Abstract: Newborn hearing screening (NBHS) is crucial for early hearing detection and intervention (EHDI). However, disparities in NBHS protocols between urban and rural hospitals in Colorado can hinder timely access to care in underserved communities. This study analyzed NBHS protocols at 32 birthing hospitals through Virtual Site Visits conducted by a multidisciplinary team. Several significant differences in NBHS protocols and practices between urban and rural hospitals were identified as a result of these visits. Findings will help to inform efforts to improve access to early intervention services and parent support for all newborns, regardless of geographic location within Colorado.
Summary: Objectives and Rationale Newborn hearing screening (NBHS) is the critical first step in the Early Hearing Detection and Intervention (EHDI) process. This study aimed to identify healthcare disparities in NBHS protocols between urban and rural birthing hospitals in Colorado.
Methods Data were collected through 32 Virtual Site Visits (VSVs) between our team and birthing hospital staff, from October 2021 through January 2024. Our VSV team included the Colorado EHDI Director, the Colorado Hands & Voices Director, a pediatric audiologist, a pediatrician and cCMV Champion with the Colorado Chapter of the American Academy of Pediatrics, and optionally a regional Colorado Home Inclusion Plan (CHIP) Coordinator. The team met with hospital representatives (e.g., manager of the NBHS program) and, as appropriate, the coordinator of any third-party contracted screening company to discuss their NBHS protocols, tests administered, staff training, screening documentation, scripts used with parents, informational handouts, and on-site audiology services.
Results Chi-squared statistical analysis was utilized to identify significant differences in NBHS practices reported by rural and urban hospitals. Results indicated that hospital employees (nurses, CNAs, etc) were significantly more likely to be responsible for performing the initial NBHS at rural sites compared to urban sites, where contracted outside companies were frequently responsible for initial NBHS (p < 0.05). The method for NBHS (Otoacoustic Emissions or Automated Auditory Brainstem Response) in the well-baby nursery differed between rural and urban birthing hospitals as well: Rural sites were more likely to utilize otoacoustic emissions screenings (p < 0.05). The method used to train NBHS personnel differed significantly between urban and rural sites (p < 0.001). More than half of the urban hospitals used the National Center for Hearing Assessment and Management (NCHAM) newborn hearing screening curriculum. Rural hospitals were more likely to utilize hands-on training without a standardized curriculum. Finally, rural hospitals were significantly less likely to report that standardized processes were in place for congenital cytomegalovirus (cCMV) screening for babies who did not pass the initial NBHS (p < 0.05).
Conclusions Universal NBHS is a cornerstone of early childhood intervention, ensuring that all newborns, regardless of geographic location or socioeconomic status, receive timely hearing screenings. Disparities in NBHS can affect multiple critical outcomes, including an increased likelihood of false results due to inadequate training, missed diagnoses of congenital cytomegalovirus (cCMV), delays in timely referral for diagnostic testing, and postponed initiation of early intervention services, which ideally should begin by six months of age. Findings from this study will contribute to a better understanding of healthcare disparities in NBHS protocols and inform efforts to improve access to early intervention services and parent support for all newborns, regardless of geographic location.
The instructional level for this poster is fundamental, as background knowledge is not required to understand the topics discussed. The lead presenter is an AuD graduate student and Leadership Education in Neurodevelopmental Disabilities (LEND) trainee who participated in Virtual Site Visits (VSVs), including writing recommendation letters for birthing hospitals, data analysis, and participation in VSV team meetings.
Learning Objectives:
Upon completion, participants will be able to compare and contrast differences in the newborn hearing screening protocols at rural and urban birthing hospitals in Colorado.
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