What is EHDI?

The goal of Early Hearing Detection and Intervention is to screen the hearing of every infant born before discharge from the hospital. Infants who do not immediately pass the hearing screening will be referred for full diagnostic testing. If the infant is then identified with a hearing loss the family will be referred to appropriate services so early intervention will occur.

PROTOCOLS FOR SCREENING AND REFERRALS: (in North Dakota)

The following material is designed to supplement
the First Sounds / Project Kaylyn Universal Newborn Hearing Screening Protocol flow chart.

Birth: Includes hospital births and home births

Initial Hearing Screening with OAE or ABR:Each infant will receive an initial hearing screening with frequency specific ABR (Auditory Brainstem Response) screening equipment or with OAE (Otoacoustic Emissions) screening equipment.

Four possible outcomes from the initial screening:

1. Pass

   • The infant passed the initial screening. Parents should be given information concerning hearing loss and normal auditory development. The infant is released from the screening process.
   • Risk Factor: If the infant falls under the risk factor category, a reevaluation should be scheduled for three years every six months. Refer the infant to appropriate personnel.
   • Enter in data and report to the State Reporting System: Each infant's results are entered into a state wide data system (Oz) by hospital staff and reported to North Dakota Center for Persons with Disabilities (NDCPD) at Minot State University

2. Fail/Refer: The infant did not pass the initial screening

   • Rescreen before discharge: The infant will be rescreened before hospital discharge. If the infant passed the screening and does not fall under the risk factor categories, he/she is released from the process.
   • Risk Factor: If the infant falls under the risk factor category, a reevaluation should be scheduled for three years every six months. Refer the infant to appropriate personnel.
   • 2-6 weeks post birth: Rescreen with OAE or ABR: If the infant failed the first screening, an additional screening should be scheduled two to six weeks post birth using OAE or ABR screening equipment.
   • Refer/Fail: If the infant fails the rescreening, an audiological evaluation with OAEs, ABR and immitance should be scheduled within six to twelve weeks post birth.
   • If hearing loss is confirmed, the infant (with prior medical approval), should begin the intervention process. Additionally, the infant must be referred to early intervention services within 30 days of identification.
   • Enter in data and report to the State Reporting System: Each infant's results are entered into a state wide data system (Oz) by hospital staff and reported to North Dakota Center for Persons with Disabilities (NDCPD) at Minot State University.

3. Missed: The infant was not screened before hospital discharge or was missed due to home birth

   • 2-4 Weeks Outpatient Screening: If the infant was missed by the screening program, the parents must be notified by phone and in writing by the hospital. Screening (OAE or ABR) must be scheduled within two to four weeks post birth.
   • Pass or Refer (Follow Pass or Refer to flow chart from top): If the infant passed and does not fall under the risk factor categories, he or she may be released from the screening process. If the infant failed the rescreening, he/she should receive an audiology evaluation with OAEs , ABR and immitance within six to twelve weeks.
   • If hearing loss is confirmed, the infant (with prior medical approval), should begin the intervention process. Additionally, the infant must be referred to early intervention services within 30 days of identification.
   • Enter in data and report to the State Reporting System: Each infant's results are entered into a state wide data system (Oz) by hospital staff and reported to North Dakota Center for Persons with Disabilities (NDCPD) at Minot State University.

4. Refused by Parents: The parents have the right to refuse the screening since law does not mandate it

   • 2-4 Weeks Outpatient Screening: If the infant was missed by the screening program, the parents must be notified by phone and in writing by the hospital. An additional screening must be scheduled within two to four weeks
   • Pass or Refer (Follow Pass or Refer to flow chart from top): If the infant passed and does not fall under the risk factor categories, he or she may be released from the screening process. If the infant failed the rescreening, he/she must receive an audiology evaluation with OAEs , ABR and immitance within six to twelve weeks.
   • If hearing loss is confirmed, the infant (with prior medical approval), should begin the intervention process. Additionally, the infant must be referred to early intervention services within 30 days of identification.
   • 2-4 weeks, Notify MD: Within two to four weeks, the infant's family physician must be notified.
   • Enter in data and report to the State Reporting System: Each infant's results are entered into a state wide data system (Oz) by hospital staff and reported to North Dakota Center for Persons with Disabilities (NDCPD) at Minot State University.

If my child has a hearing loss, what does this mean?

Most children with hearing loss can hear some speech, however, the speech tends to lack clarity since the hearing loss occurs in the higher frequencies that contain most of the consonant and vowel sounds necessary for understanding speech. However, since the child is able to respond to the lower frequencies, he or she will usually be identified later on. As a result of late identification, speech and language skills will have significant delays. Early identification is necessary before sixth months of age in order to catch that specific time frame in which optimal speech and language development occurs. Formal audiological evaluations are needed to rule out less severe but equally disabling degrees of hearing loss.