MINISTRY OF HEALTH MALAYSIA

GUIDELINES FOR NEONATAL

HEARING SCREENING
MEDICAL DEVELOPMENT DIVISION

FEBRUARY 2015 MOH/P/PAK/283.14 (GU)

 Guidelines for Neonatal Hearing Screening 2015

SURGICAL AND EMERGENCY MEDICINE SERVICES UNIT

MEDICAL SERVICES DEVELOPMENT SECTION

MEDICAL DEVELOPMENT DIVISION

 Guidelines for Neonatal Hearing Screening 2015

GUIDELINES FOR NEONATAL

HEARING SCREENING
 Guidelines for Neonatal Hearing Screening 2015

This guideline was developed by the Surgical and Emergency Medical Services Unit,
Medical Services Development Section of Medical Development Division, Ministry of Health
and the Drafting Committee.

Published in February 2015

ISBN……

A catalogue record of this document is available from the Library and Resource

Unit, Institute for Medical Research, Ministry of Health; MOH/P/PAK/283.14 (GU)

All copyrights reserved

 Guidelines for Neonatal Hearing Screening 2015

TABLE OF CONTENTS

FOREWORD BY DIRECTOR GENERAL OF HEALTH......................................................................................... ii

FOREWORD BY HEAD OF OTORHINOLARYNGOLOGY SERVICE .................................................................... iii

FOREWORD BY HEAD OF AUDIOLOGY PROFESSION.................................................................................... iv

LIST OF ABBREVIATION ................................................................................................................................. v

1. INTRODUCTION ..................................................................................................................................... 6

2. DESCRIPTIONS ....................................................................................................................................... 7

3. OBJECTIVES OF THE NEONATAL HEARING SCREENING PROGRAM ...................................................... 9

4. ROLES AND RESPONSIBILITIES OF PROFESSIONALS .............................................................................. 9

5. FRAMEWORK OF HEARING SCREENING PROCEDURE............................ Error! Bookmark not defined.

6. TRAINING FOR SCREENING PERSONNEL ................................................ Error! Bookmark not defined.

7. MANAGEMENT....................................................................................... Error! Bookmark not defined.

8. PROGRAM EVALUATION AND MONITORING......................................... Error! Bookmark not defined.

APPENDIX 1 .................................................................................................... Error! Bookmark not defined.

APPENDIX 2 .................................................................................................... Error! Bookmark not defined.

APPENDIX 3 .................................................................................................... Error! Bookmark not defined.

APPENDIX 4 .................................................................................................... Error! Bookmark not defined.

REFERENCES ................................................................................................... Error! Bookmark not defined.

DRAFTING COMMITTEE ................................................................................. Error! Bookmark not defined.

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 Guidelines for Neonatal Hearing Screening 2015

FOREWORD BY DIRECTOR GENERAL OF HEALTH

Good hearing is essential for a child’s overall development. Hearing loss is one of the most
common birth defect. Approximately 3 out of 1,000 babies are born with significant
hearing loss. If a child’s hearing loss goes undetected at birth, it can result in delays in
language and social development. Early intervention greatly improves the child’s prognosis
of achieving normal social, emotional and language development.

This book will guide health care professionals working towards attaining the highest
professional standards in the field of neonatal newborn hearing screening. In addition they
address the issues of the resources, trained and credentialed personnel and organizational
structure needed to run the screening as a national program.

I am happy that all hospital with audiology services has implemented high risk neonatal
hearing screening program successfully. In line with global standard of early detection and
intervention of hearing impairment, the expansion towards universal neonatal hearing
screening program is adopted. The Ministry of Health strongly supports the program and
will provide adequate resources needed. Continuing effort, awareness of stake holders,
policy makers, hospital administrators and all related professional is vital if program
momentum is to be sustained. Therefore, the involvement at all level of care including
primary health care providers, private hospitals and teaching institutions will be the
impetus to the success of the program for the country.

Special gratitude to all parties who have directly or indirectly contributed to the successful
publication of this guideline.

DATUK DR. NOOR HISHAM ABDULLAH

Director General of Health
Ministry of Health Malaysia

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 Guidelines for Neonatal Hearing Screening 2015

FOREWORD BY HEAD OF OTORHINOLARYNGOLOGY SERVICE

Hearing loss occurs often enough in general population to justify the need of hearing
screening program across the country. Hearing impairment in Malaysian children
constitutes particularly serious obstacle to their optimal development and education,
including language acquisition.

Congenital and early childhood deafness may affect the auditory neuropathway of children
at later developmental stage if appropriate and optimal interventions are not provided
within the critical period of central auditory pathway development. Therefore early
detection is vital important element in providing appropriate support for deaf and hearing
impaired babies that will help them enjoy equal opportunities in society alongside other
children.

It is equally important to build capacity, create the required infrastructure, services and
support for individuals, family and care providers. Therefore the need of the
comprehensive program well-orchestrated universal hearing screening program is
mandatory. This is to ensure that the hearing impaired population do not fall behind.

Collaboration between professionals in MOH is instrumental to the success of the program.

I would like to thank all our committee members for their time and expertise in the effort
on producing this second edition which took place end of 2014 till early 2015.

Dato’ Dr Abd Majid b Md Nasir Datin Dr Siti Sabzah bt Mohd Hashim

Head of Service Otorhinolaryngology 2014 Head of Service Otorhinolaryngology 2015

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 Guidelines for Neonatal Hearing Screening 2015

FOREWORD BY HEAD OF AUDIOLOGY PROFESSION

Guidelines for Neonatal Hearing Screening is a standard practical guideline intended to be

used for all health practitioners who are involved in neonatal hearing screening program in
Ministry of Health Malaysia.

The first edition of the Guidelines of High Risk Neonatal Hearing Screening was published
on 2009 with the collaboration of all professional involved such as Audiologist,
Otorhinolaryngologist, Pediatrician, Obstetrician, Speech Therapist and Nurses. This
guideline provides a unified standard of practice for newborn hearing screening program
especially for the target group of high risk newborn.

It is timely to update the current guideline due to the advancement and the availability of
the technology, the wider accessibility to the Audiology services and the increasing
awareness of the importance of universal newborn hearing screening amongst our health
care providers.

I would like to thank the committee on their efforts and painstaking task undertaken to
come out with this edition. May we strive together towards early hearing detection and
intervention for infants in Malaysia.

Thank you

NUR AZYANI BT AMRI

Head of Audiology Profession,

Ministry of Health Malaysia

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 Guidelines for Neonatal Hearing Screening 2015

LIST OF ABBREVIATION

AABR Automated Auditory Brainstem Response

ABR Auditory Brainstem Response

B/O Baby of

CI Cochlea Implant

CMV Cytomegalovirus

dBnHL Decibel normal Hearing Level

DOB Date of birth

DPOAE Distortion Product Otoacoustic Emission

HRNHS High Risk Newborn Hearing Screening

JCIH Joint Committee on Infant Hearing

KPI Key Performance Indicator

MOH Ministry of Health

NICU Neonatal Intensive Care Unit

NHS Neonatal Hearing Screening

OAE Otoacoustic Emission

ORL Otorhinolaryngology

SCN Special Care Nursery

TEOAE Transient Evoked Otoacoustic Emission

UNHS Universal Neonatal Hearing Screening

WHO World Health Organisation

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 Guidelines for Neonatal Hearing Screening 2015

1. INTRODUCTION

Hearing loss is one of the most common major abnormalities that presents at birth
and if undetected, will impair speech, language and cognitive development (Kemper &
Downs, 2000; Cunningham & Cox, 2003). In 2009, WHO reported that around 0.5 to 5 in
every 1000 neonates and infants have congenital hearing loss.

The critical period for language and speech development is generally within the first
3 years of life. Children who are identified with hearing loss between birth and 6 months of
age and received immediate interventions have significantly higher cognitive, language
and social development ( Yoshinaga-Itano, 1995 ). Therefore, a neonatal hearing screening
is the best mean to minimize the adverse effects of hearing loss.

Universal neonatal hearing screening (UNHS) program is the current standard of

practice in developed countries to detect hearing loss among children at the very early age.
The purpose of UNHS is to detect hearing loss in newborn babies before 3 months of age
and to provide appropriate intervention at no later than 6 months of age (Joint Committee
on Infant Hearing, 1994).

The high risk neonatal hearing screening program (HRNHS) has been introduced in
the Ministry of Health (MOH) hospitals since 2001. To date, 28 hospitals have implemented
HRNHS and 6 hospitals have progressed to UNHS program. It is estimated that more hospitals
will follow suit in the near future.

This Guideline is intended to provide a standard protocol of neonatal hearing

screening program in MOH hospitals. However, it is important to allow for adaptation of
this Guideline into the local policy of individual institution based on the availability of local
resources and technology.

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 Guidelines for Neonatal Hearing Screening 2015

2. DESCRIPTIONS

Automated Auditory Brainstem Response (AABR)

An automated test of hearing, and evaluate the nervous system response to sound

Hearing Screening
An objective screening method performed to identify infants who may have hearing loss
and who need follow up or more in depth testing.

Hearing Screening Database

An information management system which is used to record hearing screening data.

Hearing screening personnel

Any paramedic or nursing personnel, who had undergone a proper training in neonatal
hearing screening program. The personnel should be knowledgeable about neonatal
hearing screening protocol and technique.

High Risk Neonatal Hearing Screening (HRNHS)

A hearing screening performed on neonates who are born with high risk factors associated
with congenital or acquired hearing loss.

High Risk Hearing Register

A list of factors that place a neonate or an infant at risk for hearing loss. (See Appendix 1).

Neonate
A baby from birth to four weeks of age.

One stage hearing screening

Involves only one method of hearing screening at any time; either OAE or AABR.

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 Guidelines for Neonatal Hearing Screening 2015

Otoacoustic Emission (OAE)

Automated hearing test which measure sounds emitted by normal, healthy inner ear.
There are two types of OAE technologies: Transient Evoked Otoacoustic Emissions
(TEOAE) and Distortion Product Otoacoustic Emissions (DPOAE).

Two stage screening

Involves two different method of hearing screening at any time of the screening program.

Universal Neonatal Hearing Screening (UNHS)

Hearing screening offered to all babies delivered in MOH hospital with UNHS program

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 Guidelines for Neonatal Hearing Screening 2015

3. OBJECTIVES OF THE NEONATAL HEARING SCREENING PROGRAM

To screen babies by 1 month of age

To diagnose any hearing loss by 3 months of age.
To provide appropriate intervention by 6 months of age.
To facilitate early cochlear implantation in children.

4. ROLES AND RESPONSIBILITIES OF PROFESSIONALS

The NHS program involves a multi-disciplinary team of professionals. All team

members must work together to ensure the success of the program. The roles and
responsibilities of each team member should be well defined. The team members are:

 State Health Director

 Hospital Director
 Otorhinolaryngologist
 Pediatrician
 Obstetrician
 Family Medicine Specialist
 Audiologist
 Speech Therapist
 State and Hospital Matron
 Screening personnel / Paramedic
 Medical Social Officer

4.1 State Health Director

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 Guidelines for Neonatal Hearing Screening 2015

4.1.1 As a state advisor

4.1.2 To delegate and provide support in terms of resources

4.1.3 To implement and monitor the NHS program in hospitals and Health Clinicss

4.2 Hospital Director

4.2.1 An Advisor to the NHS program

4.2.2 To provide support in terms of:

 Manpower
o Screening Personnel (Staff Nurse, Assistant Medical Officer,
Technician, certified health personnel)
o Audiologists
o Speech Language Therapist
o Health Care Assistant (Pembantu Perawatan Kesihatan)

 Materials
o Health education (e.g. brochures, pamphlets, posters, electronic
Information about hearing screening and hearing development)
o Database for NHS program

 Equipment & consumables

 Space for hearing screening

4.3 Otorhinolaryngologist

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 Guidelines for Neonatal Hearing Screening 2015

4.3.1 To coordinate and collaborate with other clinical disciplines in terms of

comprehensive patient management.
4.3.2 To determine the etiology of hearing loss, identifying related risk indicators
for hearing loss, including syndromes that involve the head and neck, and
evaluating and treating ear diseases.
4.3.3 To determine the appropriate choice of medical and/or surgical intervention.
4.3.4 To involve in the long-term monitoring and follow-up.
4.3.5 To provide information and participate in the assessment of candidacy for
amplification, assistive listening devices, and surgical intervention

4.4 Paediatrician

4.4.1 To identify babies who are at high risk of hearing loss

4.4.2 To monitor the hearing and speech development of the baby at risk.
4.4.3 To ensure and support the continuum of audiological assessment and care.
4.4.4 To initiate referrals for further evaluation necessary to determine the
presence and etiology of the hearing loss.
4.4.5 To determine any other associated medical conditions.
4.4.6 To ensure all newborns are screened prior to discharge.

4.5 Family Medicine Specialist / Primary Healthcare Personnel

4.5.1 To review medical and family history during antenatal visits for babies with
risk indicators that requires referral for hearing screening.
4.5.2 To include hearing loss awareness in the maternal child health program.
4.5.3 To monitor the general health, development, and well-being of the infant.
4.5.4 To ensure and support the continuity of audiological assessment and care.
4.5.5 To initiate referrals for further evaluation necessary to determine the
presence and aetiology of the hearing loss.

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 Guidelines for Neonatal Hearing Screening 2015

4.5.6 To monitor hearing and speech development of children at 6, 12, and 18

months of age.

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