Does your newborn need a follow-up hearing test?
When Sophia Hill's newborn son needed a follow-up hearing test with a pediatric audiologist, after his newborn screening at Cape Cod Hospital was inconclusive, she assumed she would have to take him to Boston.
“I just figured we were going straight to (Boston) Children’s Hospital,” she said.
Instead, Boston Children’s Hospital came to them. The Brewster infant became the first to take part in a new Telehealth Newborn Audiology program that is a partnership between the Boston hospital, Cape Cod Hospital (CCH) and the state Department of Public Health (DPH). The new telehealth service made it possible for Sophia's newborn to be tested at Cape Cod Hospital, rather than at an off-Cape facility in Taunton or Boston, as was the case in the past.
“As much as possible, we like to keep care local,” said CCH Pediatrician Janelle Laudone, MD. “So, this is a way to enable families to have easier follow-up and less stress. Packing up a newborn and driving for an hour or more is never easy for families.”
The telehealth program, which is the first of its kind in the state, will also mean babies will likely receive the follow-up screening sooner than in the past, since they will not have to wait for an appointment off-Cape, Dr. Laudone said.
“If it turns out the child is deaf or has hearing loss, you want to know because the child can get early intervention services sooner,” she said. “Hearing is so important in terms of language and communication skills.”
DPH was one of 21 health departments around the country to be awarded federal funding through the Association of Maternal & Child Health Programs by the CARES Act. The grant is specifically designed for maternal and child telehealth programs, and DPH worked with Boston Children’s Hospital to bring their audiology expertise to families living on Cape Cod and the Islands. Statistically, the Cape and Islands fall into an underserved region for pediatric diagnostic audiology, as babies born in the Southeast region of the state have been more than twice as likely as those in the rest of the state to not receive documented follow-up diagnostic testing after a newborn hearing screening is unsuccessful, according to a DPH press release.
All Newborns Tested
All newborn babies at Massachusetts hospitals are required by DPH to receive initial hearing screening before leaving the hospital, said Jennifer LaCasse, director of The Family Birthplace at CCH. Known as the Automated Auditory Brainstem Response assessment (AABR), it consists of three sensors attached to the infant – on the forehead, the nape of the neck and the back of one shoulder. Soft earphones are then placed over the baby’s ears and soft clicks are transmitted through the earphones, one ear at a time. The sensors then detect brainwave response to the clicks.
Babies either pass or fail this test, and those who do not pass are then retested using the same equipment. If they fail a second time, they are referred to a pediatric audiologist for what is known as a “threshold” Auditory Brainstem Response (ABR). With this test, electrodes are placed on the baby’s head and the neural electrical activity is tested from areas within the cochlea inside the ear.
This neural activity allows the audiologist to mark responses on the waves recorded in response to stimulation presented at different intensity levels across low and high frequencies or pitches, according to LaCasse. The lowest level at which neural responses are obtained is considered the threshold of hearing for that particular frequency, she said.
The new telehealth program utilizes a “hub” and “spoke” model where audiologists at Boston Children’s Hospital assess babies at CCH. A team member from CCH’s Family Birthplace prepares the infant for the test and places equipment on the baby. The equipment based at CCH sends the signals remotely to an audiologist at Boston Children’s, who assesses the results. An iPad allows the staff at both hospitals, the baby and the parent to see and speak to each other throughout the testing, LaCasse said.
“The process was seamless,” according to Hill, who said her son was “in perfect condition” to do the test. “I had just fed him before and we swaddled him up when he went in, and they put the electrodes on his head and he stayed asleep the whole time, (the baby needs to be calm and quite during testing. We were really only there for an hour and the audiologist in Boston was on the screen in front of me and the nurse at Cape Cod Hospital was on the side of me.”
Hill and the newborn's father received the good news that their child's hearing was within normal levels right at the time of the test.
Getting Babies in Services Sooner
Infants can fail the initial newborn screening done at the hospital for various reasons, said Dr. Laudone. Amniotic fluid or vernix, the cheesy skin coating on newborns, can be in the ear canal and affect the baby’s hearing at that time. Any kind of ambient noise in the nursery can also affect it, she said.
On average, one to four infants a month born at CCH require a follow-up hearing test, according to LaCasse.
One to three of every 1,000 babies born in the U.S. have hearing levels outside the typical range, according to Dr. Laudone said. Hearing loss can either be “conductive,” where there are problems with the sound getting to the auditory nerve, or “sensorineural” where there is an issue with the inner ear or nerve itself, or a mixed picture she said.
"If a child is deaf or hard of hearing, in addition to an audiologist they need to be referred to an otolaryngologist, or doctor who specializes in the ear, for treatment. They also should be referred to the Early Intervention program that will monitor the child's development in all areas. They can help teach sign language or other communication strategies as early as possible," Dr. Laudone said.
Without a hearing test, parents may be able to tell that their child has some hearing loss by noticing their baby doesn’t startle at loud noises or turn their head toward a sound, she said.
“However, for appropriate language and communications skills to develop, a babies need to have a wide range of hearing,” she said. “So, just knowing that a baby can hear a loud noise doesn’t mean the baby can hear the full range of sound that is necessary for good language and communication skills.”
The DPH grant paid for all costs associated with the Newborn Audiology Telehealth program for the month of April, including the equipment, staff salaries and the cost of the testing. The month-long pilot will allow the staff at both hospitals to become adept at using the equipment and doing the testing and, beginning in May, the testing will be opened to anyone from the surrounding area, including Martha’s Vineyard and Nantucket, LaCasse said.
CCH will be listed on the DPH website as a hearing test site. CCH will bill for the technical portion of the testing and Boston Children’s Hospital will bill a professional fee. Insurance will cover the cost of the testing, she said.
“This is a win for Cape and Islands families,” LaCasse said. “We have services in the area, close to home, with a renowned audiology team at Boston Children’s Hospital.”
Body Image: Julia Sullivan RN, Briana Dornan AuD BCH audiologist, Jennifer Lacasse Director Women’s and Children’s Services.