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Centre for Community Child Health
The Victorian Infant Hearing
Screening Program: Update
Dr Melinda Barker
Co-director, Victorian Infant Hearing Screening Program
Royal Children’s Hospital
October 2014
VIHSP – a brief history
1992 Victorian Infant Hearing Screening Program
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Commenced two-tiered screening program (neonatal
risk factors + behavioural screening at 7-9 months)
1992-2003
• research into hearing loss, research into effectiveness of
VIHSP, lobbying government for UNHS funding
2003
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Funding secured for universal screening – VicNIC
2004
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Funding secured for expansion to UNHS in hospitals with
NICUs
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VIHSP – a brief history
2005
• UNHS in Victoria commences! VIHSP Newborn
Hearing Screening - 30% of Victoria’s births
• Distraction test ceases
2006
• Election promise – statewide expansion
2007
• May (Vic) budget: commitment for VIHSP
UNHS statewide
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VIHSP – a brief history
2008
• VIHSP NHS in all metro public hospitals (57%)
2009
• VIHSP NHS in all regional hospitals (78%)
• PM announces that NHS available to all by 2011
• VIHSP secures funds for Early Support Services
2010-12
• VIHSP NHS in remaining private metro hospitals
(100% of pop)
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Why screen for hearing loss in
newborns?
Early Intervention crucial
• Without NHS, PCHI is detected late
• Identification by 6 months = better communication skills,
including spoken language
• Technology to screen neonates is quick, easy, painless
• Diagnosis, early intervention & support services are
available
• Potential to relieve burden of disability caused by
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•
•
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language delays and deficits
academic delays and disadvantages
social impairments
economic disadvantages
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International and interstate
Pre-discharge hearing screening is the
international standard of care
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first recommended by expert panels in 2004
mandated in most states in the USA
UK screening 100% of their 600K annual births
all Australian states now have universal newborn
hearing screening
• effectiveness established – UNHS here to stay
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VIHSP Newborn Hearing
Screening State-wide Rollout
Phase & Year
Hospitals
% of Vic
births
1, 2005 - 2006
Tertiary maternity hospitals + colocated private hosps + RCH NICU
30%
2, 2008 - 2009
Public metro maternity hospitals
57%
3, 2009 - 2010
Public and private regional maternity
hospitals
78%
4, 2010 - 2012
(Remaining) private metro hospitals
100%
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VIHSP people
Director
Senior Area
Manager 3
Area
Manager
Quality
Manager
1
Senior Project
HO Admin &
3
Officer
Support Team 4
ESS
22
Hearing
Screener
81
Site Admin
Assistant
24
3
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The VIHSP screen
• Carried out at the
bedside while mother
and baby are still in
hospital
• Sometimes the
screen takes place
during at outpatient
visit
• The hearing screener explains the screen and
answers any questions
• The screener provides VIHSP information
brochure
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What does the hearing screen look
like?
• The mother will be asked to sign a
consent form before the screen
begins
• The screener places sensors on
the baby and earcups that play soft
clicking sounds
• The screen is quick and painless
and many babies remain asleep
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The VIHSP screening protocol
VIHSP screen #1
Pass result in both ears
Refer result in 1 or 2 ears
NFA
VIHSP screen #2
Pass result in both ears
Refer result in 1 or 2 ears
NFA
Referral to audiology
by VIHSP Area Coordinator
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Who can we screen?
• Any well baby who is at least 34
weeks gestational age and less
than 6 months
• Normal ear anatomy, no obvious
craniofacial abnormalities
• Preferably quiet and calm
• Suspected neurological disorder*
• Infants on CNS stimulants or
ototoxic medications**
* May become BYPASS baby
** Screen close to discharge
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Who don’t we screen?
• Babies less than 34 weeks or
greater than 6 months
• Severe craniofacial abnormalities or
skin conditions which make the
screen difficult - BYPASS
• Babies under palliative care –
unless specifically requested
• Tend to screen most babies – even
if they are going to audiology
anyway
• Screen does not replace clinical
judgement/concern
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Screen results
• The screener will give
the results of the screen
straightaway.
• Some babies will need
a second screen in
order to achieve a clear
result. The screener will
organise a time for this
to take place.
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• Pass result - baby showed a
clear response to the sounds
played.
• unlikely that the baby has a
hearing loss that would affect
early speech & language
development.
• Hearing losses can develop at a
later time;
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We do not always get a clear response
to the clicking sounds during the first
screen. This might be because
• the baby woke up or became
unsettled during the screen
• there was fluid or debris still in their
ears from the delivery
• there is a hearing loss.
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A refer result : we did not get a
clear response from the baby
to the sounds played.
This could be because:
• the baby was unsettled during
the screens
• there is still fluid or another
temporary blockage in his/her
ears
• the baby has a hearing loss.
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What happens after a refer result?
The hearing screen does not diagnose a hearing
loss.
A refer result does not always mean that the
baby has a permanent hearing loss.
A refer result simply means that the baby needs
to have a full hearing test at an audiology clinic.
If the baby needs to have a full hearing test, the
VIHSP Area Coordinator at the hospital will
arrange this appointment at the audiology centre
of the parent’s choice.
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What happens after a refer result?
•ESS
• Three ESS staff across the state
• Contact within three days to all refer families
• Attend audiology appointments where
necessary
• Provide ongoing support through to Early
Intervention
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Targeted surveillance: checking
for risk factors
Hearing loss risk factors assessment via
universal maternal and child health service.
My Health and Development Record used as
the vehicle for targeted surveillance of infants at
risk of progressive or acquired loss. Referral
details recorded in MHDR.
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My Health and
Development Record
• In Birth Details section
• Screen Results Page 1
• Screener records
• Results (Pass or Refer)
• Date of screen
completion
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My Health and
Development Record
• In Birth Details section
• Screen Results Page 2
• Screener records
• Result (Pass or Refer)
• Any risk factors present
at time of screen
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My Health and
Development Record
• 8m page
• Targeted surveillance
(risk factor follow-up)
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Program results 2013/14
Month
Eligible
• VIHSP
results
6,578
July
Declined
Screened
Screened within one
month corrected
age
19
6,505
6,482
1.2
Refer rate
August
6,503
19
6,412
6,388
1.1
September
6,393
12
6,319
6,301
1.0
October
6,645
13
6,559
6,539
0.8
November
6,338
12
6,242
6,228
0.9
December
6,342
14
6,219
6,179
1.0
January
6,471
16
6,390
6,371
1.1
February
6,274
20
6,185
6,159
1.2
March
6,648
14
6,558
6,534
1.1
April
6,417
6,404
6,265
13
10
15
6,331
6,336
6,186
6,303
6,312
6,166
0.9
1.0
0.9
77,276
179
76,234
75,956
1.0
May
June
Full Year
(%)
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Program results 2012/13
• 793 referrals to
audiology
• 50 Bypassed to
audiology
• Refer rate 0.9%
Audiology Referral Outcomes
2012-13
Permanent
Results not
available
5%
Bilateral HL
11%
Other Bilateral HL
12%
Detection
rate – 1.07
per 1000
Permanent
Unilateral HL
7%
Normal Hearing
57%
Other unilateral
HL
8%
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Comparing Median Age at
Detection (in months) – Victoria
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Points to remember
• Babies that don’t get
screened in hospital will
generally get screened as
outpatients – don’t need
audiology referral. Contact
VIHSP first
• Babies can be screened up
to 6 months
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Points to remember
• Will we screen
• Homebirths? – Yes
• Out of state? – Yes
• Decline and then changed mind? – Yes
Provided they are less than 6 months
• Check the VIHSP website for the local
VIHSP contact numbers and Audiology
referral forms and referral FAQs
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Audiology Referral Form
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Minor changes to My Health and
Development Record
• Added decline section
• Changed wording of risk factor
aminoglycoside administration to 3
consecutive days
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VIHSP – more information
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Contact an Area Manager – via the website
Visit www.vihsp.org.au
Email us on email.vihsp@rch.org.au
Call Head Office 9345 – 4941
About hearing and hearing test visit
http://infanthearing.vihsp.org.au
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