Hi, my name is Jaynee Handelsman. And I am an audiologist and the EHDI Program Coordinator at the University of Michigan. Permanent hearing loss occurs really frequently in children. In fact, it occurs in about one to three of every 1000 otherwise healthy newborns. The incidence of hearing loss is much higher however in individuals or babies who are admitted to the newborn intensive care unit or the NICU. In fact, two to four of every 100 NICU graduates is diagnosed with permanent hearing loss. We know that hearing loss can be caused by genetic factors and also environmental factors. And the negative impact of hearing loss is well established. For example, undiagnosed or untreated hearing loss can result in delays in speech and language development, which in turn results in negative impacts on social and emotional development, literacy and academic success, as well as vocational choices for adults with hearing loss. The good news is that we know that if we identify hearing loss early, and if we appropriately intervene early, the negative impacts of hearing loss can be mitigated. The principles of early hearing detection and intervention programs include the screening of all babies who are born, including those who are born at home before one month of age. And for the babies who are born in the hospital ideally that screen should take place prior to discharge from the hospital. Hearing loss when present should be diagnosed no later than three months of age. And intervention should be initiated no later than six months of age. Of course the family should be involved in all discussions regarding communication options and it's important for audiologist to present the information about the communication options in an unbiased manner. All babies who are diagnosed with permanent hearing loss, should be have access to high quality technology right away, including hearing aids when appropriate, or cochlear implants when appropriate as well as assistive technologies. Another principle of the programs is that there should be a high quality data management and tracking system, and that all decisions about outcomes should be reported using that tracking system. An important additional component of the EHDI program is that all babies, including those who passed their initial new born hearing screening who have no known risk factors for progressive or delayed onset hearing loss. Should have their hearing screened or monitored on a regular basis through their primary care physician or their medical home. So this video is of an actual baby being screened. And the technician is right now cleaning the skin and the baby which is required to remove all oils before placing the electrodes on the skin. Now she's demonstrating where the electrodes are placed. There are three electrodes that are utilized. And this screening, by the way, is automated AVR, which we'll talk about in a little bit. So once the three electrodes are placed, She's going to connect electrode leads to the electrodes that are now on the baby's skin. There will be three leads that are connected to the screening device. And now she's placing the insert earphone into the baby's ear, Which that will present to stimulate which are called clicks. Once the baby is settled, Meaning not moving because the electrodes will pick up any movement from the baby and the muscle contraction which will interfere. Now that the baby is settled, she is initiating the screening on the device. And you can see that it keeps track of the baby's nervous system response to the sound, in that little box at the top is the actual response. And in that short amount of time the baby passed the newborn hearing screening. So the components of the EHDI program include universal newborn hearing screening as we talked about, as well as diagnostic audiology that's performed by pediatric audiologists. So people with expertise in testing newborns and young infants. The medical home, which I mentioned, and the assumption with the medical home is that family center care will be provided in a compassionate, accessible, comprehensive manner that is consistent with cultural success. Additionally, the EHDI program includes early intervention and family support, as well as the data tracking management system that I mentioned before. And finally, the important component of the EHDI program, is the inclusion of an individual or a group of individuals who is or are able to talk with families about their own experience with EHDI as well as the the emotional complexities of dealing with a diagnosis of hearing loss. Universal newborn hearing screening was initiated in the late 1980s. And by about the mid 1990s, there was consensus regarding the one through six guidelines. However, it wasn't really until the early 2000s that most states had mandates for universal newborn hearing screening or EHDI programs. Still there remains a lot of variability about what the definition is of universal screening. For example, in Michigan the expectation is that 100% of babies born in the state will have their hearing screening by the deadlines that I mentioned before, and that the results of the screening will be reported to the state EHDI program right away. Additionally, individuals, babies passing the newborn hearing screen who have risk factors for late onset or progressive hearing loss will be sent to the state right away. So the state EDHI program is responsible for tracking all babies who are screened whether they pass or fail. On the other hand, there are states where the requirement for screening is only in towns of a certain size, or in birthing hospitals of a certain size. There really are two technologies that are employed for universal newborn hearing screening. And they are automated ABR, automated auditory brainstem response, which you saw in the video, as well as autocrystic emissions. The current guidelines actually suggest that otherwise healthy babies be initially screened using OAE technology. Get in some states, all babies including well babies are screened initially using automated ABR. It's important to know that follow up testing for babies who refer on their initial screening must use the same technology that was used in the initial screening. And because the guidelines for EHDI are periodically revised, rather than going through the guidelines in any great detail in this talk, you will be provided with a handout that includes links to sites that will include the most updated information that's available. So in summary, a successful EHDI program includes professionals who are committed to the 1-3-6 guidelines. The family is expected to be at the center of all decisions that are made about babies who are diagnosed with hearing loss. And communication between all of the members of the team is essential for success. Please refer to the handouts that you're being provided with in this module. And thank you so much for your attention.
