Early Hearing Detection and Intervention: Timely Diagnosis, Timely Management.

OBJECTIVE: A quality improvement study was completed to assess the impact of three clinical practice changes on the timing of diagnosis and intervention for congenital hearing loss. DESIGN: A retrospective chart review was conducted for 800 infants evaluated for congenital hearing loss before and after implementing three clinical practice changes: the use of Kalman-weighted signal averaging for auditory brainstem response testing, a tone burst-prioritized testing protocol, and expediting scheduling of initial assessment. The impact of middle ear involvement on age at diagnosis and history of neonatal intensive care unit stay on age at treatment was also examined. RESULTS: The use of Kalman-weighted signal averaging for auditory brainstem response testing, a tone burst-prioritized testing protocol, and expedited scheduling of initial assessment each resulted in a decrease of age at diagnosis. Ultimately, the age at initial assessment was the only significant predictor related to decreased timeline for diagnosis. Middle ear pathology significantly increased age at diagnosis, while history of time in the neonatal intensive care unit significantly increased the age at provision of amplification as a treatment for permanent hearing loss. CONCLUSIONS: The technology used for assessment, clinical protocol, and timing of assessment of infants can impact the timeline for diagnosis and treatment of congenital hearing impairment. Given the significant sequelae of delayed or missed diagnosis of hearing loss in infancy, implementing clinical practice changes should be considered at pediatric diagnostic centers.

Timing of newborn hearing screening in the neonatal intensive care unit: implications for targeted screening for congenital cytomegalovirus infection.

OBJECTIVE: To determine when infants in the neonatal intensive care unit (NICU) have the first hearing screen performed, and thus inform targeted testing for cytomegalovirus (CMV)-related hearing loss. STUDY DESIGN: Retrospective review of electronic health records of infants admitted to a Level 4 outborn NICU and had a first hearing screen performed from 8/2016-8/2018. RESULT: Among 1498 infants, 546 (36%) had a first hearing screen performed at age >21 days when a positive CMV PCR test cannot distinguish congenital from postnatal CMV acquisition. While most infants tested at >21 days of age were <34 weeks' gestational age (71%), 18% (n = 100) and 11% (n = 59) were ≥34 and ≥37 weeks' gestation, respectively. CONCLUSION: Targeted CMV testing for failed hearing screen in the NICU is problematic as 36% of infants did not have a hearing screen performed before 21 days of age, supporting the need for CMV screening at NICU admission.