In 1993, the National Institutes of Health issued a consensus statement on the Early Identification of Hearing Impairment in Infants and Young Children. Among panel recommendations was a statement that universal hearing screening be performed for all infants within the first three months of life. The New York State Department of Health initiated a three-year demonstration project in 1995 to test the efficacy and cost effectiveness of universal newborn hearing screening within the state. Seven regional perinatal centers, geographically dispersed across the state, were selected as demonstration sites. Screening was accomplished by transient evoked otoacoustic emission(TEOAE) or auditory brainstem response (ABR) testing. Six centers employ a two-stage in-hospital protocol: OAE followed by ABR screen on OAE referral. One site uses ABR screening as its sole in-hospital screening modality. Infants who refer on in-hospital testing are rescreened within 4-6 weeks of nursery discharge. Outpatient screening failures are referred for diagnostic hearing evaluation.

Results: In the initial 16 months of the project there were 37,891 births at the study sites: 36,191 (95.5%) were screened in-hospital; 4.3% failed in-hospital screening. Eighty-five percent of infants passed outpatient rescreening. However, only 50% of infants in need of rescreening returned. Of 76 infants (4.7/1000) in the 1995 cohort who required diagnostic evaluation, 25 (1.6/1000) had demonstrated sensorineural hearing impairment; 9(36%) of these infants had no identified risk factors. Preliminary data indicated screening costs to be $30-35/baby/screen in New York State. Analysis of costs per infant identified are not yet complete.

Conclusion: These preliminary data support the efficacy of universal newborn hearing screening in the early identification of infants with sensorineural hearing loss. Cost effectiveness and issues of practicality associated with universal screening will be more reliably presented as diagnostic outcomes are confirmed.