What happens if a newborn fails a hearing test?

What Happens When a Newborn Fails a Hearing Test

If a newborn fails a hearing screening test, they should be referred for repeat testing within 2-8 weeks after hospital discharge, followed by comprehensive audiological evaluation if needed, to ensure early diagnosis and intervention before 6 months of age. 1

Follow-up Process After Failed Screening

• Infants who fail the initial in-hospital screening (about 2% of all screened newborns) are typically scheduled for repeat testing between 2 and 8 weeks after discharge 1
• If the infant fails the second screening, they should be referred for comprehensive audiological evaluation including diagnostic Auditory Brainstem Response (ABR) testing or other electrophysiologic testing, which can be performed as early as 3 months of age 1
• Visual reinforcement audiometry cannot be performed reliably until 8-9 months of age, so electrophysiologic testing is preferred for early diagnosis 1

Understanding Test Results

• Most positive screening tests are false positives - in low-risk populations, only about 2% of infants who fail screening tests are later found to have sensorineural hearing loss (SNHL) 1
• Overall, approximately 6.7% of infants who fail in-hospital screening tests are eventually diagnosed with bilateral SNHL 1
• Parents should receive clear communication about test results in a caring and sensitive manner, preferably face-to-face 1

Importance of Follow-up

• Universal newborn hearing screening has reduced the mean age of identification of hearing impairment from 12-13 months to 3-6 months 1
• Early identification allows for earlier intervention, with the mean age for hearing aid fitting reduced from 13-16 months to 5-7 months 1
• The goal is to screen before 1 month of age, diagnose hearing loss before 3 months, and start intervention before 6 months 2

Special Considerations

• Infants who spent time in the NICU (10-15% of newborns) should be screened using ABR technology, as they are at risk for neural hearing loss 1
• For infants who fail ABR testing in the NICU, referral should be made directly to an audiologist rather than for general outpatient rescreening 1
• Infants with otitis media with effusion (OME) who fail newborn hearing screening experience significant delays in hearing loss confirmation (average 4.2 months vs. 1.0 month) and early intervention enrollment (5.4 months vs. 2.6 months) compared to those without OME 3

Common Pitfalls and Challenges

• Loss to follow-up is a significant challenge - studies show that 13% to 31% of infants who fail initial screening do not return for follow-up testing 1
• In one study, 56% of infants with OME and 12.5% without OME did not receive definitive hearing confirmation due to loss to follow-up or insufficient assessment 3
• False-positive results can produce significant anxiety in 3% to 14% of parents, even after follow-up testing 1
• To minimize loss to follow-up, a dedicated system should be implemented to track each infant who fails screening and remind parents about follow-up appointments 4

Risk Factors for Hearing Loss

• Between 50-75% of infants with moderate to profound bilateral SNHL have one or more specific risk factors 1
• Risk factors include NICU admission for 2+ days, family history of childhood SNHL, congenital infections, craniofacial abnormalities, and syndromes known to include hearing loss 1
• The presence of multiple risk factors significantly increases the likelihood of hearing impairment 5

Long-term Implications

• Children with hearing loss experience delayed development in language, learning, and speech, with impairment evident as early as age 3 1
• These developmental delays can lead to lower reading abilities, poorer school performance, and under- or unemployment throughout life 1
• Any child with risk factors for hearing loss should have ongoing developmentally appropriate hearing screening and at least one diagnostic audiology assessment by 24-30 months of age 1