Health Department

Health Improvement Strategy Division
St Andrew's House
Regent Road
EDINBURGH
EH1 3DG

Dear Colleague

NEONATAL HEARING SCREENING

Summary

1. The National Screening Committee has recommended the introduction of a phased neonatal hearing screening programme. Neonatal hearing screening is more effective in the detection of hearing impairment in babies than current screening methods including the Infant Distraction Test. Evidence-based health technology assessment has demonstrated that the detection and treatment of permanent congenital hearing impairment before 6 months of age results in substantially greater speech acquisition with consequent life-long benefits in terms of social and psychological well-being, educational achievement and employment prospects.

2. In Scotland, the introduction of neonatal hearing screening will be taken forward in 2 steps. The first involves the establishment of 2 pathfinder sites with screening beginning in these areas by April 2002. The pathfinder sites will provide an opportunity to develop quality guidelines in preparation for the second step which involves a roll out of the screening programme across Scotland commencing by April 2003. The Scottish Screening Programmes Central
Co-ordinating Unit, which is part of the National Services Division, CSA, will be responsible, in conjunction with Health Boards and NHS Trusts, for establishing the pathfinder sites and implementing the roll-out of the screening programme across Scotland.

Action

3. Health Board and Trust Chief Executives are asked to ensure that the contents of this letter and Annex are drawn to the attention of all appropriate Managers and staff, including Consultants in Public Health Medicine, Consultant Paediatricians, Heads of Midwifery Services/Senior Midwives, Lead Commissioners of Child Health Services, Medical Directors of Trusts, GPs, Health Visitors, Heads of Audiology Services and relevant medical physicists.

25th June 2001

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4. Health Boards and Trusts should work with the Scottish Screening Programmes Central
Co-ordinating Unit to ensure that the appropriate screening arrangements are in place by April 2005 at the latest.

5. A copy of this guidance is available on the SHOW website: http://www.show.scot.nhs.uk/

Yours sincerely

GODFREY ROBSON
Director of Policy

ANNEX

NEONATAL HEARING SCREENING

Background

1. The UK National Screening Committee (NSC) advises the UK Health Departments about the introduction of new population screening programmes, the modification or withdrawal of existing programmes and the quality and management of such programmes. Last year, the Committee recommended the introduction of a neonatal hearing screening programme using the Otoacoustic Emissions Test (OAE) to detect hearing impairment in babies. At present, the Infant Distraction Test is performed by Health Visitors when babies are approximately 7-8 months old but the sensitivity of the test is very low and hearing difficulties are often not detected until babies are at least 1½ years old, sometimes not until they are 3½ years. On the basis of the 57,000 live births per year it is anticipated that around 60-65 new cases of permanent congenital hearing impairment (PCHI) would be detected as a result of a national screening programme. A screening programme would offer detection of PCHI at or shortly after birth with a greater degree of accuracy and completeness of population coverage than present screening methods provide. While the objective would be to carry out screening of babies in hospital prior to their discharge there is the need for a failsafe arrangement, through midwives and health visitors working in the community service, to pick up those cases where this is not achieved.

2. This guidance outlines the action proposed to organise neonatal hearing screening and for Health Boards to develop audit programmes to ensure the effective operation of the services and that relevant interventions or treatments are implemented quickly and effectively.

Otoacoustic Emission Test (OAE)

3. It is proposed that the screening programme will use the OAE test. The OAE screening test is not complex and it is considered that it will be carried out by staff who have no special knowledge or skills in hearing science but are good with babies and can assimilate the basic training required. The test is a non-invasive test which tests the function of the hearing receptor organ, or cochlea, but does not test the functionality of the connections between the cochlea and the hearing centres in the brain stem. The test can be performed at the bedside and a pass or fail response is recorded. The range of staff who may be involved in undertaking the screening process ranges from midwives or other professional care workers to lay staff recruited and trained specifically for the task depending on local circumstances. Babies who fail the screening test will be required to undergo further confirmatory testing which is a skilled task which requires the involvement of a senior medical technical officer (audiologist) or clinical scientist.

Roles and Responsibilities

4. To ensure an effective screening process, the Scottish Screening Programme Central
Co-ordinating Unit (CCU) has been commissioned to co-ordinate and monitor the neonatal hearing screening programme using quality standards which will be derived from those recommended by the National Screening Committee and endorsed by the Clinical Standards Board for Scotland. In particular, the CCU, working with Boards and Trusts, will be responsible for establishing and supporting the infrastructure required to achieve a screening programme. The roles and responsibilities for Health Boards, NHS Trusts and the CCU are as follows:

• CCU will be responsible for the co-ordination and monitoring of the neonatal hearing screening programme using quality standards recommended by the National Screening Committee and the Clinical Standards Board for Scotland, when developed. The CCU will work with the service to establish and support the following infrastrucutre:

• the development of standard national information returns in association with the Information and Statistics Division, CSA;
  
  
• the introduction of a core training scheme for staff involved in testing babies and supporting parents;
  
  
• the establishment and support, in conjunction with the Clinical Standards Board for Scotland, of a quality assurance structure comprising of midwives, audiologists, paediatricians and other appropriate members.

• Health Boards are required to appoint a designated co-ordinator to ensure the delivery of neonatal (including hearing) and antenatal screening services in each Health Board area. The co-ordinators will meet regularly to discuss antenatal and neonatal programmes and to review monitoring data. This is a similar arrangement to that already in place for breast and cervical screening programmes.
  
  
• NHS Trusts are required to provide appropriate semi-skilled staff and train existing staff in maternity services to undertake neonatal hearing screening tests. There will also be equipment requirements of around 2 OAE screening machines per maternity hospital and one (or more) in larger Health Board areas per Primary Care Trust. The estimated costs, which the Service will be required to meet from within existing resources, are around £655,000 revenue per annum and £700,000 capital costs.
  
  
• A National Advisory Group will be established for neonatal (including hearing) and antenatal screening to bring together the work of the Scottish Screening Programmes, Health Boards and NHS Trusts and to advise the Scottish Executive Health Department on policy and any other issues which may arise. Again, this is a similar arrangement to that already in place for the breast and cervical screening programmes.

Next Steps

5. It is proposed to introduce neonatal hearing screening in 2 steps. The first involves the establishment of 2 pathfinder sites which will provide an opportunity to develop quality guidelines in preparation for a wider roll out of the screening programme across Scotland. CCU will hold a bidding process over the summer of 2001 to identify the 2 pathfinder sites with a view to screening beginning in these areas by April 2002. Roll out across Scotland will commence by April 2003 with full implementation of the screening programme by April 2005.