The screen is the easy part. What fails is the interval between a referred screen and a confirmed diagnosis, and the child who is finally assessed at eight months has lost the window in which several things could have been done.
The standard to aim at is simple to state and hard to deliver: screen by one month, diagnostic audiology by three months, intervention by six. Where a screen is referred, the appointment for diagnostic testing should be made before the family leaves, not posted. Give them the date, the place and a telephone number, and record in the notes who is responsible for chasing it if they do not attend - because the families who do not attend are not a random sample.
One specific action is worth attaching to a referred screen: if congenital cytomegalovirus is a consideration, urine or saliva polymerase chain reaction testing only distinguishes congenital from postnatal infection within the first three weeks of life. After that the diagnosis depends on a stored newborn dried blood spot, if your system keeps one. So the CMV test belongs at the time of the referred screen, not at the end of the audiology pathway.
- Aim for screening by one month, diagnosis by three, intervention by six - and measure your own intervals against it
- Book the diagnostic audiology appointment before the family leaves the building
- Send urine or saliva CMV PCR within the first three weeks of life where congenital infection is possible; after that the test no longer answers the question
- Record a named person responsible for follow-up of a referred screen that does not attend
- Re-screen a child with risk factors even after a passed newborn screen - late-onset hearing loss exists
Why it matters
The delay between a failed screen and a diagnosis is where most of the avoidable harm in childhood hearing loss occurs.
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