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

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

Out-of-hospital birth attendants are required in rule to ensure the initial newborn hearing screening is completed no later than 10 days of age. It is highly recommended that infants are screened before 72 hours of age so that if a newborn fails the hearing screening, a second screening can be completed before the infant is 10 days of age.

If the second hearing screening is failed, congenital CMV (cCMV) testing must be completed before 21 days of age. Note: If the initial newborn hearing screening was completed after 14 days of age with a ‘Failed’ result, the time-sensitive CMV testing should be completed right away in order to meet the 21 day timeline.

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 the baby’s cheek is swabbed). A blood specimen should not be used. If using a saliva sample, be sure the newborn is not breastfed for at least two hours prior to collecting the sample. If a saliva test comes back positive, a urine test must be conducted immediately for confirmation of a true positive.

To facilitate this process, the CMV and ABR testing order form opens in a new tab should be completed. The midwife can then refer the family to an outpatient hospital lab or collect the specimen (urine or saliva only) and send it directly to their preferred lab. Specimen kits are available to order directly from labs. Notify the primary care provider, if known, and Utah EHDI at email [email protected] or fax to (801) 536-0492.

The mandate requires newborn hearing screening results to be reported to the EHDI Program within 7 days of the screening. Midwives can report hearing screening results in a number of ways:

  1. Report via the Birth Certificate system
  2. Fill out the DHHS newborn hearing screening form
    1. Take a picture and text it to the EHDI Follow-Up Coordinator at 385-479-0994
    2. Email a picture of the results form to [email protected]
    3. Fax the results form to the EHDI Team at (801) 536-0492
    4. Direct entry into the EHDI database (HiTrack)

Audiologists

As an Audiologist, you play a key role in the EHDI process, whether overseeing a hospital newborn hearing screening program, providing diagnostic hearing assessments, or both. Meeting each of the Utah EHDI ⅓-3-6 milestones will give each child the opportunity to maximize their potential during these critical years.

When evaluating a newborn for follow-up:

  • If this is a hearing screening appointment, determine if it is a first or 2nd screening, and report all results to EHDI at [email protected].
    • If the baby fails a 2nd screening:
      1. Refer them for congenital CMV testing using the CMV and ABR testing order form. Do not refer them back to the pediatrician for CMV testing, and
      2. Schedule (or refer) them for a diagnostic ABR as soon as possible. Do not repeat another hearing screening. This is important to facilitate the ⅓-3-6 process.
  • For an infant diagnostic hearing assessment:
    • Report clinical history, including CMV testing results
    • ABR testing
      1. Suprathreshold click to rule-out ANSD. Complete a rarefaction and condensation run, or ‘alternating split’ waveforms.
      2. Frequency-specific stimuli (obtain a high frequency and low frequency threshold, and then complete the remaining frequencies as time allows)
      3. Otoacoustic emissions
      4. High-frequency (1000 Hz) tympanometry for infants < 9 months of age
      5. Bone-conduction ABR (as indicated; ideally, frequency-specific)
    • If a permanent hearing loss is diagnosed:
      1. Send referrals to:
      2. Send your diagnostic report to:
        • Utah EHDI (required)
        • ENT and Primary Care Provider (best-practice)
        • USDB PIP (required)
      3. If diagnosed with a permanent hearing loss, provide families with the Beginnings Book.