Newborn Hearing Screening Protocol (CG570)

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Author: A McMaster Date: February 2021

Newborn Hearing Screening

Protocol (CG570)

Approval

Approval Group Job Title, Chair of Committee Date Maternity & Children’s Services

Clinical Governance Committee

Chair, Clinical Governance Committee

5th_February 2021

Change History Version Date Author, job title Reason 3.4 Sept 2019 A McMasters, Local

manager for NBHS

Live change to include additional letter template App 7 pg 21

rationale explained in 3.6 on pg 7

3.5 March

2020

A McMasters, Local manager for NBHS

Live change to add process for informing GP & HV via letter of immediate audiology referral or targeted follow up (pg 7) New appendix 8 (pg 19) 4.0 Oct 2020 A McMasters, Local

manager for NBHS

Review due and changes to appointment letters

This document must be read in conjunction with the following:  www.nhs.uk/conditions/pregnancy-and-baby/newborn-screening/

 Infection Prevention and Control Reporting and Responsibilities Policy (CG077)  Non Attendees at Antenatal Clinics / No Access Visits protocol (CG499)

 Elective Access Policy (CG585)

 MAT-SOP-018 Assessment & management of NBH screener performance  MAT-SOP-019 NHSP Screening tasks & duties

 MAT-SOP-020 New yield & possible false positive reporting failsafe  MAT-SOP-021 NHSP Audit – failsafe schedule

 MAT-SOP-022 NHSP equipment use & maintenance  MAT-SOP-023 Staffing for the NBHS programme

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This protocol will enable trained newborn hearing screeners to perform newborn hearing screening in accordance with the National Newborn Hearing Screening Programme. It will enable early identification of potential hearing loss in newborns to audiology for optimum outcome. Early identification of hearing impairment gives children a better chance of developing speech and language skills, and of making the most of social and emotional interaction from an early age.

The protocol defines roles and responsibilities for The Hearing Screening Team, Neonatal Unit Staff and Audiology.

2.0 Scope

The newborn hearing screening protocol covers screening for detecting hearing impairment in newborn babies. The target condition for the screen is moderate to profound permanent bilateral, permanent hearing impairment (sensorineural or permanent conductive) averaging 40dB or more in the better ear.

Screening is offered to all eligible babies up to 3 months corrected age, but the aim is to complete the screening process by 4 weeks of age. Those older than 3 months of age, or otherwise not eligible for screening, should be considered for referral to audiology.

3.0 Process

The eligible population is any baby born to mothers whose registered GP practice is within the agreed boundaries of responsibility of RBH. This will include babies we are responsible for that have been born in other hospitals and in some instances, ‘shared’ babies on behalf of other responsible sites.

The eligible population of ‘new births’ or ‘new registrations’ with an NHS number, is identified through an electronic birth notification to the national NHSP IT system, Smart 4 Hearing (S4H) or via notification to the screening team via the local Child Health Department (CHRD). A list will be produced daily from S4H for all outstanding eligible babies.

Exclusion Criteria:

The following groups of babies are contraindicated and will be referred directly to Audiology for a full diagnostic assessment WITHOUT screening as follows:

 Babies less than 34 weeks’ gestation age or over 3 months of corrected age. In exceptional circumstances where the baby is not well enough by 3 months corrected age, the screening may be carried out between 3 and 6 months of age. If the baby is not well enough at 6 months of age, the baby should be discharged from the screening programme to the paediatrician and GP with a recommendation for a referral to audiology at an appropriate time.

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 Microtia/atresia in one or both ears

 Confirmed or strongly suspected bacterial meningitis or meningococcal septicaemia  Any baby with confirmed congenital cCMV infection (as determined by TORCH screen)  Any baby with a programmable ventriculo-peritoneal shunt will be referred directly to

Audiology for diagnostic assessment.

Audiology is alerted about such referrals via email and a predefined audiology search on S4H: Search 9. Screen referrals awaiting assessment. Once fully operational, the email will be replaced with a notification on the message centre within EPR to ‘CAT08Audiology’. The newborn will either enter the hearing screening pathway as a well-baby [well baby protocol] or babies’ resident in the NNU for more than 48 hours continuously [NICU/SCBU protocol] (see Appendix 1 and Appendix 2).

The term ‘NICU’ includes SCBU, PICU or other children’s ICU. It does not include transitional care.

Screening for both well babies and NNU babies will be performed by the Newborn Hearing Screening Team.

The screeners will approach all parents of eligible newborns and offer screening. The parents will have been signposted to and online link for ‘screening tests for you and your baby’ information at the beginning of pregnancy and also discussed screening at the 34-36-week antenatal appointment with their community midwife. However if necessary, the screener can also signpost the parents to the relevant link: www.gov.uk/phe/pregnancy-newborn-screening or print pdf versions of the leaflet/order printed copies for people who

are not online via the APS online ordering portal.

Consent will be verbally gained as is nationally accepted and recorded on S4H and documented in the Personal Child Health Record (PCHR) or ‘red book’. The screener can access an interpreter via prestige network 01635 246700 if necessary.

The aim is to carry out the offer of screen and complete the screen prior to discharge. Where possible, the baby should be well, not less than 34 weeks’ gestational age and any major medical or drug treatment completed. If it is not possible to perform or gain consent prior to discharge an out-patient appointment will be offered. Out-patient appointments will also be offered to the following groups:

 Babies born at home

 Babies born in another hospital (if not already screened) if we are the responsible site  Babies we are sharing and screening (when we are not the responsible site)

Initial contact will be made by phone offering an appointment. If unable to contact by phone letters will be sent dependant on the situation (see Appendices 3a - 3d for examples).

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3.1 Well Babies

Screeners will perform a hearing screen following the well baby pathway. The initial screen is called AOAE (Automated Otoacoustic Emission). The result will be - Clear response/No Clear response/Not Complete.

The terms Clear response and No Clear response is in line with National Hearing Screening Programme (NHSP) as these terms are more family friendly than pass/fail. All screening results will be provided in writing on the hearing screening page within the personal child health record book PCHR ‘red book’. If the ‘red book’ is not available an inset will be provided. Screening staff will use S4H to record all screening and follow up data.

Clear response (CR) - Screeners will document in the personal child health record book PCHR ‘red book’ the hearing test outcomes and the baby will be discharged from the screening programme.

No Clear response (NCR) - On 1st_{screen. Screeners will organise to return to} screen a minimum of 5 hours later explaining the potential reasons for a NCR and an opportunity for parents to ask any questions. Parents may choose not to stay in hospital to have 2nd_{AOAE and the screeners will organise an appointment for the} parents to return to hearing screening clinics being run throughout the week.

No Clear response (NCR) on 2nd test. Screeners will refer parents back to the patient information leaflet ‘Screening Tests for You and Your Baby’. The AABR test will either be performed immediately (depending on availability of a machine, availability of screeners or suitability for baby to have the test) or following agreement with the parents, the screener will organise an appointment for the parents to return to the next, most convenient hearing screening out-patient clinic. If there is No Clear Response from the AABR- The screeners will provide parents with National Screening Committee leaflet, ‘Your Baby’s Visit to the Audiology Clinic’ and be responsible for organising a referral to audiology. Parents should be seen within 4 weeks of screening completion or 44 weeks’ gestational age for the appointment. Screeners will document in the personal child health record (PCHR) book ‘red book’ the hearing test outcomes.

Not Complete (NC) – For AOAE tests a maximum of 3 test attempts per ear per protocol stage is permitted. Once the maximum number of attempts has been reached, the AABR would be the next protocol stage of the screen.

For AABR tests a further test is permitted following an incomplete result in one or both ears, if the incomplete result was due to poor test conditions. However, if the second AABR outcome is an incomplete result in one or both ears, a referral to audiology is required. Parents should be seen within 4 weeks of screening completion or 44 weeks’ gestational age for the appointment.

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Targeted Follow up – Some conditions may result in the baby developing a hearing loss after the screen has been completed. These babies, despite having CR/CR at screening, should be offered a targeted follow-up appointment with audiology at 7-9 months of age. Conditions include:

 Craniofacial anomalies e.g. cleft palate

 A syndrome associated with hearing loss e.g. Downs Syndrome  Congenital infection: - Rubella or toxoplasmosis

 NICU baby with bilateral NCR at AOAE and bilateral CR at AABR

 Audiology is alerted about targeted follow-ups via email and a predefined audiology search on S4H: Search 10. Children awaiting targeted follow-up. Once fully

operational, the email will be replaced with a notification on the message centre within EPR to ‘CAT08Audiology’.

Paediatricians can also refer directly to audiology at their discretion.

In the event that either an immediate referral or targeted follow-up referral is necessary to Audiology, a letter will be sent to the GP/HV to inform them (see

Appendix 8). The screeners will upload screening outcomes daily to S4H, the National Newborn Hearing Screening database.

At the end of each day the screeners are responsible for setting ‘outcomes’ of each screened newborn on the national database (including any ‘incomplete’ screening outcomes). This allows for recognition of outstanding hearing screens and failsafe’s to be actioned to ensure no baby has missed the offer and acceptance or decline of newborn hearing screen.

If parents decline hearing screening, then they will be signposted to the PCHR for checklists they can carry out to monitor their baby’s’ hearing. The screener will be responsible for giving a decline letter to the parents and notifying their GP (in the letter will be details of how the parents can contact the screening team if they change their mind). The HV will be aware of parents declining Newborn Hearing Screening as it will be documented in the PCHR (see Appendix 4).

3.2 NICU Babies

Local infection policies will be followed.

In instances where the baby has been in NICU for a period of > 48 hours, screeners will perform a hearing screen following the NICU/SCBU baby pathway (see

Appendix 2) once the baby is well enough and over 34 weeks’ gestation. Screening

of NICU babies will only be carried out after the ‘NICU NHSP Risk Factor’ sheet has been completed by a Paediatrician (see Appendix 5).

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3.3 Baby born out of area

The Screening local manager will be responsible for ensuring babies the RBH is responsible for, but are born in other hospitals, have completed the screen (transfer ins). Completed means result of CR/CR, CR/NCR, and NCR/NCR with referral or decline. The local manager achieves this by using S4H to provide a list of babies that require a Newborn Hearing Screen. The Local Manager will ensure that if the baby was born in a hospital other than RBH that an ‘outcome’ has been set. If there is no outcome set it will be the Local Managers responsibility to request that this information is added by the screening site. Excellent pathways of communication will be fostered between hospital sites to greater improve offer rates.

The Local Manager will also monitor share in and share out of newborns to ensure screen has been completed or is offered.

3.4 Babies Moving in to the Area

CHIS will provide weekly failsafe reports, listing any babies (under the age of 3 months) on CarePlus within our CCG area and not currently recorded under the RBH S4H namespace. If not already carried out elsewhere, the Local Manager will be responsible for ensuring screening is offered. The case will be closed when appropriate investigations have confirmed that screening has already taken place elsewhere and no follow-up is required by our site or the parents have been offered the screen with an outcome or declined the screen.

3.5 Deceased Babies

CHIS are responsible for the timely notification, via email, to the newborn hearing team of any infant deaths in the area. The Local Manager is responsible for ensuring that these emails are checked daily, that S4H is updated accordingly and without delay and that the notification is forwarded to relevant parties within the Trust.

3.6 DNA for Newborn Hearing Screening Appointments

If the parents do not bring their baby to the appointment on two consecutive occasions the Newborn Hearing Screening Programme follows the Trusts’ Elective Access Policy (CG585)

See Appendix 4 for the letter that is sent to GP/HV who are discharged from the newborn hearing screening programme as a result of non-attendance. A letter will be sent to the parents and HV accordingly (see Appendix 6). The Health Visitor will also be made aware of this as there will be an incomplete form in PCHR record.

In the event that a screening appointment is requested but not attended after the screen was initially declined, a letter will be sent to the GP/HV to inform them (see

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3.7 Equipment

Only screening equipment that has met the NHSP technical specification, as determined within the NHS supply Chain Framework agreement will be used. Equipment will be used in accordance with manufacturer specification and NHSP screening protocols. This equipment will be capable of electronic transfer of screening data to S4H. Appropriate safety and quality checks will be undertaken in accordance with programme guidance/protocols.

3.8 Record Retention

Paper copies of patient ‘proformas’ will be retained in the NHSP Local Manager’s Office for a period of 6 months, after which, they will be destroyed.

4.0 Roles and Responsibilities

The screening team is structured with a Team Leader who is strategic lead for the local programme. They have clinical and professional responsibility for the overall running of the programme.

The NHSP Local Manager (formally known as the Local Co-ordinator) is the operational lead for the local NHS Newborn Hearing Screening Programme and is responsible for the day to day management of all aspects of the programme and staff. This includes ensuring protocols for the screening programme are adhered to and dissemination of National Screening Programme updates in to clinical practice.

The NHSP Screener works as a member of a team participating in the hearing screening of newborn babies, under the supervision of the NHSP Local Manager. The NHSP screener role involves the gathering and accurate recording of clinical and test data relevant to the screening process and communicating with parents about outcomes. The role involves direct handling of newborn babies.

5.0 Consultation Undertaken PHE National newborn hearing programme

RBH has undertaken the role of ensuring newborn hearing screens are performed to the eligible population. Service specifications were agreed between Public Health England and RBH. The service is to be provided as a hospital based service, with a dedicated team of staff. Accommodation has been provided in the relevant settings to enable good quality screening to take place. Stakeholders include NHS Public Health England, Head of Midwifery, NHSP Screeners, GP’s, Neonatal Unit and Health Visitors.

6.0 Dissemination/Circulation/Archiving

This protocol will be published on the Maternity Intranet site and will be available for all Trust employees. In addition, service users and GPs can access the site via the Intranet.

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Author: A McMaster Date: February 2021 Staff involved in Newborn Hearing Screening will regularly be updated and monitored in compliance with NHSP standards.

7.0 Training

Only appropriately trained and accredited NHSP screening staff will carry out newborn hearing screens.

8.0 Monitoring of Compliance

Quality Assurance (QA) within the screening pathway is managed by including failsafe processes and monitoring of compliance. These ensure that if something goes wrong in the screening pathway, processes are in place to identify what is going wrong and what action follows to ensure a safe outcome.

Details of daily, weekly, monthly, quarterly and annual activities are detailed in MAT-SOP-021 Newborn Hearing Programme Audit/Failsafe Schedule and National

Operational Guidance at https://www.gov.uk/government/publications/newborn-hearing-screening-programme-nhsp-operational-guidance

The Trust reserves the right to amend its monitoring requirements in order to meet the changing needs of the organisation.

**S4H is the current national database; however, the previous national database, eSP was decommissioned in January 2019.

9.0 Supporting Documentation and References 9.1 NHSP Contacts

Contact Number

Newborn Hearing Screening Office 0118 322 7556 Newborn Hearing Screening mobile 0774 818 1174

Newborn Hearing Screening email [email protected]

Jo Young - Team Leader [email protected]

Audiology 0118 322 7238

Child Health Information Services 01235 431313

10.0 Suspected Screening Incidents

Suspected safety or serious incidents within the screening programme will be notified by the Screening Midwives to the QA team and the screening and immunization team at PHE via the Screening incident assessment Form (SIAF). She will then act as guided by the QA Team. Managing Safety incidents in NHS Screening Programmes Guidance and the Screening Incident Assessment form (SIAF) can be obtained at:

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https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/672737 /Managing_safety_incidents_in_National_screening_programmes.pdf

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Appendix 1: Well baby Protocol

https://www.gov.uk/government/publications/newborn-hearing-screening-care-pathways

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Appendix 2: Newborn hearing screening NICU or NNU Protocol

https://www.gov.uk/government/publications/newborn-hearing-screening-care-pathways

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Newborn Hearing Screening Protocol (CG570)

Newborn Hearing Screening

Protocol (CG570)

Contents