Copyright 1999 The Washington Post
The Washington
Post
August 10, 1999, Tuesday, Final Edition
SECTION: HEALTH; Pg. Z09
LENGTH: 1216 words
HEADLINE:
Don't Come Home Without It; Many States Are Requiring Hospitals to Screen
Newborns for Hearing Loss
BYLINE: Tomoko Hosaka,
Washington Post Staff Writer
BODY:
If people born with hearing loss have it caught early--as
infants--many will be able to learn and communicate normally, unlike most
children whose hearing problems are detected later as toddlers.
That's
the theory behind a growing movement among audiologists, pediatricians and
legislators who believe that the easiest, most effective way to find and treat
babies with hearing loss is to screen all newborns before they are discharged
from the hospital.
Study after study has shown that by the time most
children with hearing loss are identified, generally at about 3 years old, the
most critical period for speech and language development has already passed.
Less serious cases of hearing loss often go undetected even longer.
According to the National Institutes of Health, serious hearing loss can
have devastating results, ranging from delayed language to inadequate social and
emotional development to poor academic performance.
But if hearing
problems are caught soon after birth and children are fitted with hearing aids
or are given some other form of immediate intervention, such as being taught
sign language, their speech and language skills can develop normally, said
Gilbert Herer, a professor of pediatrics at George Washington University Medical
School and chair of hearing and speech at Children's National Medical Center in
Washington.
"I'd be willing to bet that these babies that have been
fitted with hearing aids will be in regular kindergarten and will be able to
learn just like other kids," Herer said. "That's not the case with kids who are
discovered at 2 1/2."
So far, 20 states, including Maryland and
Virginia, have adopted laws that either expand access to newborn hearing
screening programs or mandate hospitals to test hearing in all newborns before
they go home. Infant hearing screening bills are pending in
five states, while two others plan to study the need for legislation. In
addition, bills to help states fund universal newborn hearing screening programs
have been introduced in Congress.
Last year, only eight states had such
laws on the books, said Jim Potter, director of government relations and public
policy at the American Speech-Language-Hearing Association. "We are very pleased
with the success we've had this year," Potter said. "We're going to try to
redouble our efforts for the year 2000."
Such success, though, doesn't
come without criticism. In a commentary published five months ago in the journal
Pediatrics, physician Jack Paradise argues that the nation's pediatricians are
moving too quickly to implement universal newborn hearing screening without full
understanding of the potential costs.
"The problem is that we don't
really know what the right thing to do is," says Paradise, a pediatrician at
Children's Hospital in Pittsburgh. "There's a benefit side and there's a risk
side. That risk side has never really been examined."
Paradise's main
concern is errors that wrongly identify a child as having a hearing problem.
"There is much evidence . . . that identifying a child as abnormal in the
newborn period, even when that identification soon proves incorrect, can
engender lasting anxiety on the part of certain parents and can have long-term
adverse effects on parent-child relationships and on children's later
psychological development," he states.
But Paradise admits that his
views are in the minority and that the nationwide momentum for universal newborn
hearing screening is picking up speed so fast that it's difficult for critics to
be heard. Advocates say the push for universal screening is justified, backed by
evidence that outweighs any drawbacks.
For every 1,000 babies born,
about three have some sort of hearing impairment, making it the most common
birth defect in the country, according to the National Center for Hearing
Assessment and Management at Utah State University. And yet more than 85 percent
of all hospitals do not screen hearing before newborns are discharged.
Instead, most hospitals screen only babies with high-risk factors for
hearing loss, such as a family history of childhood hearing loss, low birth
weight and facial deformities. But when states such as Virginia looked at data,
officials discovered that about half the children later diagnosed with hearing
problems had no identifiable risk factors at birth.
"We knew that we
were missing 50 percent of babies," said Pat Dewey, speech and hearing services
administrator at the Virginia Department of Health. "So the natural progression
was to screen everyone."
Virginia passed its universal newborn hearing
screening legislation last year, and as of July 1, every hospital in the state
with a neonatal intensive care unit was required to screen all its newborns
before discharge. The law extends to all Virginia hospitals next July.
Loudoun Hospital Center is one of 23 hospitals across the state that
began its screening program last month. Since then, nurses have detected one
baby with possible hearing loss. The infant, who had no high-risk factors, would
probably have slipped through the cracks before the universal screening program
began, said Nancy Sehnert, team leader of the hospital's nursery.
Maryland passed its universal screening legislation in April and will
require all its hospitals to comply with the law beginning next July.
Holy Cross Hospital in Silver Spring has had a universal newborn hearing
screening program for more than two years and screens 6,500 babies a year. Grant
money helped start the program, which is managed by Herer of Children's National
Medical Center. The pilot program has demonstrated that universal screening
could be cost-effective at a very large hospital.
The push for universal
screening wasn't possible until the early 1990s, when equipment was developed
that evaluates babies' hearing by examining their brain waves. "As an
audiologist, this is the dream of all dreams--that we'd be able to identify
children with hearing loss as babies," Herer said.
Several other
Maryland hospitals have tried to start programs in the past but were
unsuccessful in maintaining them because of budgetary constraints, said Susan
Panny, director of the Office of Hereditary and Congenital Disorders at the
Maryland State Department of Health and Mental Hygiene.
The new Maryland
law, which mandates insurance companies to pay for screening, will help ensure
funding for screening. Once hospitals buy the proper equipment, the cost is
between $ 25 and $ 40 per baby.
Michelle Reilly, of Odenton, says her
2-year-old son, Matthew, would never have had his hearing screened if it weren't
for the program at Holy Cross. Although he had no high-risk factors, the
screening detected a problem. At 4 1/2 months, audiologists confirmed that
Matthew had no hearing in his left ear and some loss in his right ear. At 5
months, he was wearing hearing aids.
Although Matthew can't make out
sounds as well as most children, tests show that his speech and language
development is right on track.
"We're so incredibly lucky. Because they
caught it early enough, we were able to get amplification for Matthew," Reilly
said. "It's empowered us with time to do research and get knowledge and start
working on things sooner rather than later."
LOAD-DATE: August 10, 1999
