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Universal newborn hearing screening: should we leap before we look?

Across the nation pediatricians are being importuned, and indeed propelled, to implement universal newborn hearing screening, despite a total lack of information concerning ultimate costs and, particularly, risks. Without question, early detection of severe sensorineural hearing loss is a laudable goal, to be pursued devoutly. However, I would contend again, as Fred Bess and I argued in a commentary in Pediatrics 5 years ago,1 that universal newborn hearing screening in our present state of knowledge is not necessarily the only, or the best, or the most cost-effective way to achieve that goal, and more importantly, that the benefits of universal newborn hearing screening may be outweighed by its risks. The nagging question of ultimate costs and risks that Bess and I posed in that commentary remains unanswered, and in fact, virtually unaddressed.

Advocacy for screening on a national scale gained momentum after the 1993 publication of a National Institutes of Health (NIH) Consensus Statement that arose out of a Consensus Development Conference convened jointly by the National Institute on Deafness and Other Communication Disorders and the NIH Office of Medical Applications of Research, and cosponsored by the National Institute of Child Health and Human Development and the National Institute of Neurological Disorders and Stroke. The NIH Consensus Statement recommended that all infants be screened for hearing impairment within the first 3 months of life, and preferably before discharge from the hospital newborn nursery.2

Bess's and my commentary disputing the wisdom of that recommendation provoked a flurry of mainly dissenting, and in some cases, indignant letters to the editor, mainly from members of the audiology community ( Pediatrics 1994;94:948–959). These provided us with the opportunity, in our responses, to explain and expand on our position in greater detail.3 Together, the letters and our replies provide a comprehensive and still …