Guidelines to Establish a Hospital Based Neonatal Hearing Screening Program in the Indian Setting

Abstract

The challenges to implement universal neonatal hearing screening (UNHS) in India are limited funding, manpower shortages, inadequate support services, low public awareness and uncertainty regarding commitment from health care practitioners. Nevertheless there are isolated groups in India who have been implementing UNHS. St. John’s Medical College Hospital, Bangalore has been implementing UNHS since September 2002. Till date we have screened 5100 neonates. In this article we detail the steps we followed to establish the program and make it a standard of care in our hospital. A qualitative design is used to describe every stage. A team consisting of faculty from Neonatology, Audiology and speech Pathology, Otorhinolaryngology, Child psychology and Medico-Social work constituted the screening team. Due to a high birth rate the strategy we followed was as follows. All infants not at risk were screened by behavioural audiometry using 60 and 70 dB warbled tones. The infants at risk were screened by a two stage otoacoustic emissions (OAE) screening as well as behavioural audiometry. As a safeguard against false negatives of our strategy all the infants irrespective of the results were given a language and hearing milestone chart for parents to report if the age appropriate milestone was absent. Screening in the NICU caused a lot of referrals so it is best avoided . If a sound proof room is available adjacent to the NICU it would be ideal. In our experience a pilot program should be run for at least one year to get an idea of the inputs required as well as aid in formulating a screening strategy. At regular intervals an audit should be conducted and the data published in indexed journals so that others who want to start UNHSP can benefit. Also a national dataset should be collated based on these data to guide institutions to initiate similar programs so that not a single hearing impaired child in this country is neglected.