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Key Findings: Infants with Suspected Hearing Loss May Not Receive Timely Diagnosis

An American Journal of Perinatology article, “Provider Perspectives: Identification and Follow-Up of Infants who are Deaf or Hard of Hearing,” describes barriers to identifying and following up with infants with hearing loss and suggests strategies to increase the number of children with hearing loss identified early.

Without timely screening, diagnosis, and intervention, hearing loss can cause significant delays in a child’s speech, language, social, and emotional development. Recommended Early Hearing Detection and Intervention (EHDI) benchmarks include screening for hearing loss before 1 month of age, diagnostic evaluation before 3 months of age, and enrollment in early intervention before 6 months of age, known as the 1-3-6 plan.

Nationally, 1 in 4 infants who do not pass their newborn hearing screen are missed due to loss to follow-up (LFU), when an infant needs a recommended service but does not receive it, or loss to documentation (LTD), when an infant receives services but the information is not reported to the state. This means public health professionals do not know whether these infants are receiving timely services. In 2019, Texas had nearly twice the average rate of LFU or LTD among infants who did not pass their newborn hearing screening compared to the United States overall (51.1% vs. 27.5%).

To understand barriers to follow-up and reporting, CDC and staff from the Texas Department of State Health Services led an investigation to understand challenges related to LFU/LTD and identify potential opportunities to reduce LFU/LTD among infants in need of diagnostic or early intervention (EI) services from the provider perspective. The CDC team interviewed 56 healthcare providers in Texas along the hearing care continuum, including hospital newborn screening staff, audiologists, physicians, and early intervention program staff.

The EHDI 1-3-6 Benchmarks

It is recommended that all babies are screened for hearing loss no later than 1 month of age.

If a baby does not pass the hearing screening, it is important that they get a diagnostic hearing test and evaluation by a hearing specialist as soon as possible, by no later than 3 months of age.

Intervention services are recommended for children diagnosed with hearing loss, beginning as early as possible but no later than 6 months of age.

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