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This resource is for Universal Neonatal Hearing Screening Program (UNHS) staff and other health professionals who provide hearing assessments of infants and young children.

Contents

Screening Model
Referral Criteria
Referral Pathways
Support for staff

Screening model

The screening model adopted by the South Australian UNHS program involves dedicated screeners, hospital and community midwives, Women's and Children's Health Network (WCHN) community nurses and dedicated Audiologists.

The primary role of the:

Midwife/Screener is to link a single OAE/AABR screen to an infant's Neonatal Screen (Guthrie) prior to discharge from hospital. In this way, high coverage can be achieved and monitored.
WCHN Community Nurse is to contact the families of all infants following birth as part of the universal home visiting service and to provide hearing screening follow-up as required (2nd OAE +/- AABR). In this way, effective and timely follow-up can be achieved.
Audiologist is to provide diagnostic services for infants and their families in their local service centre. This involves traveling within the metropolitan area in addition to rural and remote areas across the state. In this way, Audiological assessment is accessible for all infants and all families.

The following chart outlines the function of UNHS

Download Chart (PDF - 52Kb)

Referral Criteria

Babies who should be screened by Otoacoustic Emissions (OAE):

All well infants

Babies who should be screened by Automated Auditory Brainstem Response (AABR):

NICU (level 2) > 48 hours

In general, this single indicator is a useful alert to the following groups, at risk of auditory neuropathy:

Infants <32 weeks gestation or <1500gm
Grade 2 neonatal encephalopathy (HIE) - lethargy, hypotonia, bradycardia lasting >24 hours, or with seizures
Needing prolonged assisted ventilation
Hyperbilirubinaemia constituting risk of kernicterus
- SBR >350µmol for a healthy term infant
- SBR >250µmol for a sick or premature infant
- Haemolytic disease (Rh factor)

Babies should not be screened until:

34 weeks of age
any ototoxic medication eg. gentamicin has been completed

Babies should be referred directly to the Universal Neonatal Hearing Screening Program:

if they have cranio-facial abnormalities that might imply abnormal anatomy of the central neurological pathways, eg., major deformities, hydrocephalus
with conditions that necessarily impede hearing, eg., atresia of the external auditory meatus
if they have a recognised TORCH (toxoplasmosis, rubella, CMV, herpes simplex) infection or meningitis.

These infants have such a high risk of hearing impairment that they require full audiological assessment rather than screening. Referral to the UNHS audiologists is made by the hospital midwife or dedicated UNHS screener.

Referral Pathways

Well Infants
Download (Word document - 29Kb)

Level 2 Nursery Infants
Download (Word document - 25Kb)

Definitive Audiological Assessment
Download (Word document - 32Kb)

Permanent Childhood Hearing Impairment (PCHI)
Download (Word document - 31Kb)