University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

Question

• Universal newborn screening has recently been implemented in the newborn nursery. Does early identification of and intervention for hearing loss improve language outcomes?

Clinical Bottom Lines

1. Congenital hearing loss occurs in 1.2-5.7/1000 live births.
   
2. Targeted newborn hearing screening of high-risk infants only identifies ~50% of those with hearing loss.
   
3. Language skills of children with hearing loss who receive intervention (hearing aids and educational programs) before the age of 6 months are significantly better than children with hearing loss who receive intervention after 6 months of age.
   
4. Hearing impaired children with lower cognitive abilities who receive intervention before 6 months of age have language skills similar to hearing impaired children of normal cognition who receive intervention after 6 months of age.

Summary of Key Evidence

1. 150 deaf and hearing-impaired children living in Colorado were divided into two groups based on age of identification and intervention. Group 1 were those identified between birth and 6 months of age; group 2 were those identified after 6 months of age. The two groups were similar except in cognitive ability. Group 2 had a significantly higher percentage of low cognition patients.¹
2. Outcome measures were receptive and expressive language skills as assessed by the Minnesota Child Development Inventory.
3. Children whose hearing loss was identified between birth and 6 months had significantly better language skills than those who were identified later. This held true even when controlling for cognitive ability.
   

Additional Comments

• Randomized controlled trial for early v. late intervention is seemingly impossible. Most states have mandated universal newborn hearing screening. In addition, patients with suspected hearing loss are protected by the Individual with Disabilities Education Act.
• Universal newborn hearing screening is extremely costly. However, it remains impossible to determine the educational resources saved down the road.²
• The AAP, 1994 Joint Committee on Infant Hearing, Health People 2000, NIH consensus statement and the American Academy of Audiology endorse universal newborn hearing screening.³
  
  

Citation

1. Yoshinaga-Itano C, Sedey AL, Coulter DK, Mehl AL. Language of early- and later-identified children with hearing loss. Pediatrics 1998; 102(5):1161-71.
2. Kemper AR, Downs SM. A cost-effectiveness analysis of newborn hearing screening strategies. Archives of Pediatrics and Adolescent Medicine 2000; 154(5): 484-88.
3. Task Force on Newborn and Infant Hearing. Newborn and infant hearing loss: Detection and intervention. Pediatrics 1999; 103(2): 527-30.
   
   

CAT Author: Tracy Richmond, MD

CAT Appraisers: Jonathan Fliegel, MD

Date appraised: December 21, 2001