STEP 1: Parents will be asked if they want to consent to expanded hearing screening, consent to hearing screening alone, or decline all hearing screening
Hearing screening is not mandatory but is a medical recommendation. Parents or legal guardians can decline hearing screening altogether. However, before making a final decision please speak with a health care provider about the pros and cons of this decision.
Parents or legal guardians can consent to the hearing screen alone. At a later date parents or legal guardians can always change their mind regarding whether or not to proceed with expanded hearing screening. The blood spot screen for hearing loss risk factors will only be performed if a baby has been referred to an audiologist and consent for testing has been provided.
The Infant Hearing Program hearing screeners will discuss the options that are available (expanded hearing screening, hearing screening alone. or no hearing screening) and explain in some detail what each option means. Once a parent or legal guardian has had their questions answered and has enough information to make a decision, the hearing screener will document the choice for hearing screening. The selection will be recorded on the hearing screening form, along with the name of the person providing consent and the hearing screener who provided the information. The last page of the hearing screening form (parent education page) will be torn off and the selection recorded and provided to the parent or legal guardian for their records.
If hearing screening has been chosen, the screen will be performed by an Infant Hearing Program hearing screener. For additional information about the hearing screen and for contact information, please visit: www.ontario.ca/infanthearing
STEP 2: The Infant Hearing Program screening form is sent to Newborn Screening Ontario
The Infant Hearing Program sends the screening form to Newborn Screening Ontario (NSO) to i) notify NSO to perform the hearing loss risk factor blood spot screen and ii) record that hearing screening was offered to each baby.
Newborn Screening Ontario and the Infant Hearing Program have collaborated to:
i) provide screening for hearing loss risk factors. The dried blood spot is already available for many babies so it is painless to have the hearing loss risk factor blood spot screen. As well, testing for congenital cytomegalovirus needs to be performed on a blood sample taken during the first 3 weeks of life. In most cases the dried blood spot is taken in the first week of life and sent to Newborn Screening Ontario for newborn blood spot screening.
ii) provide identification of babies who may have missed hearing screening. Regardless of the decision surrounding expanded hearing screening, the form is sent to NSO as documentation that hearing screening was offered. Without documentation the baby would appear to be a missed screen and parents or legal guardians would be contacted again regarding the option of hearing screening.
STEP 3: NSO performs screening for hearing loss risk factors with consent if a referral is made to audiology
The hearing loss risk factor blood spot screen will be performed with consent if there has been an Infant Hearing Program recommendation that the baby see an audiologist for a hearing assessment. If a baby passes their hearing screen, they will not be eligible for the hearing loss risk factor blood spot screen. Results from the hearing loss risk factor blood spot screen should be available within a week once NSO is notified to perform the screen.
STEP 4: Results of the hearing loss risk factor screen will be sent to the Infant Hearing Program
If the results do not detect cytomegalovirus (negative) they will be sent to the Infant Hearing Program.
If the results detect cytomegalovirus (positive) they will be sent to the closest Follow-Up Centre Infectious Diseases (ID) clinic and to the Infant Hearing Program. Someone from NSO or the ID clinic will contact the family directly to talk about the screen positive results and arrange an appointment.
If congenital cytomegalovirus infection is found through the hearing loss risk factor blood spot screen, the baby will be checked for symptoms. If symptoms are present, they will be followed by specialists and may be offered additional treatment. If they do not have symptoms at birth, they will be offered ongoing appointments to check for hearing loss and problems with development during early childhood. The risk of going on to develop a problem during early childhood is ~7-15%.