Explanation of the process, involvement, link to healthcare system and benefits and disadvantages of newborn hearing screening.


Process

Selection

  • After the child’s birth has been officially registered by its parents at the city hall, the Child Healthcare organisation receives the child’s details from the Municipal Personal Records Database.
  • The child’s details are then transferred from the Child Healthcare organisations’ information systems to the newborn hearing screening information system.

Invitation

  • In the third trimester of pregnancy, the obstetric health care provider (midwife, obstetrician or obstetric general practitioners) gives the parents a leaflet containing general information about the hearing test and the heel-prick test.
  • The parents are given another copy of this leaflet when they officially register their child’s birth.
  • Child Healthcare makes an appointment for the hearing test and the heel-prick test to be performed at the parents’ home. Screeners will sometimes visit the parents without having made an appointment.
  • In the provinces of Zuid-Holland and Gelderland, some Child Healthcare organisations offer the hearing test at the child health clinic, as heel-prick tests there are still performed by midwives and not by Child Healthcare. The parents are sent an invitation to attend for this test.

The screening test

  • In theory, newborn hearing screening is performed as soon as possible after the first 96 hours of the child’s life, and in any case within 168 hours of its birth. The hearing test is carried out in the hospital, four to five weeks after the birth, if the child has not been discharged by that time. In cases of premature birth, corrections can be made to allow for the duration of pregnancy.
  • If insufficient hearing test results are obtained for one or both ears then the test may be repeated twice, usually with an interval of one week.
  • In the first two rounds, the OAE (otoacoustic emission) test method will be used. In the third round, the AABR (Automated Auditory Brainstem Response) test method will be used.
  • The test results are available immediately.
  • With certain situations/disorders, testing commences with the AABR method as the hearing impairment involved in these cases can not always be detected using the OAE method (e.g. after an exchange transfusion or after a meningitis).

Referral

  • In the event of an insufficient test result for one or both ears, the child is referred to an Audiology Centre where it undergoes further diagnostic testing and, if necessary, treatment.

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Who is involved in the screening programme?

  • At national level, the screening programme is directed and coordinated by the National Institute for Public Health and the Environment’s (RIVMNational Institute for Public Health and the Environment ) Centre for Population Screening (CvB), on behalf of the Ministry of Health, Welfare and Sport.
  • The Municipal Executive is responsible for provision of the newborn hearing screening. Local authorities do not have any discretionary powers in this matter.
  • The Child Healthcare organisations are responsible for the provision and quality of the newborn hearing screening.
  • The first and second screening is performed by screeners from Child Healthcare organisations, and, in a few cases, from maternity care organisations.
  • The regional coordination of the newborn hearing screening is carried out by one of the nearly 30 regional coordinators. These individuals are usually employees of the Child Healthcare organisations. Some Child Healthcare organisations have purchased these services from the Dutch Foundation for Deaf and Hearing-impaired Children (NSDSK). The regional coordinators conduct the third round of screening, monitor the screening process, provide on-the-job training for OAE screeners, offer continuing education and coaching to the screeners if necessary, and assist in the interim quality monitoring of implementation.
  • Annual monitoring of the quality of screening is carried out by an external organization.
  • The Programme Committee for Newborn Hearing Screening, which was established by the RIVM–CvB, advises the CvB on the national coordination of the programme. The Programme Committee is composed of experts from relevant professional groups and organisations (including parent’s organisations).

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Link to the healthcare system

In principle, all tested children who are referred for diagnosis and, if necessary, treatment will go to an Audiology Centre. The first visit to the Audiology Centre must take place within three weeks of referral. The diagnosis must then be completed within the first three months of life. In cases of premature birth, corrections can be made.

In principle, children with bilateral hearing impairment of at least 40dB in the better ear will be prescribed hearing aids. In cases of moderate to severe hearing impairment, one of the seven family counselling services in the Netherlands will be called in. The intervention must be started before the child reaches the age of six months.

If necessary, the child can be referred by its family doctor to one of the University Medical Centers for further tests, to establish the cause of its hearing impairment.

The regional coordinator monitors the link to the healthcare system as good as possible and reports to her Child Healthcare organisation if the child’s parents decide not to participate. This is important, as in recent years it has been found that, at the time of referral, children have a 40% risk of hearing impairment in one or both ears, on average. If testing reveals a loss in both ears, the risk of bilateral hearing impairment can even be over 60%.

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Benefits and disadvantages

Benefits

  • The early identification and treatment of hearing disorders in young children makes it possible to favourably stimulate communicative and linguistic development, thus enhancing the developmental potential of hearing impaired and deaf children. The hearing test programme has particularly high specificity: 99.8%. Its sensitivity is difficult to determine. This is because it can not be reliably determined whether hearing impairment that manifests itself at a later stage was already present at the time of testing.

Disadvantages

  • Children with mild hearing impairment are not detected. This group can include children with progressive hearing impairment.
  • Soon after its birth, parents are confronted with the fact that their child is hearing impaired. Among the parents of children whose hearing test results were unsatisfactory, 78% think it is important (or very important) that their child’s hearing be tested at this age. Among the parents of children with permanent hearing impairment in both ears, this figure is no less than 88%.

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