Paeds · preventive-and-community-paediatrics
Newborn hearing screening
Also known as Universal newborn hearing screening · UNHS · Neonatal hearing screen · EHDI · Early hearing detection and intervention · Otoacoustic emissions newborn screen · Automated ABR newborn screen
Fellowship guide to universal newborn hearing screening: OAE and AABR pathways, pass versus refer counselling, 1-3-6 EHDI clocks, high-risk and NICU strategies, late-onset loss after a pass, congenital CMV interfaces, incomplete screens, equity and regional programme differences.
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Target exams
Red flags
- Bilateral hearing screen refer without a booked diagnostic audiology pathway
- Incomplete or invalid screen with no named owner before discharge
- Parent told the baby is deaf on the basis of screening alone
- High-risk infant discharged after a pass with no residual-risk surveillance plan
- Lost-to-follow-up after refer discovered at a later well-child visit
- Suspected auditory neuropathy risk cancelled because OAE passed
- Unilateral permanent loss dismissed as unimportant
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Neonatal medicine
- Neurodevelopment
- Current 2026 PREP curriculum — newborn care and preventive paediatrics
- Renewed curriculum for first-year trainees from 2027 — essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — communication with patients, families, and health professionals
- Renewed curriculum for first-year trainees from 2027 — regional, rural, and remote paediatric care
- Clinical Applications
- Medical Sciences
- Long Cases
- Short Cases
- Patient management
- Communication
- Health promotion and illness prevention
- Foundation of Practice (FOP)
- Theory and Science (TAS)
- Applied Knowledge in Practice (AKP)
- Clinical
- History
- General Pediatrics Content Outline — Domain 1: Preventive Pediatrics/Well-Child Care
- General Pediatrics Content Outline — Universal Task 2: Epidemiology and Risk Assessment
- General Pediatrics Content Outline — Universal Task 3: Diagnosis
- General Pediatrics Content Outline — Universal Task 4: Management and Treatment
- Patient Care: health promotion and screening
- Systems-Based Practice: coordination of care and transitions
- Interpersonal and Communication Skills: patient- and family-centered communication
- Medical Expert
- Health Advocate
- Communicator
Overview & Definition
Most babies with permanent hearing loss look completely well in the first days of life. They feed. They startle to a slammed door. Families go home reassured. Without a population screen, many of those babies would only be recognised when speech is already behind. That delay costs language. [2] [7]
Universal newborn hearing screening means offering a validated screen to every newborn, not only those with risk factors. Screening is not diagnosis. Screening sorts infants into pass, refer, incomplete or invalid states. Diagnostic audiology then confirms or excludes permanent childhood hearing impairment and defines laterality and type. Early hearing detection and intervention (EHDI) is the whole system: screen, confirm, intervene, and keep high-risk infants under surveillance. [1] [9]
The programme meets classic screening principles. Permanent childhood hearing loss is important. There is an accepted early intervention pathway. There is a suitable point-of-care test. There is an agreed policy on whom to treat. And the system must be able to deliver confirmation and care, not only a machine printout. A result without follow-through is not a programme. [9] [10]
What you actually do from birth to early intervention
- 1
Screen on time
Complete a local OAE and/or automated ABR pathway before discharge when possible, and by 1 month of age at latest.
- 2
Name the result state
Record pass, unilateral refer, bilateral refer, incomplete or invalid. Never leave a blank that looks like a pass.
- 3
Counsel in plain language
Refer means more testing is needed. It does not mean the baby is deaf.
- 4
Book the next step
Diagnostic audiology for refers. Residual-risk plan for high-risk passes. Named owner for incompletes.
- 5
Close the loop
Confirm diagnosis by 3 months when loss is present, start early intervention by 6 months, and keep surveillance open for progressive risk.
References19ShowHide
- [1]American Academy of Pediatrics, Joint Committee on Infant Hearing Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics, 2007.PMID 17908777
- [2]Yoshinaga-Itano C Language of early- and later-identified children with hearing loss. Pediatrics, 1998.PMID 9794949
- [3]Kennedy CR Language ability after early detection of permanent childhood hearing impairment. The New England journal of medicine, 2006.PMID 16707750
- [4]US Preventive Services Task Force Universal screening for hearing loss in newborns: US Preventive Services Task Force recommendation statement. Pediatrics, 2008.PMID 18595997
- [5]Pimperton H The impact of universal newborn hearing screening on long-term literacy outcomes: a prospective cohort study. Archives of disease in childhood, 2016.PMID 25425604
- [6]Kemper AR Universal newborn hearing screening improves quality of life for children with permanent hearing impairment. The Journal of pediatrics, 2011.PMID 21482247
- [7]Grindle CR Pediatric hearing loss. Pediatrics in review, 2014.PMID 25361905
- [8]Awad R Meeting the Joint Committee on Infant Hearing Standards in a Large Metropolitan Children's Hospital: Barriers and Next Steps. American journal of audiology, 2019.PMID 31084570
- [9]Kemper AR A framework for key considerations regarding point-of-care screening of newborns. Genetics in medicine, 2012.PMID 22899090
- [10]Andermann A Revisiting Wilson and Jungner in the genomic age: a review of screening criteria over the past 40 years. Bulletin of the World Health Organization, 2008.PMID 18438522
- [11]Pollick SA Newborn congenital cytomegalovirus screening and hearing outcomes: a systematic review of current literature. Current opinion in otolaryngology & head and neck surgery, 2024.PMID 39146216
- [12]Corazzi V Late-onset, progressive sensorineural hearing loss in the paediatric population: a systematic review. European archives of oto-rhino-laryngology, 2024.PMID 38411671
- [13]Ren AZ Factors that influence health service access in deaf and hard-of-hearing children: a narrative review. International journal of audiology, 2024.PMID 37335176
- [14]Behzadpour HK COVID Effects on Adherence to Joint Committee on Infant Hearing Newborn Screening Recommendations. Otolaryngology--head and neck surgery, 2025.PMID 39887832
- [15]Lund A Newborn hearing screening in infants at risk of hearing loss: diagnostic outcomes, false-negative results, and the role of surveillance. International journal of pediatric otorhinolaryngology, 2026.PMID 42143905
- [16]Ravin K Congenital cytomegalovirus: Screening strategies and diagnostic challenges. Seminars in perinatology, 2026.PMID 42386471
- [17]Sommerfeldt J Hearing Loss Assessment in Children. Pediatrics in review, 2026.PMID 35593817
- [18]Pimperton H The impact of early identification of permanent childhood hearing impairment on speech and language outcomes. Archives of disease in childhood, 2012.PMID 22550319
- [19]Worsfold S Predicting reading ability in teenagers who are deaf or hard of hearing: A longitudinal cohort study. Research in developmental disabilities, 2018.PMID 29660589