What are the recommended screening tests and timeline for a baby who has experienced birth asphyxia?

Screening Requirements for Birth Asphyxia Infants

Birth asphyxia places infants at high risk for both retinopathy of prematurity (ROP) and hearing loss, but the specific timing of screening depends on gestational age and clinical course rather than the asphyxia event alone.

ROP Screening in Birth Asphyxia

When ROP Screening is NOT Indicated at 1 Month

• Term infants (>37 weeks gestation) with birth asphyxia do NOT require ROP screening, regardless of the severity of asphyxia, as ROP screening is only indicated for premature infants 1
• Infants between 29-37 weeks gestation who had a medically stable course (no supplemental oxygen requirement) may not need screening 1
• The statement that all birth asphyxia babies need ROP screening at 1 month is incorrect - screening criteria are based on prematurity and oxygen exposure, not asphyxia alone 1

When ROP Screening IS Indicated

• Only premature infants (<32 weeks gestation) require ROP screening, with the first examination performed at the later of either 31-33 weeks postmenstrual age or 4 weeks chronological age 1
• Infants with chronic lung disease of infancy (CLDI) should be screened even if between 29-37 weeks gestation, as oxygen exposure increases ROP risk 1
• The examination must be conducted by an ophthalmologist experienced in ROP evaluation 1

BERA (Auditory Brainstem Response) Screening in Birth Asphyxia

Why Birth Asphyxia Requires Hearing Screening

• Birth asphyxia is a recognized risk factor for hearing loss that warrants ongoing developmentally appropriate hearing screening 2, 3
• Infants with risk factors for hearing loss should have at least one diagnostic audiology assessment by 24-30 months of age, regardless of newborn screening results 2, 3

Appropriate Timing for Hearing Assessment

• The initial hearing screening should occur before hospital discharge using otoacoustic emissions (OAE), ideally after the first 24 hours of life 3
• If the infant fails initial screening, repeat testing should occur between 2-8 weeks after discharge 2, 3
• If repeat screening is failed, comprehensive audiological evaluation including diagnostic ABR testing should be performed as early as 3 months of age - not at 4-6 months 2
• Infants who spent time in the NICU (≥2 days) should be screened using ABR technology rather than OAE alone, as they are at higher risk for neural hearing loss 3

The 4-6 Month Timeline is Suboptimal

• Waiting until 4-6 months for BERA is delayed compared to current best practice, which recommends diagnostic ABR testing as early as 3 months of age for infants who fail repeat screening 2
• Universal newborn screening has reduced the mean age of identification of hearing impairment from 12-13 months to 3-6 months 2
• Earlier identification allows for earlier intervention, with mean age for hearing aid fitting reduced from 13-16 months to 5-7 months 2

Critical Caveats

• Birth asphyxia alone does not automatically trigger ROP screening at 1 month - this is a common misconception 1
• Loss to follow-up is significant, with 13-31% of infants who fail initial hearing screening not returning for follow-up 2, 3
• Birth asphyxia accounts for less than 10% of cerebral palsy cases, and the presence of asphyxia does not predict all neurodevelopmental outcomes 4
• The key determinant for ROP screening is prematurity and oxygen exposure, not the asphyxia event itself 1