Newborn Hearing Tests Keep Kids' Language Skills on Track

Screening spots problems early, so they can be overcome, study finds

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By Ed Edelson
HealthDay Reporter

WEDNESDAY, May 17, 2006 (HealthDay News) -- Tests that spot hearing problems in newborns can spare those children delays in learning language as they grow, a new British study confirms.

The study of 120 children with severe hearing impairment found that those born during a time when there was mandatory screening developed better language skills than those born when screening was not mandated.

The report should help overcome lingering doubts about the value of newborn screening programs and the need for swift follow-up if a potential problem is detected, said two American experts who wrote an accompanying commentary.

Studies such as this one "confirm what has been intuitively obvious to people in the field," said one of the experts, Dr. Walter E. Nance, chairman of human genetics at the Medical College of Virginia.

The findings appear in the May 18 issue of the New England Journal of Medicine.

Nance pointed out that the first studies promoting newborn hearing screening programs in the 1960s were roundly criticized by epidemiologists because they were done by Marion Downs, an audiologist.

"There was a lot of skepticism in the medical profession about the value of screening," Nance said.

Also, there was "a tremendous outcry by the pediatric community" when screening programs were first introduced, because the tests used at the time mistakenly identified many children as having problems that weren't there, Nance said. However, as better tests were developed, states began to mandate such programs -- Rhode Island in 1989, Hawaii in 1990 and Colorado in 1993, for example.

Universal screening was endorsed in 1993 by a consensus conference of the U.S. National Institutes of Health, and now "practically every state has newborn screening," Nance said. The newest tests can show the brain's response to sounds or even the activity of the sound-detecting hair cells deep within the ear, he said.

The new British study involved 120 hearing-impaired children averaging about 8 years of age. The researchers found that children who were born and automatically tested for hearing trouble after the screen was mandated scored up to 40 percent higher on tests aimed at assessing their language ability, compared to children born before mandated testing went into effect.

However, many parents fail to get the proper follow-up tests that are needed to confirm the hearing problem spotted in their newborn, said Cynthia C. Morton, a professor of obstetrics, gynecology and reproductive physiology at Brigham and Women's Hospital in Boston, and a co-author of the commentary.

"It's easy to do testing in the first couple of days, because the newborn is quietly sleeping," Morton said. "Later, it is difficult to get a good test, because the baby is not cooperating."

She told of one woman whose newborn baby required three follow-up tests to confirm a hearing problem and who then discovered that her 15-month-old daughter had a severe problem.

Suspicious test results can be difficult for doctors, Morton said, because "no one wants to deliver anything but good news." That attitude can sometimes lead to negligence in conducting follow-up tests to confirm a hearing problem, she said. But failure to do so can damage a child's development, Morton said.

"It's absolutely been proven that if you don't have input into your speech and language center at six months of age, you won't realize your expected full potential," Morton said.

Mandatory screening for newborns has just gone into effect in Britain, said study author Dr. Colin R. Kennedy, a reader in pediatric neurology at the University of Southampton. He said his team's findings played a key role in the U.K. National Health Service ruling.

"The evidence that this actually leads to a benefit in terms of language skills has been weak," Kennedy said. "This is the best evidence that it does."

Screening for hearing defects should be seen as essential as screening for dangerous inherited metabolic conditions, Morton and Nance said.

"We compare it with newborn metabolic screening," Nance said. "Detecting a hearing problem is [just] as important."

More information

For more on pediatric hearing loss, head to the American Speech-Language Hearing Association.

SOURCES: Colin R. Kennedy, M.D., reader in pediatric neurology, University of Southampton, England; Cynthia C. Morton, Ph.D, professor, obstetrics, gynecology and reproductive physiology, Brigham and Women's Hospital, Boston; Walter E. Nance, M.D., Ph.D, chair, human genetics, Medical College of Virgina, Richmond; May 18, 2006 New England Journal of Medicine

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