Guidance

Newborn hearing screening pathway requirements specification

Published 21 June 2021

Applies to England

© Crown copyright 2021

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This publication is available at https://www.gov.uk/government/publications/newborn-hearing-screening-pathway-requirements-specification/newborn-hearing-screening-pathway-requirements-specification

This document provides an overview of the NHS Newborn Hearing Screening Programme (NHSP) by describing what should happen at each stage of the pathway. It should be read alongside other guidance for NHSP including:

Please also read the general information relevant to all the NHS screening programme pathways.

Newborn hearing screening

The NHS offers newborn hearing screening for bilateral permanent hearing impairment (sensorineural or permanent conductive) to all eligible babies born or resident in England.

NHSP aims to identify permanent moderate, severe and profound deafness and hearing impairment in newborn babies within 4 to 5 weeks of birth. Early identification gives babies a better ‘life chance’ of developing language, speech and communication skills and of making the most of social and emotional interaction from an early age.

The programme does this by ensuring the provision of safe, high quality age-appropriate assessments and support for deaf children and their families.

Newborn hearing screening is delivered in 2 models. These are:

  • hospital (well-babies) – the majority of babies will start screening by 10 days of age
  • community (well-babies) – screening will not usually start until after 10 days of age

NICU babies, in hospital and community models, should be screened before discharge home as soon as they are well enough.

Find out more about hearing screening in the programme overview.

End-to-end pathways

Well baby pathway

The well baby pathway for newborn hearing screening consists of the following elements.

NICU pathway

The NICU pathway for newborn hearing screening consists of the following elements.

The dotted boxes and numbered labels show how the different parts of the pathways map to the generic headings used below.

Accessible text-only version of these pathways is also available.

1. Pre-screening

These requirements relate to making sure that screening is offered to the correct babies.

Providers must have systems in place to:

  • identify the eligible population through a birth notification to the NHSP national IT system (S4H) or notification to the screening team by the local child health department
  • not screen babies less than 34 weeks’ gestational age or greater than 3 months corrected age, though in exceptional circumstance where the baby is not well enough by 3 months corrected age, screening may be carried out between 3 and 6 months corrected age
  • ensure the local maternity service, or child health department, enter high quality, timely data into the NHS number registration system (patient demographic system) to enable the automatic transfer of demographic information into S4H to identify and track the population of eligible babies
  • identify eligible babies where an NHS number has not been generated for any reason
  • identify babies under 3 months who move into the area and have not been screened
  • add records manually where a record does not exist in S4H for any eligible baby
  • identify any deceased baby and inform other relevant screening/audiology services without delay

2. Screening

These requirements relate to the processes of carrying out the screening test.

Coverage

Providers must have systems in place to:

  • urgently refer any babies who are contraindicated for the screen for audiological assessment as the risk of hearing loss is high
  • use a variety of prompts and reminders to maximise screening attendance where the offer of screening has been accepted; these may include but may not be limited to:
    • text reminders
    • follow up contact for ‘was not brought’ or DNAs
  • make sure that all babies who start the screen complete the testing pathway
  • record the offer of screening and subsequent acceptance or decline on S4H and document in the personal child health record (PCHR or ‘red book’) (see ‘Offering the newborn hearing screen’ in NHSP operational guidance: patient journey from screen to referral)
  • direct parents or carers who decline the screen to the making and reacting to sounds checklists in the PCHR
  • review coverage standard NHSP-S01 (KPI NH1)

Screening test

Providers must have systems in place to:

  • use the correct multi-stage screening protocol - the ‘NICU’ protocol for babies who have been in a neonatal intensive care unit (NICU) for greater than 48 hours continuously (who have a higher chance of hearing loss) and the ‘well baby’ protocol for all other babies
  • perform the 2 types of newborn hearing screening test, which are the:
    • automated otoacoustic emission (AOAE)
    • automated auditory brainstem response (AABR)
  • ensure that screening results are explained to parents or carers by appropriately trained NHSP screening staff
  • ensure that there are adequate numbers of appropriately trained staff in place to deliver the service (see NHSP operational guidance: roles and responsibilities), including:
    • NHSP local manager
    • NHSP team leader
  • facilitate hearing screener training in line with the programme requirements
  • ensure that audiology services have trained and accredited clinical audiologists of appropriate grade and experience to undertake the post-screen audiological assessments
  • only use newborn hearing screening equipment and consumables in accordance with appropriate safety and quality checks as specified by manufacturers and NHSP equipment protocols
  • review data on:

Well babies

Providers must have systems in place to:

  • follow the well baby screening protocol (see ‘Well baby protocol’ in NHSP operational guidance: patient journey from screen to referral)
  • commence the screen prior to discharge from hospital; if the screening process cannot be completed as an inpatient, an outpatient/home visit appointment will be arranged so that the screen can be completed within 4 weeks (or 5 weeks in a community model)
  • refer babies to audiology diagnostic services if no clear response is obtained on completion of the screen, so they are seen within 4 weeks of screen completion or by 44 weeks corrected age

Neonatal intensive care unit (NICU) babies

Providers must have systems in place to:

  • follow the NICU screening protocol (see ‘NICU baby protocol’ in NHSP operational guidance: patient journey from screen to referral)
  • screen babies when they are well and aged not less than 34 weeks’ gestation, having completed any major medical or drug treatment
  • ideally complete the screen prior to discharge from hospital, otherwise to arrange an outpatient/home visit appointment so that the screen can be completed within 4 weeks
  • perform AOAE and ABBR screening tests; if the results are:
    • clear response in both ears at AABR and no clear response in both ears at AOAE: refer to audiology for a (targeted) follow-up at 7 to 9 months of age
    • clear response in both ears at AABR and any other combination of results at AOAE: discharge [footnote 1] from service
    • a no clear response outcome: refer to audiology and initially see within 4 weeks of screen completion or by 44 weeks corrected age
  • babies with risk factors will be referred to audiology for a (targeted) follow-up at 7 to 9 months of age
  • carry out screening between 3 and 6 months corrected age in exceptional circumstance where the baby is not well enough by 3 months corrected age
  • discharge babies to the paediatrician and the GP if they are not well enough at 6 months corrected age, with the recommendation to refer to audiology at an appropriate time

Screening outcome and referral

The desired outcome is the optimal development of language, speech and communication skills for children born with moderate to profound permanent bilateral hearing impairment. Providers must have systems in place to:

  • record every screening outcome on S4H and document it in the PCHR; completed screens can have an outcome of:
    • a clear response in both ears
    • a clear response in both ears but due to relevant risk factors [footnote 1] the baby requires a targeted follow-up at 7 to 9 months corrected age
    • no clear response in one or both ears (baby is referred to audiology)
  • have a mechanism for sharing screening results with the Child Health Information Service (CHIS)
  • review data on test standard NHSP-S03: referral rate to diagnostic assessment

3. Post-screening (diagnosis)

These requirements relate to the process of following-up babies with screen positive results to get a confirmed diagnosis.

Providers must have systems in place to:

4. Post-screening (diagnostic outcome)

These requirements relate to the process of following-up babies with a confirmed diagnosis.

Treatment

Providers must have systems in place to:

Pathway outcome

The desired outcome is the optimal development of language, speech and communication skills for children born with moderate to profound permanent bilateral hearing impairment. To allow screening outcomes to be effectively assessed, providers must have systems in place to:

  • use S4H to record all screening and follow-up data
  • ensure that audiology services add timely assessment and outcome data for babies referred from the screen as well as for any children with later identified permanent childhood hearing impairment (PCHI), including information on aetiological referral, into S4H
  • update the records annually of any child where PCHI is confirmed until they are 5 years of age
  • ensure that parents or carers of children confirmed to have PCHI are offered referral to an aetiological investigation service
  • ensure that medical teams add aetiological investigation data into S4H for children with PCHI
  • review local outcome and audiology data quality reports to enable surveillance and audit of data quality and completeness

  1. Babies with risk factors will be referred to audiology for a (targeted) follow-up at 7 to 9 months of age. The risk factors are listed in the guidelines for surveillance and audiological referral for infants and children following the newborn hearing screen. ↩ ↩2

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