Newborn Hearing Screening Program Handbook Rev A

Distribution of contents to persons other than customers of Natus Medical Inc. and/or for use in establishing a newborn hearing screening program which does not involve the ALGO® Newborn Hearing Screener is expressly prohibited. Reproduction of any part of this document without the express written permission of Natus Medical Inc. is prohibited. Natus, ALGO, AABR, and ALGO DataBook are registered trademarks of Natus Medical Inc. Flexicoupler, Jelly Tab, and SpeedScreen are trademarks of Natus Medical Inc. Patent Pending © Natus Medical Inc., April 2003, All Rights Reserved ii

Newborn Hearing Screening Program Handbook – P/N 051185 Rev. A Copyright © Natus Medical Inc, April 2003

Dear Customer: In the February 1999 issue of the Pediatrics journal, the American Academy of Pediatrics (AAP) provides a statement of endorsement for Universal Newborn Hearing Screening (UNHS). The endorsement is based upon a recommendation from a special AAP task force on newborn and infant hearing. Some of the recommendations of the AAP task force include: • The use of a screening technology that yields 100% sensitivity. • A refer rate of 4% or less. • 95% of all newborns screened. • Appropriate training and monitoring of the personnel responsible for screening all infants. • Information to parents regarding the screening procedure and the benefits of early detection and intervention. • Proper procedures for communicating screening results to parents and pediatricians. This Program Handbook offers guidelines and tips that will help you to achieve the recommendations of the AAP. The information provided in this handbook is the result of a collaborative effort between Natus’ team of Clinical Consultants and various hospitals who have implemented successful newborn hearing screening programs. Please do not duplicate or distribute this information outside of your program. To use this handbook: • Review the Table of Contents and find the sections that are of interest to you. • Take sample policies and procedures, result forms, etc... and adjust them to suit the needs of your own screening program. • This CD folder contains electronic files of many of the forms that appear in the handbook. You may take these electronic files and customize them for your individual program. We hope that you find the handbook useful. If you have any questions regarding the information provided in the Program Handbook or feel that you need further program consultation, contact Natus Medical Inc. to schedule an appointment with a Clinical Consultant. Natus Medical, Inc.

Newborn Hearing Screening Program Handbook – P/N 051185 Rev. A Copyright © Natus Medical Inc, April 2003

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Contents 1

Getting Started... 1 1.1 THINGS TO CONSIDER AS YOU IMPLEMENT A UNIVERSAL NEWBORN HEARING SCREENING (UNHS) PROGRAM... 2 1.2 UNIVERSAL NEWBORN HEARING SCREENING IMPLEMENTATION CHECKLIST... 6

2

Community Education... 7 2.1 PROMOTIONAL KIT MATERIAL ... 8

UNHS Fact Sheet ... 9 Key Facts about Natus Medical’s ALGO® Newborn Hearing Screener ... 15 “Your Baby’s Hearing” pamphlet... 17 2.2 ARTICLES SUPPORTING UNHS ... 19

3

Financial Considerations ... 21 3.1 BILLING AND REIMBURSEMENT ... 21 3.2 SECURING FUNDS... 22

Solicitation Letter ... 23 Agencies and Organizations ... 24

4

Screening Protocol... 25 4.1 SAMPLE PROTOCOLS... 26

Sample Protocol #1 ... 26 Sample Protocol #2 ... 30 Overview of Screening Procedure for the ALGO® 3 Newborn Hearing Screener ... 32 Overview of Screening Procedure for the ALGO® 3i Newborn Hearing Screener ... 33 4.2 CONSENT/WAIVER DOCUMENTATION ... 39

Sample Consent/Waiver Form... 40

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Newborn Hearing Screening Program Handbook – P/N 051185 Rev. A Copyright © Natus Medical Inc, April 2003

Contents

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Recruiting and Training Staff... 41 5.1 SAMPLE JOB DESCRIPTIONS AND QUALIFICATIONS... 42

Newborn Hearing Screening Program Director ... 43 Volunteer... 45 Newborn Hearing Screening Technician... 47 5.2 TRAINING MATERIAL ... 50

Sample Training Agenda ... 53 Sample Parent Script (English) ... 55 Sample Parent Script (Spanish) ...56 AABR® Diagram... 57 Volunteer Well-Baby and NICU Nursery Screening Procedures... 59 Post Training Tests and Competency Checklists... 60 Clinical Update: Optional Screening with your ALGO Newborn Hearing Screener ...79 Overview of Screening Procedure for the ALGO® 3 Newborn Hearing Screener ... 91 Overview of Screening Procedure for the ALGO® 3i Newborn Hearing Screener ... 92

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Documenting and Reporting Results ... 93 6.1 DOCUMENTING RESULTS ... 93

Screening Result Form ... 95 Sample Sheet from Logbook... 96 6.2 PARENT NOTIFICATION ... 97

Sample Parent Notification Cards (English) ... 99 Sample Parent Notification Cards (Spanish)...101 Sample Parent Information Sheet (English)... 103 Sample Parent Information Sheet (Spanish) ... 104 Sample Parent Script (English) ... 105 Sample Parent Script (Spanish) ...106 6.3 PHYSICIAN NOTIFICATION ... 107

Sample Physician Letter ... 108 Newborn Hearing Screening Program Handbook – P/N 051185 Rev. A Copyright © Natus Medical Inc, April 2003

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Continuous Quality Improvement ... 109 7.1 PERFORMANCE MEASURES ... 109 7.2 MEETING HOSPITAL ACCREDITATION STANDARDS ... 111 7.3 DEVELOPING AND UTILIZING PERFORMANCE MEASURE EVALUATION LOGSHEETS ... 113

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Data Management, Tracking, and Follow-Up. ... 117 8.1 DATA MANAGEMENT... 117

Things to Consider for Data Managment ... 118 DataBook NHS Data Tracking System Software...119 Exporting ALGO Screening Data...120 Natus NHS Benchmarking Tool ...120 Data Management Flowchart ...121 8.2 PATIENT TRACKING... 122 8.3 SAMPLE FOLLOW-UP PROTOCOL ... 124

Tracking and Follow-up Protocol Flowchart ... 125

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General Information... 127 9.1 SCREENING SUPPLIES... 127

Ordering Screening Supplies... 127 9.2 EQUIPMENT MAINTENANCE ... 128

Corrective Service/Maintenance ... 128 ALGO Screener Calibration Requirements... 128 Calibration Considerations ... 128 Replacing Battery Packs... 129 Calibration Logsheet ... 130 9.3 NATUS CONTACTS ... 131

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Newborn Hearing Screening Program Handbook – P/N 051185 Rev. A Copyright © Natus Medical Inc, April 2003

1 GETTING STARTED Ensuring that your Universal Newborn Hearing Screening (UNHS) program meets all of the guidelines of the AAP involves considerable planning. Before you begin to screen infants, it may be beneficial for you to first create a checklist that includes all of the key tasks essential for a successful universal newborn hearing screening program. Consider creating a timeline for each item on the checklist to make sure that each task is completed in an orderly and timely fashion. The individual that oversees your UNHS program can post the checklist next to a calendar and use it as a reminder of upcoming project deadlines. Keep in mind that there are many steps that must be completed before you actually begin to screen infants in your healthcare facility. Completing these tasks may be a long process. For example, it may take several weeks to secure funding and for the hospital administration to approve your proposal for the implementation of a universal newborn hearing screening program. It is important that you take these facts into consideration so that you can create a realistic timeline for reaching your goal. The following chapter serves as a “starting point” for implementing your UNHS program. This chapter includes: • An overview of major items to consider as you design your program. • A checklist, that consists of ten steps to fully implementing your universal newborn hearing screening program. Please keep in mind that some items in this chapter may not be applicable to your healthcare facility. Furthermore, this checklist may not address some tasks that are essential to the protocol of your screening program. You can take this checklist and re-shape it to meet the needs of your screening program.

Newborn Hearing Screening Program Handbook– P/N 051185 Rev. A Copyright © Natus Medical Inc, April 2003

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1 Getting Started

1.1 THINGS TO CONSIDER AS YOU IMPLEMENT A UNIVERSAL NEWBORN HEARING SCREENING (UNHS) PROGRAM

Doing Research • Determine the most appropriate screening technology: • The screening device should provide an accurate and complete screen of the hearing pathway in one step. • The screening device should be completely standardized so that your does not have hospital to worry about setting screening parameters or making other adjustments. • The screening device should be cost effective for your screening program. •The screening device should be clinically proven to achieve refer rates less than or equal to 4% and false positive rates less than 3% (as recommended by the AAP) • The screening device should be easy-to-use and require minimal training, thereby allowing a wide range of personnel to screen babies at your facility. • Consult published newborn hearing screening protocols. • Contact neighboring hospitals to learn more about their newborn hearing screening program.

Establishing Population to Be Screened • Remember that universal screening involves the screening of all infants (i.e., well-baby and sick population) prior to discharge. • Determine differences between well-baby and sick population. • Determine the best age for screening.

Establishing Multidisciplinary Team • The Multidisciplinary Team may include the following disciplines: • Pediatrics • Nursing • Hospital Administration • Early Intervention • Audiology/Rehabilitation

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• Neonatology • Accounting/Billing • State Department of Health • State Legislation • Hearing Impaired Community

Newborn Hearing Screening Program Handbook– P/N 051185 Rev. A Copyright © Natus Medical Inc, April 2003

1.1 Things to Consider as You Implement a Universal Newborn Hearing Screening (UNHS) Program

• It is important to include members of the Multidisciplinary Team in the initial planning of your UNHS Program, and continue to involve them throughout the program implementation and evaluation process. • Arrange specific dates and times for meetings with the Team so that you can accomplish your goals and objectives in a timely manner.

Marketing your Program • Educate your community about the incidence of hearing impairment in newborns and the importance of implementing a newborn hearing screening program. • Inform physicians about your program. Include information on UNHS at Health Fairs and in brochures describing your Maternal-Child Health Programs. Ask the prenatal educator to show the Natus Parent Video and discuss the importance of the hearing screen with parents. Place information in your hospital newsletter or on bulletin boards. • Distribute the material contained in the Natus Newborn Hearing Screening Promotional Kit to the appropriate individuals. • Contact your local television/radio stations and newspapers to solicit their assistance in educating the community about newborn hearing screening and your facility’s program. Publicize the first baby screened and other milestones at your healthcare facility.

Securing Funds • Develop a budget, which takes all of your program costs into consideration. Program expenses include the purchase of screening equipment and supplies, follow-up testing for those infants that refer the first screen, training of personnel, and data management tools. • Identify agencies where you can acquire funding to implement your newborn hearing screening program.

Creating a Business Plan • Identify a Program Coordinator to oversee your UNHS Program. This person may be responsible for the overall program organization, planning, implementation, and evaluation. The program coordinator may also facilitate communication between multidisciplinary members of the UNHS Team. The coordinator may also be accountable for ensuring that follow up procedures are in place for identifying babies with a hearing impairment.

Newborn Hearing Screening Program Handbook– P/N 051185 Rev. A Copyright © Natus Medical Inc, April 2003

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1 Getting Started

• Outline a process and procedure for managing screening results. Proper documentation of ALGO results, physician and parent notification, adequate referral procedures, and follow-up guarantee that infants will be forwarded to the appropriate resource. Proper management of screening results also allows you to continually monitor the effectiveness of your screening program. • Identify the personnel that will be actively involved in screening the newborns at your healthcare facility. The screening personnel may include nurses, audiologists, volunteers, or physicians. Keep in mind that minimal training is required with the ALGO screener. • Survey the physical layout of the NICU and the Well-Baby nursery to determine the best locations for screening babies. You may want to consider offering outpatient screens as a service to the physicians in your community. • Determine the best time to screen babies. In the NICU setting, most programs screen their babies 24 to 72 hours prior to discharge after the baby has been stabilized, off most equipment and medications, and in an open crib area. In the hospital’s Well-Baby nursery, many very successful programs do their screens six hours after the baby’s birth. • Develop result notification material for primary care physicians and parents. Your methods of notification should ensure that both physicians and parents are well-informed about the child’s screening results, as well as the child’s developmental milestones. Determine who will be responsible for notifying parents of the screening results. • Develop follow-up protocol. Construct flowcharts for tracking patient screening results. Identify referral agencies for those infants who are identified with a hearing impairment. • Develop program material. Your program material may include educational material, as well as result notification forms for parents and physicians.

Developing Newborn Hearing Screening Protocol Create a screening protocol, which outlines your procedures for screening babies, and documenting and reporting results. Your protocol should be given to the appropriate individuals.

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Newborn Hearing Screening Program Handbook– P/N 051185 Rev. A Copyright © Natus Medical Inc, April 2003

1.1 Things to Consider as You Implement a Universal Newborn Hearing Screening (UNHS) Program

Training Personnel • Schedule training sessions for all screening personnel. • Develop training material that is appropriate for the experience level of the employees involved in your program. • Monitor and evaluate personnel on their screening techniques and provide additional training if necessary.

Setting up Continuous Quality Improvement (CQI) Measures To evaluate the effectiveness of your newborn hearing screening program, monitor the following: • Refer rates • Percentage of infants screened prior to discharge • False-positive rates • Number of infants lost to follow-up after discharge

Newborn Hearing Screening Program Handbook– P/N 051185 Rev. A Copyright © Natus Medical Inc, April 2003

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1 Getting Started

1.2 UNIVERSAL NEWBORN HEARING SCREENING IMPLEMENTATION CHECKLIST

√

TASKS TO COMPLETE

DATE INITIATED

DATE COMPLETED

COMMENTS

1 Do Research • Determine most appropriate screening technology • Consult published protocols • Contact neighboring hospitals

2 Establish Multidisciplinary Team • Hospital Administrator • Pediatrician • Neonatologist • Audiologist • Nurse • Billing Department Representative • State Department of Health Representative • Parent of hearing impaired individual

3 Educate Community • Present at Pediatric Section meetings • Attend other professional organizational meetings • Mail letters to medical community to gain support • Contact local newspapers and T.V stations • Contact hospital administration

4 Secure Funding • Create a billing plan • Contact agencies and organizations • Contact state health department

5 Create Business Plan • Purchase equipment and supplies • Identify screening personnel • Select best location and time for screening • Identify Program Coordinator • Develop follow-up procedure • Identify referral agencies • Develop flowcharts for patient management • Create method for managing results • Identify additional resources • Create administrative material Parent notification cards Result forms Physician letters • Develop Continuous Quality Improvement measures

6 Develop Newborn Hearing Screening Protocol 7 Recruit Staff and Conduct Interviews 8 Train Personnel • Assemble screening device • Schedule training session • Develop training material • Monitor and evaluate personnel

9 Implement Program and Evaluate Program Performance Measures 10 Publicize the Start of The Screening Program • Send out letters to pediatricians • Send out letters and brochures to parents • Announce the start of your facility’s screening program on local TV news stations and local newspapers

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Newborn Hearing Screening Program Handbook– P/N 051185 Rev. A Copyright © Natus Medical Inc, April 2003

2 COMMUNITY EDUCATION Studies have suggested that when you screen only the high-risk population for hearing loss, 50% of the infant population with a hearing impairment goes undetected.1 Studies have also shown that the first six months of age is the critical period to identify those infants with a hearing impairment and implement early treatment measures.2 Educating your community about such findings will allow you to rationalize the need for the implementation of a universal newborn hearing screening program and market your program effectively. Promoting a program may involve speaking at pediatric and nursing meetings, sending out solicitation letters to physicians, developing features on newborn hearing screening for newspapers and television stations, and arranging roundtable discussions at your own healthcare facility. In promoting your program, consider the following: • Arrange pediatric, nursing, and parenting meetings to discuss your plans for a universal newborn hearing screening program. Post colorful brochures and flyers in obstetricians’ offices and around your healthcare facility to advertise your meetings. • Get assistance from individuals who support your cause. For instance, you may be able to find parents of hearing impaired children that were not identified early. The testimonies of these parents can be compelling to the medical community. • Identify and target the key decision makers involved in implementing a universal newborn hearing screening program. • Contact your local newspaper and television stations. Create features on the importance of early identification and the need for screening all infants for hearing impairment before discharge. • Update your healthcare facility’s website and newsletters to include information about universal newborn hearing screening. • Distribute educational material (i.e., parental videos and brochures) to lamaze classes and obstetricians’ offices.

Newborn Hearing Screening Program Handbook – P/N 051185 Rev. A Copyright © Natus Medical Inc, April 2003

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2 Community Education

This chapter provides you with the following material: • Bibliography listing important articles that can be used to educate the community about universal newborn hearing screening. • Material from Natus’ Newborn Hearing Screening Promotional Kit, which can be used to promote your newborn hearing screening program.

Reference 1 Mauk G et al. The effectiveness of screening programs based on high-risk characterstics in early identification of hearing impairment. Ear and Hearing. 1991; 12(5):312-319 2 Yoshinaga-Itano C et al. Language of Early- and Later-identified Children with Hearing Loss. Pediatrics. 1998; 102(5):1161-1171

2.1 PROMOTIONAL KIT MATERIAL

The following material comes from a Newborn Hearing Screening Promotional Kit provided by Natus. The Promotional Kit contains information about the importance of universal newborn hearing screening, and sample promotional materials that you can use to help publicize your own program. If you would like to obtain the full Natus Promotional Kit, contact a Natus Customer Service representative.

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Newborn Hearing Screening Program Handbook– P/N 051185 Rev. A Copyright © Natus Medical Inc, April 2003

Universal Newborn Hearing Screening (UNHS) Fact Sheet

___________________________________________________ Incidence of Hearing Impairment §

Hearing impairment is the most common disability in newborns, with a higher incidence than cerebral palsy, Down’s syndrome, and severe mental retardation.

§

In the United States 12,000 children are born every year with a hearing impairment. It is far more common than many conditions typically screened in newborns:1,2,14 Hearing Loss Far Exceeds Conditions Commonly Screened in Newborns1,2,14 330 2,000

1,000

2,000

PKU (330) Cystic Fibrosis (2,000) Hypothyroid (1,000) Hemoglobinopathy (2,000) Hearing Loss (12,000)

12,000

•

Despite this prevalence, only 65 percent of newborns in the U.S. are screened for hearing impairment at birth.

Importance of Early Identification •

Hearing impairment has no visual indicators.

•

The most important period for speech and language development is from birth to six months of age.3

•

Delay in diagnosis can impair a child’s language, speech, psycho-social, and cognitive development.3,4

•

The average age of identification of hearing impairment is 14 months of age, well after the most critical period for language development has passed.

P/N 050318C Natus Medical Inc. 1501 Industrial Road San Carlos CA 94070-411 Tel: 650-802-0400 Fax: 650-802-0401

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Universal Newborn Hearing Screening (UNHS) Fact Sheet

___________________________________________________ •

Through therapy, children identified at birth with hearing loss can learn and progress at a rate comparable to those with normal hearing.

Each bar indicates the 75th to the 25th percentile vocabulary ranges for 36-month old children. In each category, the black dot represents the median vocabulary range. 5-10

Importance of Universal Newborn Hearing Screening •

Babies have typically been screened for hearing loss only if considered ‘at risk’. Yet 90% of babies born with hearing impairment have parents with normal hearing, and more than 50% of newborns with hearing impairment have no risk factors.11

•

Universal screening is the only reliable method to identify children with hearing impairment before the irreversible consequences of unidentified hearing impairment occur.

•

The annual cost of educating hearing impaired children in self-contained classrooms in American public schools is $9,689, compared with $3,383 for those in mainstream classes.12

•

Researchers estimate that up to $129 million dollars could be added to the U.S. economy each year if the children born deaf were provided intervention that resulted in superior language skills.13

P/N 050318C Natus Medical Inc. 1501 Industrial Road San Carlos CA 94070-411 Tel: 650-802-0400 Fax: 650-802-0401

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Universal Newborn Hearing Screening (UNHS) Fact Sheet

___________________________________________________ •

A majority of states have legislation or mandates in place that support universal newborn hearing screening.

•

The American Academy of Pediatrics Task Force on Newborn and Infant Hearing issued a statement endorsing universal newborn hearing screening methodologies, program refer rates, protocols, tracking, follow-up and intervention, and overall program costs.14

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REFERENCES

Universal Newborn Hearing Screening Fact Sheet. National Center for Hearing Assessment and Management (NCHAM) Utah State University Website. Available at: http://www.infanthearing.org 2. Projections based on total annual U.S. birth rate. Center for Disease Control and Health Prevention (CDC) and March of Dimes. 3. Yoshinaga-Itano C. Language of Early-and Later- identified children with hearing loss. Pediatrics. 1998;102(5):1161-1171. 4. Moore W. Managing the infant impairment problem: the contributions of industry. Seminars in Hearing. 1991;12(2):175-182. 5. Appuzo, M.L., Yoshinaga-Itano, C. Early identification of infants w/significant hearing loss and the Minnesota Child Development Inventory. Seminars in Hearing. 1995;16:124-139. 6. Mayne, A, et. Al. Expressive Vocabulary development of infants and toddlers who are deaf or hard of hearing. The Volta Review. 2000;100(5)(Monograph):1-28. 7. Fenson, L. et. al. Variability in early communicative development. Monographs of the Society for Research in Child Development. 1994;59(5, Serial #242). 8. Moeller, M.P. The deafness early intervention project: Strategies and outcomes. 1998; Paper presented at Marion Downs National Center Symposium on Infant Hearing, Denver, CO. 9. Robinshaw, H.M. Early intervention for hearing impairment: differences in the timing of communicative and linguistic development. British Journal of Audiology. 1995;29:315-334. 10. White, S.J. & White, R.E.C. The effects of hearing status of the family and age of intervention on receptic and expressive oral language skills in hearing-impaired infants monographs of the American Speech, Language and Hearing Association. 1987;26:9-24. 11. Mauk G. et al. The effectiveness of screening programs based on high-risk characteristics in early identification of hearing impairment. Ear and Hearing. 1991;12(5):105-119. 12. Johnson et al. Implementing a statewide system for infants and toddlers with hearing disabilities. Seminars in Hearing. 1993;14:105-119. 13. Downs, Marion P. The case for detection and intervention at birth. Seminars in Hearing. 1994;15(2):76-83. 14. American Academy of Pediatrics. Newborn and infant hearing loss: detection and intervention. Pediatrics. 1999;103(2):527-530.

P/N 050318C Natus Medical Inc. 1501 Industrial Road San Carlos CA 94070-411 Tel: 650-802-0400 Fax: 650-802-0401

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Key Facts About Natus Medical's ALGO® Newborn Hearing Screener__________________ The Technology:

The ALGO screener uses proprietary Natus AABR technology, which screens the entire hearing pathway, from the outer ear to, and including, the brainstem. The ALGO screener‘s fully automated technology provides a complete and accurate hearing screen in one step.

Published Clinical Sensitivity:

>99% [Oudesluys-Murphy AM, et al. Eur J Pediatr. 1996;155:429435]. 1

Published Clinical Specificity:

96 - 98.7% [Oudesluys-Murphy AM, et al. Eur J Pediatr. 1996;155:429-435]. 1

Screening Time:

The ALGO device screens both ears in an average of 4 - 7 minutes (both ears screened simultaneously).

Screening Location:

The ALGO screener may be used in any nursery environment. There is no need for a special quiet screening location.

Babies Screened to Date:

Over ten million babies worldwide have been screened with the ALGO screener.

Installed Base in the U.S.:

Approximately 60% of all birthing hospitals in the United States use the ALGO screener (over 2000 hospitals). Natus has assisted in developing universal newborn hearing screening (UNHS) programs in hospitals with annual birth rates of 12 to 16,000 babies.

International Placements:

The ALGO screener is used in 24 countries (over 4500 systems installed) worldwide.

Training Requirements:

Minimal. Since the ALGO screener is fully automated, users become quickly proficient. An audiologist or trained professional is not needed to review or interpret results.

Interpretation of Results:

Objective "PASS" or "REFER" results are automatically printed after every screen. No subjective or comprehensive interpretation of results is necessary.

Available Program Assistance:

Natus is committed to supporting every aspect of newborn hearing screening programs with on-site training, and ongoing clinical education, customer service, and technical support.

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References available upon request.

© 2003 Natus Medical Inc.

P/N 050255E

Natus Medical Inc. 1501 Industrial Road, San Carlos, CA 94070 – 4111 Ph: 650-802-0400 Fax: 650-802-0401

P/N 050932A

2.2 Articles Supporting UNHS

2.2 ARTICLE S S UP P ORTING UNHS

To increase awareness in the community about the importance of screening infants early for hearing loss, it may be beneficial for you to provide the key decision makers at your healthcare facility with articles from peer-reviewed journals that support your case for implementing a universal newborn hearing screening program. The listing below provides you with important articles that you may distribute. To obtain a reprint of these articles, you may contact a Natus Customer Service representative. American Academy of Pediatrics. Newborn and Infant Hearing Loss: Detection and Intervention. Pediatrics. 1999;103(2):527-530. Down P. The case for detection and intervention at birth. Seminars in Hearing. 1994;15(2):76-83. Marlowe J. Legal and Risk Management issues in Newborn Hearing Screening. Seminars in Hearing. 1996;17(2):153-163. Mauk et al. The effectiveness of screening programs based on high-risk characteristics in early identification of hearing impairment. Ear and Hearing. 1991;12(5):312-316. Mehl A, Thomson V. Newborn Hearing Screening: The Great Omission. Pediatrics. 1998;101(1). Yoshinaga-Itano et al. Language of Early-and Later-identified Children With Hearing Loss. Pediatrics. 1998;102(5):1161-1171. Refer to the Newborn Hearing Screening Bibliography on the Natus website for additional articles that you may use to educate the community.

Newborn Hearing Screening Program Handbook – P/N 051185 Rev. A Copyright © Natus Medical Inc, April 2003

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