetics, and to Connecticut Birth to Three for early intervention supports.
Pediatricians should continually monitor all their patients for Risk Factors & Genetics and achievement of developmental milestones.
Which specialists should be considered for a child who is diagnosed with a hearing loss?
The diagnostic audiology evaluation may indicate referrals to appropriate medical specialists such as an ear, nose and throat (ENT), ophthalmologist, and genetics. Other tests to consider include: CT, MRI, EKG, or ultrasound.
Are there other resources available to the parents of children with a hearing loss?
Yes, please see the bottom of the Parent FAQs page.
Other guidelines and resources for providers on hearing loss:
Department of Public Health (DPH) Early Hearing Detection & Intervention Program Guidelines for Infant Hearing Screening
The Journal of Early Hearing Detection and Intervention The Joint Commission on Infant Hearing Year 2019 Position Statement.
American Academy of Pediatrics (AAP) and National Center for Hearing Assessment and Management Utah State University (NCHAM) EHDI Guidelines for Pediatric Medical Home Providers.
American College of Medical Genetics and Genomics (ACMG) Genetics Evaluation Guidelines for the Etiologic Diagnosis of Congenital Hearing Loss.
Provider resources for families:
Department of Public Health (DPH) Family Plan of Care for Infants\Children Who are Deaf or Hard of Hearing (Family Plan of Care).