Because early detection and treatment of hearing loss leads to significantly improved speech and language delay for those children affected, Lucile Packard Children's Hospital (LPCH) provides hearing screening for all newborns, regardless of perceived risk.
ALGO Hearing Screen
At LPCH, all infants are screened with an ALGO machine before discharge from the newborn nursery. Infants who do not pass this screen are retested; those who do not pass the second time are then referred for further evaluation.
What is ALGO?
ALGO is the brand name of the machine we use here at LPCH to assess infant hearing. The ALGO machine is manufactured by Natus®. Also known as an Automated Auditory Brainstem Response assessment (or AABR), it is designed as a screening tool for the early identification of infant hearing loss.
Since it is well documented that early intervention for hearing loss results in significantly improved outcomes for children with regard to speech and language development (especially if treatment is started by age 3 months), assessing hearing in newborns is standard practice at LPCH.
The screening process itself is painless and takes only about 5 minutes. The test is ideally performed when the infant is asleep as motion artifact can affect the ability of the machine to detect a response.
To start, 3 sensors with self-adhesive tabs are placed on the infant: one on the upper forehead, one on the nape of the neck, and one on the back of the shoulder. Then soft plastic earphones are placed over the infant's ears.
The screening is started by selecting the appropriate setting on the laptop control panel. During the screening, soft clicks are transmitted through the earphones, one ear at a time. The sensors placed on the baby's skin then detect brainwave response to the clicks. If the detected response matches the anticipated response within the variance allowed by the machine, the ear receives a "PASS". If not, the ear receives a "REFER".
Who should be screened with ALGO?
All infants who meet the following criteria may be screened with the ALGO machine:
- Term, healthy newborn
- NICU graduate, 34 weeks gestational age or older
- Newborns with normal external ear and no obvious head or neck deformity
- Ready for discharge
- Receiving NO central nervous system stimulants
- In an open crib
- Sleeping or in a relaxed state
Does a "REFER" mean the child has hearing loss?
Not necessarily. About 90% of newborns who fail their initial screening will go on to pass subsequent testing. However, follow-up testing is critical, because up to 10% of those initial referrals may have true congenital hearing loss and need treatment.
Vernix or fluid in the ear canal or fluid in the middle ear may cause an ear to "REFER." Delaying the screening until near the time of discharge allows more time for the body to clear this fluid/debris and decreases the false positive rate. An interesting example of this phenomena is the fact that our audiologists note a higher "REFER" rate on the left than on the right, thought to be due to the fact that our newborns are usually placed in an open crib with their head rotated to the right side. This puts the left ear up, giving less opportunity for it to drain.
Results of the testing are recorded in a variety of locations. They should be on-line in powerchart as well as in the progress note section of the medical record.
While the infant is still in the nursery, a green check mark on the white board after the mother's name as well as a green card on the baby's crib indicate that the screen was passed. A purple check mark on the board, or a yellow card on the crib, indicate a "REFER." In most cases, those infants who do not initially pass will have a second ALGO screening before discharge. Rescreening results will be posted in the same locations.
Pink crib cards are given if the infant cannot be tested due to activity or excessive ambient noise or if the child is about to be discharged without screening and needs to return for outpatient screening.
This is offered by the LPCH audiology department free of charge.