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Infant screening protocols

Susan Moore smoore at otolaryngology-po.oto.uiowa.edu
Mon Sep 9 12:50:01 EST 1996

The Univ. of Iowa Hospital's screening program is carried out by CFYs and the 
occasional staff person.  Between all of us, we log in a lot of time just keeping 
track of who needs to be screened, etc.

We attempt to screen all babies who are in the intermediate care nursery for more 
than 48 hours, as well as well-babies with high risk factors, or babies who's 
parents indicate they have a concern for hearing loss.  We try and keep our miss 
rate under 10% per 3 month period and we usually can achieve this goal.  

Our follow-up, I fear, is lacking in many ways, but given our resources, it seems 
the best we can do at this time.  I have raised the issue of re-evaluating our 
follow-up procedures but nothing has happened thus far.  We don't have much time to 

For babies we miss entirely, we send a registered mail letter stating that we 
normally would've screened your kid but he/she was discharged before we were able to 
do so and therefore ....blah blah hearing is important because....blah blah...we can 
screen your child here or we refer you to your pediatrician, family doctor, AEA 
(area education audiologists....Iowa actually has audiologists working for each 
school district....AMAZING!) etc.  For babies who fail one ear, we send a version of 
the same letter and recommend behavorial testing in 6 months.  I think this is a bad 
recommendation since you still can't isolate ears at this age, but at least it 
alerts the parent/caretaker that a problem might exist.  For kids who fail both 
ears, we recommend ABR at 2-4 months gestational age via letter format again.  For 
kids who pass both ears, no further testing is done unless they come back through 
the oto clinic for some reason, or if the pediatric clinic refers the child to oto.

Originally, OTO tried making scheduled appointments for follow-up for babies who 
failed or were missed and the percentage of no-shows was so high that they just 
stopped doing it.  With the miss babies, we send a stamped return addressed card 
that has a number code on it to let us know who the card is for that, if returned, 
lets us know the parent/caregiver actually did follow up on our recommendation and 
what the results were.  We get a low percentage of these cards back, however.

SO, that's how the chips fall around here.  It's not the best system, but it 
functions to a degree, and we have early IDed kids via this program--which is the 
ultimate goal.  Universal screening of the children in this hospital is not possible 
with the staff we have right now and nursing cannot be asked to do the training 
because of similar problems with workload.  

Susan Moore
CFY audiologist
smoore at otolaryngology-po.oto.uiowa.edu

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