Guidance

Newborn hearing screening: supporting information

Updated 23 February 2022

Applies to England

Introduction

These revised screening standards for the NHS newborn hearing screening programme (NHSP) replace previous versions. They apply to data collected from 1 April 2022.

The UK National Screening Committee (UK NSC) recommends all eligible newborn babies in England are offered screening to identify those with bilateral (both ears) moderate or worse permanent childhood hearing impairment (PCHI). Moderate or worse is defined as an average hearing threshold (over the frequencies 0.5, 1.0, 2.0 and 4.0 kHz) of 40dB or more in the better hearing ear.

The NHSP national programme in NHS England (NHSE) aims to make sure there is equal access to uniform and quality-assured screening across England and that families are provided with high quality information so they can make an informed choice about newborn hearing screening.

The national programme collects data and reports on outcomes, including the number of cases of PCHI and the age at confirmation. Audiology services should record the audiology follow-up data on babies that are referred from screening as well as any children with later identified PCHI on the national IT system for newborn hearing screening.

These standards cover the screening journey up to and including the point of referral to audiology and entry into audiological assessment. The setting of standards for paediatric audiology, medical or early intervention services is not within the scope of this document.

The standards provide a set of measures screening services have to meet to make sure the local service is safe and effective. Using an agreed method set out by the English screening programmes data group, the review looked at ranges within the data and used these as a starting point for a major review of the standard thresholds. The thresholds are the level of performance which services are expected to reach to show that the screening programme is safe and effective. It was decided at the beginning of this review to use the 2018 to 2019 data because it was likely that the 2019 to 2020 data would be affected by the impact on the screening pathway caused by coronavirus (COVID-19). Thresholds are also reviewed every 12 months and can be changed as part of a minor standards review.

The standards documents link to the screening glossary of terms, NHS population screening explained and NHS.UK for definition of terms.

For the purposes of the NHSP standards and key performance indicators (KPIs) the use of corrected age is applied to all babies whose gestational age is less than 40 weeks at birth. The auditory brainstem response (ABR) is the principal assessment tool used in the audiological assessment of babies referred from the screen. It is a neural response and matures with age. For this reason, it is recommended that for babies born less than 40 weeks gestational age, measurement of the response is delayed until the baby is equivalent to 40 weeks. Guidelines for the early audiological assessment and management of babies referred from the newborn hearing screening programme can be found on the British Society of Audiology (BSA) website.

Summary of changes from previous version of standard

All 5 NHSP standards have had changes to the terminology in their:

• description
• rationale
• definition
• caveats
• data collection and reporting
• reporting periods

These changes bring the wording of the standards in line with other national screening programmes and incorporate specific changes to thresholds.

Thresholds have only been changed in standards NHSP-S02 and NHSP-S03. In addition, these 2 standards have been changed to reflect both the hospital and community service model thresholds separately. A threshold range has been applied to NHSP-S03 because referral rate should not be as low as 0.0%.

There are currently only 5 community model services in England. As this number decreases a critical point may be reached where, due to small numbers, it becomes no longer possible to reflect 2 service models and the hospital thresholds will be applied to all services.

NHSP-S02: test: well babies who do not show a clear response in both ears at automated otoacoustic emission 1 (AOAE1)

This standard will become NHSP-S02a for services providing a hospital model and NHSP-S02b for services providing a community model.

The performance threshold data has been reviewed.

For NHSP-S02a for hospital service:

• the acceptable threshold remains at less than or equal to 27.0%
• the achievable threshold was met by 25% of services and is changing from less than or equal to 22.0% to less than or equal to 20.0%
• consideration will be given to changing the achievable level to less than or equal to 18.0% if the data supports this at the 12 months minor standards review

For NHSP-S02b community services have met the April 2018 thresholds since 2019 and the:

• acceptable threshold is changing from less than or equal to 15.0% to less than or equal to 14.0%
• achievable threshold is changing from less than or equal to 13.5% to less than or equal to 12.0%

NHSP-S03: test: referral rate to audiological assessment

This standard will become NHSP-S03a for services providing a hospital model and NHSP-S03b for services providing a community model.

The performance threshold data has been reviewed.

For NHSP-S03a for hospital services the:

• acceptable threshold is changing from less than or equal to 3.0% to a range greater than 2.0% to less than or equal to 2.8%
• achievable threshold is changing from less than or equal to 2.0% to a range greater than 0.5% to less than or equal to2.0%

For NHSP-S03b for community services the:

• acceptable threshold is changing from less than or equal to 1.6% to a range greater than 1.3% to less than or equal to 1.6%
• achievable threshold is changing from less than or equal to 1.3% to a range greater than 0.5% to less than or equal to 1.3%

Pathway themes

NHSP standards look at 4 themes to assess the pathway and 2 KPIs are derived from standards NHSP-S01 and NHSP-S05.

Theme: coverage

The related standard is:

NHSP-S01: coverage

Theme: test

The related standards are:

• NHSP-S02a and NHSP-S02b: test: well babies who do not show a clear response in both ears at automated otoacoustic emission 1 (AOAE1)
• NHSP-S03a and NHSP-S03b: test: referral rate to audiological assessment

Theme: referral

The related standard is:

NHSP-S04: referral: time from screening outcome to first offered appointment for audiological assessment

Theme: diagnosis or intervention

The related standard is:

NHSP-S05: diagnosis or intervention: time from screening outcome to attendance at an audiological assessment appointment

Resources to support providers and commissioners

Additional NHSP operational guidance is included in the:

• newborn hearing screening pathway requirement specification
• national operational guidance
• audiology diagnostic protocols

Reporting and publishing standards

NHSE is responsible for publishing annual standards and quarterly KPI data.