Page 15 - Delaware Medical Journal - April 2018
P. 15
SCIENTIFIC ARTICLE
Until recently there was no accurate, inexpensive way to screen babies for
hearing loss. In 1978, physicist David Kemp, working at the Royal National Throat Nose Otoacoustic Emissions (OAE).7 Dr. Kemp eventually developed a device that could be used to detect OAEs; this device tests the integrity of the cochlea by measuring the outer hair cells’ response to sound, and when present, is generally accepted as evidence of intact hearing in most babies. This particular screening test became widespread in its usage, but until recently was generally
only offered to babies who had one or more risk factors for hearing loss: family history, exposure to ototoxic medications, or others. Therefore, at least 50% of babies with hearing loss were not being screened and diagnosed because of the absence of a known risk factor.
In 1993, the National Institutes of Health (NIH) convened experts for a Consensus Conference of Universal Newborn Hearing Screening. The Consensus included the following:
(1) all infants admitted to the neonatal intensive care unit be screened for hearing loss prior to discharge;
(2) universal screening be implemented for all
(3) the preferred model for screening should begin with an evoked otoacoustic emissions test and should be followed by an auditory brainstem response test for all infants who fail the evoked otoacoustic emissions test; and
(4) comprehensive intervention and management programs must be an integral part of a universal screening program.8
In 1993, Delaware newborn hearing screening was only offered in a few of the birthing hospitals. This included the
existing NICUs in Christiana Hospital, Saint Francis Hospital and Kent General Hospital. At that time, approximately 8%
of Delaware babies were being screened.
A few years later, in 1995, Christiana Care based universal newborn hearing screening program in Delaware. This screening was done by a combination of audiologists and volunteers testing OAEs. This work was done voluntarily by the hospitals without any government or other mandate and often without reimbursement. By this time, there were some audiologists, physicians, and public health staff interested in developing
a statewide Universal Newborn Hearing Screening program. The Delaware Division of Public Health had an employed audiologist who had written a white paper advocating for Universal Newborn Screening, something that was already being done by a few states.9 A separate white paper was developed by Betty Simmons and Carlos Duran, proposing a statewide program managed by the Division of Public Health.10 There was no money for this endeavor in the budget and, therefore, this had not been accomplished.
A group of interested providers, including pediatricians, nurses, audiologists, and neonatologists, had multiple discussions regarding this issue and called together a meeting of interested parties, including
a representative from all the Delaware
birth hospitals and representatives from Delaware’s Division of Public Health (DPH). This group was initially working informally, then formed an ad hoc committee that later came under the auspices of the Delaware Chapter of the American Academy of in May 1999 and named itself the Delaware Infant Hearing Assessment and Intervention Program. (DIHAIP, after Rhode Island’s RIHAIP program).
This initial volunteer group had
recognition and yet, evidence shows that it was successful in increasing the number of babies screened every year. The group continued to meet regularly and partnered with the local DEAAP to become one of its committees. By the year 2000, all Delaware birthing hospitals had implemented Universal Newborn Hearing Screening, and DPH had begun tracking this data using funds from Early Hearing Detection & Intervention (EHDI) HRSA grants.
This program continued as a voluntary program and the DIHAIP Advisory Board continued meeting regularly to support its growth. In 2001, the national AAP started its EHDI Chapter Champion program whereby an AAP fellow from each chapter the states and support the development
and implementation of Universal Newborn Hearing Screening. In that same year, DPH working with the DIHAIP group applied
for and obtained a HRSA grant to support the Delaware EHDI program. In 2002, the Vienna, Virginia with representation from the Delaware RIHAIP Advisory Committee.
During these years, a substantial problem
follow-up of the babies with abnormal
or missing screens. Each hospital had a different system, and Delaware did not have a system in place for tracking and follow-up. The program operated with basic computer programs like Excel® and pen and paper. Delaware contracted with for this purpose, but after thousands
of dollars spent, the software proved ineffective. To this day the screening team still uses an Excel® database for tracking purposes. The DPH staff was mostly part- were trained since they often moved to
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