So You Can Refuse Tests But Should You
Today Ive explained the four tests that are done on all newborns before they can leave the hospital.
Those are the Hearing Test, the Bilirubin Test, the Critical Congenital Heart Defect Test, and the Newborn Screening Test.
They all have their own special importance.
However, they all share one common purpose, and thats to detect health issues before you would ever even know a problem was there.
So, should you refuse any of these tests?
Ultimately, that decision is yours to make as a parent.
But, if you want my opinion,
I wouldnt refuse any of them.
While its distressing to see your baby uncomfortable or in pain, its worth it for a short time if it means discovering your baby has hearing loss, or has a heart defect, or is at risk for having brain damage.
I assure you that your baby wont remember the pain or discomfort they had for a few minutes during these tests.
And theyll definitely be forever grateful to you if you improved their quality of life, or even saved their life, by having these newborn tests done.
Disclaimer:The content that I share on Purely Postpartum is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. I encourage you to always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions.
About The Author
Leesa Johnson, RN, BSN, RNC-Maternal Newborn Nursing
California RN Licence # RN727819
Other Warning Signs Of Hearing Loss
Your newborn might be at risk for delayed onset hearing loss if any of the following applies to your baby.
- You or another caregiver has concerns.
- Family history of childhood hearing loss.
- Neonatal intensive care stays with ECMO therapy.
- Some infections that occur before and after birth .
- Some disorders that affect the babys nervous system.
If one or more apply to your newborn, make an appointment with your childs physician or an audiologist.
Once an appointment has been made for your newborns next hearing test, make sure you have the following information:
- Audiologists Name
What The Results Mean
Donât be alarmed if your newborn doesnât pass their hearing test. Some babies with normal hearing donât pass this first screening. There are many reasons why this may happen:
- The test was given in a noisy room.
- The person giving the test didnât have enough experience.
- The earphones or probes didnât fit into your babyâs ears well.
- Your baby moved around too much during the test.
- There was fluid in your babyâs ears when they were tested.
If your child didnât have a normal hearing test, theyâll need to see a special hearing doctor, called an audiologist, before theyâre 3 months old. When you take them to see this doctor, theyâll take follow-up tests to see if thereâs really a hearing problem. If there is, the doctor will find out whatâs causing the problem and how much hearing loss your baby has. Sometimes, the doctor may send you to an ear-nose-throat specialist for your babyâs treatment.
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When Will My Child’s Hearing Be Checked
Your child’s hearing may be checked:
- Within a few weeks of birth this is known as newborn hearing screening and it’s often carried out before you leave hospital after giving birth. This is routine for all children and even those having a home birth will be invited to come to hospital to have this.
- From 9 months to 2.5 years of age you may be asked whether you have any concerns about your child’s hearing as part of your baby’s health and development reviews, and hearing tests can be arranged if necessary.
- At around 4 or 5 years old some children will have a hearing test when they start school, this may be conducted at school or an audiology department depending upon where you live.
Your child’s hearing can also be checked at any other time if you have any concerns. Speak to a GP or health visitor if you’re worried about your child’s hearing.
How Are Hearing Problems Diagnosed
There are a few ways to detect hearing loss very early in life. The oto-acoustic emission test is the most common one . A specialist will put a small microphone in your babys ear, which sends a sound. The echo that comes back is sent to a portable computer. The computer can tell whether the baby heard the sound. The test, which takes 10 to 15 minutes, can often be done before your newborn baby leaves the hospital or at a designated hearing screening unit after leaving the hospital.
The Canadian Paediatric Society recommends that all newborns have their hearing tested. Many Canadian provinces and territories have universal newborn hearing screening programsmeaning all babies are tested at birth. Families of babies who screen positive should follow up with a full hearing evaluation.
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Oaes And Abrs Is One Test Better Than The Other
Both tests have advantages and disadvantages when used for screening, and depending on the program and experience of the audiologist, either one can be utilized successfully.
- The OAE is easy and cost-effective. However, the false-positive rate may be higher for an OAE than for an ABR.
- The false-positive rate for ABR testing is approximately 4% when testing is done during the first three days of life.
- The false positive rate for OAE testing is 5%-21% for testing done during the first three days of life.
- This large variation between ABR and OAE testing is commonly felt to reflect the OAE testing device’s increased sensitivity to residual amniotic fluid and vernix that is commonly found in the neonate’s ear canal.
The two tests, however, rely on different mechanisms of hearing for the screening. For in-depth testing and a complete hearing evaluation of infants, these tests work best together as a complement to each other.
Hearing Loss In Babies
1 to 2 babies in every 1,000 are born with permanent hearing loss in 1 or both ears.
This increases to about 1 in every 100 babies who have spent more than 48 hours in intensive care.
Most of these babies are born into families with no history of permanent hearing loss.
Permanent hearing loss can significantly affect babies’ development.
Finding out early can give these babies a better chance of developing language, speech and communication skills.
It will also help them make the most of relationships with their family or carers from an early age.
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Some States Use Different Tests
In some states, an alternative form of hearing screening is performed using Transient Evoked Otoacoustic Emissions .
In this test otoacoustic emissions evaluate the integrity of the outer hair cells within the cochlea. The testing is performed by placing a probe in the external ear canal that emits soft sounds to stimulate the cochlear. Within this probe is a sensitive microphone that is able to detect any outer hair cells auditory response to this initial stimulus. The recorded response must be a certain strength in order to pass this screen.
Causes Of Hearing Problems In Babies And Children
There are a number of reasons why a child may have a hearing problem, including temporary hearing loss from a common illness such as a common cold.
Some possible causes of hearing loss that may be detected during routine tests include:
- glue ear a build-up of fluid in the middle ear, which is common in young children
- infections that develop in the womb or at birth, such as rubella or cytomegalovirus, which can cause progressive hearing loss
- inherited conditions which stop the ears or nerves from working properly
- damage to the cochlear or auditory nerves this could be caused by a severe head injury, exposure to loud noise or head surgery, for example
- being starved of oxygen at birth
- illnesses such as meningitis and encephalitis
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Automated Auditory Brainstem Response
With the AABR test, technicians are measuring how your babys auditory nerve, the hearing nerve, and brain stem respond to sound.
Your baby will have small headphones placed on their ears and sticker-like electrodes placed on their head. Since babies cant tell test administrators what they can or cant hear, the electrodes measure the auditory nerve and brain stem response to gentle sounds like clicks or tones.
How Is The Newborn Hearing Test Done
The newborn hearing test is called the automated otoacoustic emission test. It takes just a few minutes.
A small soft-tipped earpiece is placed in your baby’s ear and gentle clicking sounds are played.
It’s not always possible to get clear responses from the 1st test. This happens with lots of babies, and does not always mean your baby has permanent hearing loss.
It could mean:
- your baby was unsettled when the test was done
- there was background noise
- your baby has fluid or a temporary blockage in their ear
In these cases, your baby will be offered a 2nd test. This may be the same as the 1st test, or another type called the automated auditory brainstem response test.
The AABR test involves placing 3 small sensors on your baby’s head and neck. Soft headphones are placed over your baby’s ears and gentle clicking sounds are played. This test takes between 5 and 15 minutes.
These tests will not harm your baby in any way.
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Why Is It Important To Screen For Hearing Loss In All Newborn Infants
Significant hearing loss is the most common disorder at birth. Approximately 1%-2% of newborns are affected.
Several national committees, including the National Institutes of Health, the American Academy of Otolaryngology/Head and Neck Surgery, and the American Academy of Pediatrics, have recommended that hearing loss in infants be identified, and when possible treated, prior to 6 months of age.
This recommendation is based on studies that have shown that children identified with hearing loss prior to 6 months of age have a better chance of developing skills equivalent to their peers by the time they enter kindergarten.
Children not identified until later may ultimately suffer from irreversible and permanent impairments in speech, language, and cognitive abilities when compared to their peers.
Prior to the implementation of hearing screen programs, it was customary to only test those newborns who had known significant risk factors for hearing loss. This group included infants whose mothers suffered from illness during pregnancy, those who had a family history of hearing loss, or those who were exposed to drugs known to affect hearing. In addition, infants with the following conditions were included for hearing screening:
However, despite the testing of all infants who fell into this “high-risk registry,” over half of all newborns with hearing loss were missed!
Hearing Screening Often Fails In C
By Amy Norton, Reuters Health
4 Min Read
NEW YORK – Newborns delivered by cesarean section may be more likely to fail their first hearing test, even if their hearing is perfectly normal, a new study suggests.
The problem arises if hearing screening tests are done within a babys first two days of life, researchers say. At that point, newborns delivered by C-section have a higher failure rate than babies born by vaginal delivery.
So to avoid needless repeat tests — and anxiety for parents — the researchers are recommending a delay in hearing tests for C-section babies.
The American Academy of Pediatrics recommends that all infants have their hearing tested before they are one month old. Thats often done before a newborn leaves the hospital, though it varies by country and hospital.
The new study looked at more than 1,600 infants born at one Israeli hospital, where all newborns have their hearing evaluated before going home.
Researchers found that when babies born by C-section had their hearing tested in their first two days of life, about 21 percent failed the test. That compared with seven percent of babies delivered vaginally — a three-fold difference.
The gap narrowed when the researchers looked at babies tested after two days: eight percent of C-section babies failed, versus one percent of vaginally delivered babies.
And in the end, all of the babies referred for further hearing tests passed, meaning that the failures had all been false alarms.
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How The Test Is Done
The newborn hearing screening test checks your babys inner ear . When a healthy ear receives sound, the inner part produces an echo. Recording this tells us that the hearing is satisfactory.
This screening test can be repeated if a clear response is not achieved in either one or both ears.
Why Is There A Hearing Test For Babies
Being able to hear well is important for learning how to speak as well as for learning and social development. The sooner any hearing impairment is picked up in a baby or child, the sooner they can get any treatment or support they need.
This screening programme started in New Zealand in 2007 after similar programmes overseas showed strong benefits.
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When Should My Baby Have A Hearing Test
Most babies are screened before they leave hospital for the first time. If this doesnt happen, ask your midwife or family doctor to help organise a screening for your baby. Ideally, this should be done before your baby is 1month old.
In New Zealand, the programme is provided free of charge for eligible babies.
What Is Newborn Hearing Screening
Most babies are born with normal hearing and experience the beauty of sound from the beginning but 1-3 out of 1000 are born with hearing loss. Those children cannot properly hear their parents speak, sing or read to them which delays speech and language learning. Newborn hearing screening identifies babies at risk for hearing loss so they can be evaluated and treated early.
The hearing screening is performed in the hospital by a nurse or outside of the hospital by a health professional. Many countries have implemented Universal Newborn Hearing Screening so that every baby has access to hearing screening soon after birth.
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What Does It Mean If A Baby Does Not Pass The Newborn Hearing Screening
When a baby does not Pass the hearing screening it means that more testing is needed. The baby could have hearing loss and it is important to follow-up.
It does not mean that your baby definitely has permanent hearing loss. Temporary conditions can affect the result even for a baby with normal hearing. These conditions include:
- The ear canal was blocked with fluid or vernix which clears in a few days.
- The baby was too active or awake during the screening.
- There was interference in the test room such as background noise or electrical interference
Screeners try to control the test conditions to get a reliable test. Waiting to screen until the baby is at least 12 hours old can avoid issues with fluid in the ear canal. It is best to screen when the baby is sleeping quietly after being fed. Also screeners should try to find a quiet room for testing.
When a baby does not pass the first screening, many Newborn Hearing Screening programs will perform a second screening before sending the baby on for more in depth testing.