Screening on newborns with risk’s factors for auditory neuropathy (Fig. 2)

Universal neonatal hearing screening for newborns with risk factors. Legend: flowchart for the neonatal hearing screening in newborns with risk factors for auditory neuropathy

A distinction between the execution of screening protocol in newborns with and without risk’s factors for auditory neuropathy is needed. So, newborns with the characteristics reported in Table 1 must undergo the screening both with TEOAE and AABR, in order to identify possible cases of auditory neuropathy. It is well known that AN has an higher incidence in the categories of babies reported in Table 1 and it is not identified with TEOAE (that may results present in those patients).

All the newborns that show the condition reported in Table 1 must undergo a specific diagnostic protocol.

If the newborn is preterm, the screening’s procedure has to be executed at the end of the 35th gestational week or after, but within the discharge, in order to reduce the incidence of false positive; before the 35th week, indeed, the execution of TEOAE may be difficult for the limited dimensions of the external auditory canal and the AABR’s responses may be not revealed for an immaturity of the central hearing pathways.

Babies belonging at the categories reported in Table 1 have to execute the TEAOE and AABR measurement before the discharge from the childbirth centre or within a month (II level centres). If the result is refer, is suggested to execute the tests at least 2 times before the discharge. For this procedure is strongly suggested a collaboration with skilled personnel (in particularly with audiometrist).

Newborns resulted refer at TEOAE must execute, within the 15th day from the birth, the research of CMV DNA by PCR in urine.

Babies resulted refer for one or both ears are addressed to the III level centre for an audiological evaluation.

At the discharge, the responsible personnel for the screening procedure or its collaborators must follow the guidelines reported in the previous paragraph at point 1, 2, 3, 4, 5, 6.

Babies included in risk categories that was born in I level centre, must undergo AABR in II or III level centre to complete the screening’s procedure within a month from the birth.