Timing of Repeat Newborn Screening After Initial Failure
Newborns who fail initial screening should be rescreened by 1 month of age, with the optimal timing being no later than 1 month after birth for outpatient rescreening. 1
Screening Timeline for Different Conditions
Metabolic and Genetic Disorders
- Initial screening should occur at 24-48 hours after birth to ensure results are available by 5 days of age for critical conditions 1, 2
- Infants who fail initial screening should complete rescreening by 1 month of age 1
- The benchmark is that less than 4% of all newborn infants should fail initial screening and any subsequent rescreening before comprehensive evaluation 1
- More than 95% of all newborn infants should complete screening by 1 month of age 1
Special Considerations for NICU Infants
- NICU infants require modified screening protocols due to metabolic instability, blood transfusions, aminoglycosides, and heparinized solutions that can affect results 3
- NICU screening should include: screening on day of birth prior to interventions, repeat screening at 1 and/or 2 weeks of life, and additional screening as needed 3
- For readmissions in the first month of life with conditions associated with potential hearing loss (hyperbilirubinemia requiring exchange transfusion or culture-positive sepsis), ABR screening should be performed before discharge 1
Hearing Screening Specifics
- Patient rescreening for hearing should occur at no later than 1 month of age and should test both ears even if only one ear failed initial screening 1
- Infants who fail hearing rescreening should complete comprehensive audiological evaluation by 3 months of age, with a benchmark of 90% completion 1
- For newborns with positive CF newborn screen, sweat chloride testing should be performed as soon as possible after 10 days of age, ideally by the end of the neonatal period (4 weeks of age) 1
Critical Follow-Up Benchmarks
Diagnostic Confirmation
- 90% of infants who fail rescreening should complete comprehensive evaluation by 3 months of age 1
- For infants with confirmed bilateral hearing loss whose families elect amplification, 95% should receive devices within 1 month of confirmation 1
- For infants with confirmed hearing loss qualifying for Part C services, 90% should have a signed IFSP by no later than 6 months of age 1
Common Pitfalls to Avoid
Loss to Follow-Up
- Too many children are lost between failed screening and rescreening, and between failed rescreening and diagnostic evaluation 1
- Only 34.6% of newborns who failed initial hearing screening returned for 1-month follow-up testing in one large study, highlighting the need for dedicated tracking systems 4
- A dedicated secretariat system should be implemented to follow up each "failed" newborn and remind parents about appointments 4
Communication Issues
- Screening results should be conveyed immediately to families in a confidential, caring, and sensitive manner, preferably face-to-face 1
- Before discharge, an appointment should be made for follow-up testing to prevent loss to follow-up 1
- Educational materials must be provided at an appropriate reading level and in a language families can comprehend 1
Timing Errors
- Specimens collected before 24 hours after birth may yield false results due to insufficient time for metabolic abnormalities to manifest 2
- Screening performed too early (before adequate feeding) can miss certain metabolic disorders that require protein intake to become detectable 1
Special Populations Requiring Attention
Out-of-Hospital Births
- States should develop mechanisms to systematically offer newborn hearing screening for all out-of-hospital births 1
- Outpatient screening at no later than 1 month of age should be available to infants discharged before receiving birth admission screening 1