The Victorian Infant Hearing
Screening Program
Dr Melinda Barker
VIHSP Co-director
Maternal & Child Health
Conference, October 2011
The Victorian Infant Hearing
Screening Program (VIHSP) - history
VIHSP - since 1992
•
High risk status ascertainment (1992 – present)
+ behavioural screening via distraction test at 79m (1992 – 2005)
VicNIC 2003 - 2005
•
Pre-discharge AABR screening of all babies in
NICU and associated SCNs
Program of research into HL in childhood
Public Health Hearing Group, Murdoch Childrens
Research Institute/Royal Children’s Hospital
VIHSP Newborn Hearing Screening
State-wide Rollout
Phase &
Year
Hospitals
% of Vic
births
1
Tertiary maternity hospitals + co2005 & 2006 located private hosps + RCH NICU
30%
2
Public metro maternity hospitals
2008 & 2009
57%
3
Public and private regional
2009 & 2010 maternity hospitals
78%
4
(Remaining) private metro hospitals
2010 & 2011
100%
Basic principles of screening
•
a screening test is not diagnostic: it is designed
to identify those who are AT HIGHER RISK
•
all screening tests will have a certain number of
false positives and false negatives
•
important that a positive result on a screening
test results in referral to diagnostic testing
•
condition being screened for should be an
important health problem
Why screen for hearing loss in
newborns?
•
•
•
•
•
•
one in every 1000 babies will be born with a permanent,
moderate or greater hearing loss in both ears that can
be identified at birth
without NHS, PCHI is detected late
intervention by 6 months = better communication skills,
including spoken language
technology to screen neonates is quick, easy, painless
diagnosis, early int & support services are available
potential to relieve burden of disability caused by
language delays and deficits
academic delays and disadvantages
social impairments
economic disadvantages
•
•
•
•
The VIHSP screening process
VIHSP screen #1
Pass result in both ears
Refer result in 1 or 2 ears
NFA
VIHSP screen #2
Pass result in both ears
Refer result in 1 or 2 ears
NFA
Referral to audiology
by VIHSP Area Coordinator
Joint Committee on Infant Hearing
(2000 & 2007)
Benchmarks for key components of the UNHS/EHDI process
Age
Benchmark
(months)
1
Screen by 1 month of age
3
Diagnostic audiological evaluation by 3 months
for infants at risk (refer result on screen)
6
Enrolment of infants with HI into early intervention
by 6 months
A hearing screen is one of the
routine health checks babies have
soon after birth. This is a quick and
simple way to check the hearing of
newborn infants.
Information brochure ‘Your baby’s
hearing screen’ during one of the
antenatal visits, in the preadmission pack, or when the
VIHSP screener visits after the
baby is born.
Generally, the hearing
screen will be done
whilst the baby is still
in hospital.
A hearing screener
attends the hospital
room and the screen is
done at the bedside.
The hearing screener
will explain the screen
and will answer any
questions parents
might have.
If parents want their baby
to have the hearing
screen, they will be asked
to sign a consent form.
The screen is not
compulsory, however
almost all parents choose
to have their baby’s
hearing screened.
The hearing screen is now the only routine hearing check that
babies are offered.
The screen is quick and painless.
Most babies are not unsettled by the screen and most
stay asleep in their cots whilst the screen is being
carried out.
The screener will put a
sensor on the baby’s
forehead, shoulder and
neck. Two ear cups will be
put over the baby’s ears
and soft clicking sounds
will be played to the baby.
As the baby hears those
sounds, the sensors will
send his/her responses to
the screening machine.
We can do the
hearing screen whilst
the baby is being
cuddled or breastfed.
The screener will give
parents the results of
the screen straight
away.
A pass result means that the baby
showed a clear response to the
sounds played.
Hearing losses can develop at a
later time; if parents have
concerns about their baby’s
hearing they can arrange to have
another hearing check at an
audiology clinic.
We do not always get a clear
response to the first screen. This
might be because
• the baby woke up or became
unsettled during the screen
• there was fluid or debris still in
their ears from the delivery
• there is a hearing loss.
If a baby does not pass their first
screen, they have a repeat screen
either before the baby goes home
or as an outpatient.
A refer result means that, during
two screens, we did not get a
clear response from the baby to
the sounds played.
This could be because:
• the baby was unsettled during
the screens
• there is still fluid or another
temporary blockage in his/her
ears
• the baby has a hearing loss.
What happens after a refer result?
The hearing screen does not diagnose a hearing loss.
A refer result does not always mean that the baby has
a permanent hearing loss.
A refer result simply means that the baby needs to
have a full hearing test at an audiology clinic.
If the baby needs to have a full hearing test, the
VIHSP Area Coordinator at the hospital will arrange
this appointment at the audiology centre of the
parent’s choice.
Targeted surveillance: checking for
risk factors
Hearing loss risk factors assessment via
universal maternal and child health service.
Child Health Record used as the vehicle for
targeted surveillance of infants at risk of
progressive or acquired loss. Referral details
recorded in CHR.
New Child Health Record
Birth Details page
Some risk factor information is
recorded here
New CHR
In Birth Details section
Screen Results Page 1
Screener records
- Results (Pass or Refer)
- Date of screen completion
New CHR
In Birth Details section
Screen Results Page 2
Screener records
- Result (Pass or Refer)
- any risk factors present at time
of screen
New CHR
8m page
Targetted surveillance
(risk factor follow up)
New VIHSP
Referral Form
The VIHSP/MCH partnership

VIHSP
 recording of results of NHS
 referral coordination following NHS

MCH
 Following up on babies who have been referred
 Assisting to arrange screen for babies who missed it
 Risk factor ascertainment
 Screened babies (passed screen): at 8m [“targetted
surveillance”]
 Language promotion
 Ongoing role in developmental surveillance
Why continue surveillance if a baby
has passed the screen?


Hearing can change over time
Risk factors can change over time
Therefore,
 Regardless of screen result, the MCH nurse
should review risk factors at the 6 -8 month visit
and refer to audiology if any risk factors are
present
Some results to date

Over 230,000 screened since 2005

98% capture rate

97% screened within 30 days

0.6 – 1.0% referred

Over 223 detected (rate approx 1 per 1000)
Comparing Median Age at Diagnosis
(in months) – Victoria
25
20.3
20
14.2
15
10
5
1.1
0
Pre-VIHSP
(DOB 1989)
VIHSP Risk Factor
Screening (DOB
1993)
VIHSP UNHS
(DOB since Feb
2005)*
www.vihsp.org.au

Screen shot
New website LIVE
http://infanthearing.vihsp.org.au
For more information:
The Victorian Infant Hearing Screening Program
C/o Centre For Community Child Health
Royal Children’s Hospital
Flemington Road
Parkville, Vic 3052
T: (03) 9345 4941
F: (03) 9345 5049
E: email.vihsp@rch.org.au
W: www.rch.org.au/vihsp