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 • 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 • Funding secured for universal screening – VicNIC 2004 • Funding secured for expansion to UNHS in hospitals with NICUs Centre for Community Child Health 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 Centre for Community Child Health 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) Centre for Community Child Health 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 • • • • language delays and deficits academic delays and disadvantages social impairments economic disadvantages Centre for Community Child Health International and interstate Pre-discharge hearing screening is the international standard of care • • • • 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 Centre for Community Child Health 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% Centre for Community Child Health 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 Centre for Community Child Health 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 Centre for Community Child Health 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 Centre for Community Child Health 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 Centre for Community Child Health 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 Centre for Community Child Health 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 Centre for Community Child Health 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. Centre for Community Child Health • 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; Centre for Community Child Health 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. Centre for Community Child Health 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. Centre for Community Child Health 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. Centre for Community Child Health 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 Centre for Community Child Health 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. Centre for Community Child Health My Health and Development Record • In Birth Details section • Screen Results Page 1 • Screener records • Results (Pass or Refer) • Date of screen completion Centre for Community Child Health 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 Centre for Community Child Health My Health and Development Record • 8m page • Targeted surveillance (risk factor follow-up) Centre for Community Child Health 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 (%) Centre for Community Child Health 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% Centre for Community Child Health Comparing Median Age at Detection (in months) – Victoria Centre for Community Child Health 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 Centre for Community Child Health 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 Centre for Community Child Health Audiology Referral Form Centre for Community Child Health Minor changes to My Health and Development Record • Added decline section • Changed wording of risk factor aminoglycoside administration to 3 consecutive days Centre for Community Child Health VIHSP – more information • • • • • Contact an Area Manager – via the website Visit www.vihsp.org.au Email us on [email protected] Call Head Office 9345 – 4941 About hearing and hearing test visit http://infanthearing.vihsp.org.au Centre for Community Child Health
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