Birthing Facilities and Midwives

Did you know approximately 95 percent of babies with hearing loss are born to hearing parents and over 50 percent of babies born with hearing loss have no known risk factors for hearing loss? Of the over 120,000 babies born in North Carolina each year, approximately 200 will be diagnosed with a hearing loss shortly after birth. Another 2 to 3 percent of those children that initially passed their newborn hearing screen will be diagnosed with late-onset hearing loss. 

Screening a baby's hearing is very important, even if there is no family history of childhood hearing loss. Equally important is ensuring infants that do not pass their hearing screen receive timely follow-up (re-screen and diagnostic assessment, as needed). The first six months of an infant’s life are the most critical for speech and language development. If a hearing loss is detected early, much can be done by families to encourage language development!

Hospital staff play a vital role in newborn hearing screening and follow-up in our state. The way in which a screener communicates hearing screening results can have a direct impact on a family’s decision to follow-up for a recommended outpatient rescreen.

Hearing screening results or missed screens should be promptly transmitted to the medical home and the North Carolina Early Hearing Detection and Intervention program. Communication of the importance of hearing screening, results of the hearing screening and recommended follow-up is key to the best possible outcomes for children and to a sustainable system supporting families in North Carolina.

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Hearing Screening in North Carolina 

North Carolina passed legislation to require birthing hospitals to screen hearing in 1999 and most hospitals began such screening in 2000. Therefore, the vast majority of infants entering a medical practice in North Carolina will have received a hearing screening at their birthing facility. Results of the Newborn Hearing Screening are sent to the primary care medical practice serving an infant by the birthing facility. Results can also be obtained directly from the NC Early Hearing Detection and Intervention Program office.

Read more in the flyer: Twenty Years of Newborn Hearing Screening in North Carolina. 

North Carolina Early Hearing Detection and Intervention (NC EHDI) Program

The NC Early Hearing Detection and Intervention (EHDI) Program's goals are to ensure that all deaf or hard of hearing babies are screened/rescreened by one month of age, are diagnosed by three months, and have received amplification (if warranted) and/or have early intervention in place by six months of age. If these goals are met, the majority of deaf or hard-of-hearing children can develop normal speech and language skills and function optimally in the hearing world.

The EHDI Program offers consultation, training and education to birthing facilities, medical providers, audiologists, early interventionists and other providers working with infants and children to help meet the EHDI goals.

The EHDI Regional Consultants provide help to families and service providers at no charge. 

NC EHDI Advisory Committee

Mission: The EHDI Advisory Committee is committed to the adoption of Universal Newborn Hearing Screening and Early Hearing Detection and Intervention Programs. Our goal is to facilitate the early identification, diagnosis, amplification and intervention of infants and children with hearing loss in order to maximize developmental outcomes.

Purpose: The purpose of the EHDI Advisory Committee is to guide the development, coordination, and quality evaluation of community-based EHDI programs. Specifically,

  • To foster an understanding of the Early Hearing Detection and Intervention (EHDI) process within community settings with families and professionals;
  • To encourage the development of efficient programs involved in the EHDI process including screening, re-screening, diagnosis, amplification, habilitation, and intervention within community settings;
  • To encourage research of EHDI services within community settings; and
  • To review NC State EHDI program performance as compared to the National EHDI quality indicators and outcome measurements for a Universal Newborn Hearing Screening Program and EHDI Tracking and Surveillance System.

Most initial hearing screenings are conducted with an Automated Auditory Brainstem Response (AABR) screener, although some hospitals use an Oto-Acoustic Emission (OAE) screener. Both methods screen mid to high-frequency sounds. An AABR screening tests the responsiveness of the complete auditory system from the ear to the brain whereas an OAE screening results from Outer Hair Cell response in the cochlea. It is possible, although rare, for a baby to pass an OAE screening but still have a condition of hearing loss called Auditory Neuropathy/ Dyssynchrony. In this condition, the auditory signal does not arrive in the brain in a synchronous manner and the child will hear a very distorted signal. Thus, the child may not meet speech and language developmental expectations.

Infants who have received care in the NICU represent 10% to 15% of the newborn population and have been shown to have a higher prevalence of elevated hearing thresholds compared to infants from well-baby nurseries (Robertson et al., 2009; Vohr et al., 2000). For complete information review the 2019 JCIH Position Statement, Page 9.

Per JCIH 2019, The equipment used for screening must be calibrated, and annually re-calibrated, by the manufacturer or other entity (e.g., special-instruments distributor or hospital clinical engineering department).

Read frequently asked questions by parents about the newborn hearing screening process and follow-up.

Comparison of Newborn Hearing Screening Equipment:

To learn more about the different newborn hearing screening equipment review this table created by the National Center for Hearing Assessment and Management (NCHAM). The table was last updated in 2021. Additional research may be necessary to identify all available hearing screening equipment.

EHDI Goals

The NC Early Hearing Detection and Intervention (EHDI) Program’s goal is to facilitate the early identification, diagnosis, amplification and intervention of infants and children with hearing loss to maximize developmental outcomes. National EHDI Goals include the following 1-3-6 timeline:

1 - Infants complete screening by one month of age;

3 - Infants needing a diagnostic test have it done by three months of age; and,

6 - Infants with hearing loss receive intervention by six months of age.

Best Practices for Birthing Facilities

The 2019 Joint Committee on Infant Hearing (JCIH) Position Statement provides best practices for newborn hearing screening and follow-up. 

Timing of Newborn Hearing Screening

  • Infants should have their hearing screened as close to discharge as practicable, while at the same time allowing sufficient time for a single repeat screen to be performed if the infant does not pass the first screen.
  • The second screen, should it be required, should not be performed immediately following the first screen, but should occur at least several hours later.
  • Infants with congenital aural atresia in one or both ears or with visible pinna/ear canal deformity such as stenosis or severe malformation should not be screened in either ear but should be referred for diagnostic audiologic evaluation immediately upon discharge. The diagnostic audiologic evaluation can also be accomplished while the infant is in the NICU or other inpatient hospital unit.

Infants in the NICU

  • For some infants in the NICU (e.g., infants on ventilators), it may not be feasible or practical to complete a hearing screening prior to one month of age due to the high likelihood of middle ear effusion, noise interference, and electrical interference from equipment. Alternative arrangements should be made for completing the hearing screening on these infants at a time when they are medically stable.
  • AABR is the most appropriate screening technology for infants who receive care in the NICU. This recommendation was made based on evidence of the prevalence of neural hearing losses in that population.
  • Infants who were hospitalized in the NICU and who did not pass a hospital-based screening should be referred directly to a pediatric audiologist.
  • Infants exposed to ototoxic medications are at greater risk for permanent hearing loss.
  • Babies that pass their newborn hearing screening and have known risk factors for late-onset or progressive hearing loss should receive audiological follow-up per JCIH.

Link to: Risk Factor Guidelines for Infants Who Pass NBHS-for PCP_5.16.20.pdf

Link to: Risk Factor Parent Education Card – coming soon

Communicating Newborn Hearing Screening Results

  • Screening results should be conveyed immediately to the family so that they can understand the outcome of the screening and the importance of follow-up when indicated. Newborn Hearing Screening: Sharing “refer” results with families.
  • Clearly communicate to the family that a pass outcome implies that the infant passes both ears simultaneously (in the same screening session). Specifically, an infant who does not pass both ears in the same screening session, even if each ear has separately passed a screening, does not constitute a pass outcome. Parents should not be advised, “one ear passed, and the other ear did not pass.”
  • Both the family and the primary care provider should be advised that passing a hearing screening performed either by OAE or by AABR testing does not imply that hearing thresholds are within normal limits (WNL), only that thresholds are not greater than approximately 35-40 dB HL.
  • Provide hearing screening results to the NC EHDI program via entry in Hearing Link.
  • Reducing and preventing loss to follow-up/ loss to documentation (LTF/LTD) starts with birth-hospital hearing screening personnel and training. To facilitate the screening process for primary care providers and better ensure timely follow-up, birthing facilities should ensure that medical professionals: 1. Receive the results of the screening test (pass, fail, or not completed) and the type of test administered (OAE or AABR), as documented in the hospital medical record. 2. Receive communication directly from the hospital for each infant who does not pass the newborn screening or leaves the hospital unscreened, with any pertinent recommendations for follow-up included in the communication.
  • For the baby who does not pass the hospital screen, the family should be informed in a manner that maximizes the likelihood that follow-up will occur when needed, a manner not overly stressful for the family, but at the same time not suggesting overly optimistic estimates of the reasons for the failed outcome.
  • Before discharge, an appointment should be made for follow-up rescreening or for audiological testing.

Rescreen

A critical function in the success of UNHS is the ability to ensure timely rescreening for all infants who do not pass their initial (birth) hearing screening.

  • Infants who were in the NICU and who did not pass a hospital-based screening should be referred directly to a pediatric audiologist.
  • Outpatient rescreening should be performed as soon as possible after hospital discharge, and always before one month of age (or, in the case of an older infant, as soon as possible following discharge).
  • Rescreening should comprise a single valid rescreen of both ears in the same session, even if only one ear did not pass the inpatient screening, to ensure that fluctuation or progression in hearing levels are not missed.
  • If the infant does not pass in one or both ears on the rescreen, immediate referral to a pediatric audiologist with capabilities for a diagnostic ABR testing should be made.
  • Referral pathways and timelines should be developed in conjunction with community resources and the state EHDI program, including the EHDI Regional Consultant to ensure timely rescreening of those infants who do not pass their birth hearing screens, as well as timely and appropriate diagnostic audiologic evaluations.

Additional Outpatient Hearing Screening

Outpatient hearing screening at no later than one month of age should also be made available to infants who were discharged before receiving the birth admission screening, and to infants who were born outside a hospital or birthing center in a location that does not provide newborn hearing screening. Similarly, outpatient screening also should be made available to the infant whose parents previously declined or were unable to complete the hearing screening and subsequently decided to have their baby screened.

Compliance Guide

NC birthing facilities are required to participate in an annual program compliance guide meeting with the EHDI Regional Consultant. The Compliance Guide is designed to ensure best practices are being implemented by birthing facilities.

Birthing Facility Compliance Guide Manual

Profile and Score Sheet_UNHS Birthing Facility Compliance Guide

A Pediatric Audiologist is trained in the evaluation, diagnosis, and fitting of amplification in infants and young children with hearing loss, requiring knowledge of child development, equipment particular to the evaluation of this age group, and the patience, willingness, and effective communicative skills needed to work with parents and other professionals involved with this age group.

Your EHDI Regional Consultant can provide you with the names of such practices in your area.

You can also use the Early Hearing Detection and Intervention-Pediatric Audiology Links to Services (EHDI Pals) website to locate pediatric audiologists in your area.

Read questions frequently asked by parents about the newborn hearing screening process and follow-up.

Newborn Hearing Screening

Critical Congenital Heart Disease (CCHD)

Metabolic Screening

Family Support Resources in North Carolina: EHDI Program resources and NC family support resources.

Funding Information: Medical care for hearing loss can be expensive. You can explore the resources below to find ways to pay for services and devices.

More Resources: Additional North Carolina resources that may help families navigate their child’s hearing loss.

Family Support: As a family who is learning about your child's hearing loss, we know you may be feeling many emotions. A valuable resource is Family Support. Family support is a way to connect with other families who have children with hearing loss. Families often feel empowered when they talk to other families who have been on a similar journey and are able to share their stories and provide unbiased support. We encourage you to learn about family support resources available in North Carolina to support your family's needs.

Family Support Resources in North Carolina

EHDI Regional Consultants and Parent Consultants: EHDI has ten regional consultants and two-parent consultants, one of whom is bilingual in English and Spanish. Our staff can help connect your family to available resources.
Look at the Regional Map to find the consultant who serves your region.
NOTE: Parent consultants provide service to the entire state.

The EHDI Parent Support Team: The Early Hearing Detection and Intervention (EHDI) Parent Support Team is a diverse network of parents formed to provide parent-to-parent support for families that have a child who is deaf or hard of hearing. Each parent mentor has been trained to provide support for your family in an unbiased way as you and your child navigate the journey of hearing loss. The role of the parent mentor is to listen, help when asked, and connect you to various parent resources available in our state. 

See the Parent Support Team flyers for more information: English, Spanish 

The EHDI Family Focus Email: This is a monthly email specifically designed for families who have children that are deaf or hard of hearing. At the beginning of each month, you can receive an email that:

  • Spotlights a resource in NC for D/HH kids and their families
  • A list of community events for families with D/HH kids
  • Facts and information to help you advocate for your child
  • Personal Stories of families with D/HH children in NC

If you are interested in receiving this monthly email from NC EHDI - You can Subscribe here. The email is currently available in English but a Spanish Family Focus Email is under development.

The Care Project: The Care Project is a nonprofit organization dedicated to bringing hope to families who have children and/or adults with hearing challenges through counseling experiences aimed at the processing of the emotional stages of grief. Family retreats are organized, funded, and hosted by The CARE Project.

BEGINNINGS for Parents of Children Who are Deaf or Hard of Hearing: BEGINNINGS assists parents of children who are deaf or hard of hearing, deaf parents with hearing children and professionals serving them from birth through age 21 by providing information and support to empower them as informed decision-makers. Support is provided by helping parents access services, promoting early identification of hearing loss and awareness of early intervention programs and educational services.

Hearing Impaired Toddlers and Children Have Unlimited Potential (HITCHUP): These groups are organized and led by parents of children with hearing loss and share information and support with other families at several locations across the state. HITCHUP operates mainly via Facebook.

  • NOTE: For Facebook pages, you may be prompted to log in to your personal Facebook account before you are taken to the HITCH-UP page. These are private groups so you will need to submit a request to join the group.
  • Triangle
  • Charlotte
  • TRIAD
  • Spanish: Triunfa Caracol Latino: Este es un grupo de apoyo para los padres que tienen niños con pérdidas auditiva de cualquier tipo. Por éste medio nos podemos aconsejar unos con otros, compartir experiencias o simplemente publicar algún comentario relacionado con el tema.

CODA Connections, Inc.: CODA Connections, Inc. is a 501(c )3 non-profit established to serve Deaf families and Children Of Deaf Adults. They strive to connect Deaf families and children to critical resources to ensure each family member reaches their full potential.

Camps

Support resources for general special needs

Exceptional Children's Assistance Center (ECAC) is dedicated to empowering families and improving lives, particularly for North Carolina families raising children ages 0 to 26 with disabilities. As a non-profit organization operated by and staffed primarily with parents of children with disabilities, we understand the needs of families as they navigate the special education process.

Family Support Network (FSN) of North Carolina enhances the lives of children who have special needs by providing support, education, and caring connections to their families. Find an FSN affiliate program that services your county.

First Resource Center connects individuals with disabilities and their families with the resources they need to thrive in the community including coordinating with government agencies, schools, or community partners. Serving Buncombe, Henderson, and Madison counties.

Children with Special Health Care Needs Help Line (1-800-737-3028)is a toll-free contact for those living with, caring for, or concerned about a child with special health care needs. Callers can learn about health care programs as well as funding resources available to North Carolina residents.

NCCARE360 is the first statewide network that unites health care and human services organizations with a shared technology that enables a coordinated, community-oriented, person-centered approach for delivering care in North Carolina. NCCARE360 helps providers electronically connect those with identified needs to community resources and allow for feedback and follow-up.

Funding Information:

Medical care for hearing loss can be expensive. You can explore the resources below to find ways to pay for services and devices.

North Carolina Resources:

Assistive Technology (AT) through the Children’s Developmental Services Agency (CDSA) is an Infant-Toddler Program service. Decisions about AT needs are made by the Individual Family Service Plan (IFSP) team.

BEGINNINGS Grants to Parents Program helps North Carolina families with children birth to 22 who have a relationship with BEGINNINGS. Assistance is available for transportation costs, therapies, devices, services, or parent education associated with their child’s hearing loss, for which no other source of funding is available.

Carolina Children's Communicative Disorders Program (CCCDP) provides communication devices, as well as UNC physician, audiological, and speech services for qualifying children with hearing and other communication disorders.

Early Hearing Detection and Intervention (EHDI) program provides funding for hearing aids not covered by insurance for children ages 0 to 3 who are diagnosed with permanent hearing loss at no cost to the family.

North Carolina Medicaid serves low-income parents, children, seniors, and people with disabilities.

North Carolina State Education Assistance Authority (NCSEAA) offers three programs that expand school choice for eligible students in kindergarten through 12th grade. The Opportunity Scholarship, Disabilities Grant, and Education Savings Account can cover tuition and required fees at a participating nonpublic school. In addition, the Disabilities Grant and Education Savings Account can cover certain other expenses related to educating a child with a disability.

National Resources:

Funding Assistance for Audiology Services offers suggestions on where to find funding resources in your community.

Hearing Aid Loaner Programs are a resource that can provide immediate, though temporary, access to appropriate amplification for young children with hearing loss whose parents choose that option.

Hearing Loss Association of America (HLAA) features information about how to pursue financing for hearing devices via private insurance, Medicaid, Medicare, and charities.

HIKE Fund helps provide hearing devices for children from ages of birth to 20 years. This is an extensive, six-page application that requires a family letter as well as a prescription from the doctor.

Starkey Hear Now is an application-based program that provides hearing help to low-income Americans.

Travelers Protective Association of America (TPAA) provides assistance to help families obtain hearing devices and treatment as well as speech therapy, note-takers, interpreters, and in other areas that are related to hearing loss.

United Healthcare Children's Foundation (UHCCF) provides grants for medical-related services that have the potential to enhance either the clinical condition or the quality of life of the child and that are not fully covered by the available commercial health benefit plan, including hearing aids and speech therapy.

More Resources:

Here are some other North Carolina resources that may help you navigate your child’s hearing loss:

Communication Services for the Deaf and Hard of Hearing (CSDHH) is a non-profit agency that works on the local level to empower and inspire change through community outreach and advocacy. Includes information about captioning, interpreters, sign language classes, silent dinners, and the T.A.G. Mentoring Program.

The Division of Services for the Deaf and Hard of Hearing (DSDHH) works to ensure that all Deaf, Hard of Hearing, or Deaf-Blind North Carolinians have the ability to communicate their needs and to receive information easily and effectively in all aspects of their lives, especially their health and well-being. Services are provided through its seven North Carolina regional centers. Deaf, Hard of Hearing and Deaf-Blind individuals, family members, professionals, agencies and individuals seeking information or assistance have access to these services for no charge.

North Carolina Association for the Deaf (NCAD) is a non-profit organization founded that oversees important educational, civil, health and social issues of deaf, hard of hearing and deaf-blind citizens in NC.

North Carolina Public Schools, Exceptional Children Division, Deaf and Hard-of-Hearing Statewide System of Support serves as a support to local education agencies, including charter schools, and the two schools for the deaf. Consultants for the Deaf and Hard-of-Hearing Program are available for consultation in program planning and development, training, mentoring and technical assistance that lead to a quality education for students who are deaf or hard of hearing.

North Carolina Schools for the Deaf

Eastern North Carolina School for the Deaf (ENCSD) (Wilson Campus) provides individualized comprehensive educational, vocational, and residential programs for deaf, hard of hearing, and deaf-blind students leading to productive, independent, and successful lives.

North Carolina School for the Deaf (NCSD) - Western (Morganton Campus) is a day/residential facility for the education of children who are deaf and hard of hearing holding dual accreditations from the Council of Educational Administrators for Schools for the Deaf (CEASD) and Advanced Education. NCSD boasts a rich, 125-year history, honoring tradition and culture, and improving academic and postsecondary outcomes for its students.

Here are some other national resources may help you navigate your child’s hearing loss:

American Society for Deaf Children (ASDC) is a non-profit parent-helping-parent organization promoting a positive attitude toward signing and Deaf culture. It also provides support, encouragement, and current information about deafness to families with deaf and hard of hearing children.

Babyhearing.org was created to answer parents' questions about infant hearing screening and follow up testing, steps to take after diagnosis of hearing loss, hearing loss & hearing aids, language and speech, and parenting issues.

Boys Town National Research Hospital is internationally recognized as the leader in hearing research.

Centers for Disease Control and Prevention - Information for Families section has tools and information about hearing loss for families.

Communicate with Your Child presents introductory information about newborn hearing screening.

Division for Early Childhood (DEC) promotes policies and advances evidence-based practices that support families and enhance the optimal development of young children (0-8) who have or are at risk for developmental delays and disabilities.

Ear Community offers a supportive community for individuals who were born with Microtia and Atresia, Hemifacial Microsomia, Treacher Collins Syndrome, and Goldenhar Syndrome, including varying degrees of hearing loss.

Fostering Joy is a movement to celebrate the magic of raising children who are Deaf or Hard of Hearing.

Hands & Voices is a non-profit, parent-driven organization dedicated to supporting families of children who are deaf or hard of hearing.

Hands and Voices Phone App. The app is designed especially for the needs of parents of children newly identified as deaf or hard of hearing (D/HH) and navigating a new path with their child. Each day for 90 days, parents receive 4 valuable tools: wisdom from experienced parents, insight from adults who are D/HH, articles related to raising a child who is D/HH and a Resource/website to explore. The app is available for android and iOS. Search “Hands & Voices” in your app store to locate it.

Hearing First offers families and professionals ways to improve outcomes for children who are deaf or hard of hearing through listening and spoken language.

Hear to Learn is a learning resource available from NCHAM to help parents of young children support spoken language development. Spanish website available.

Learn the Signs. Act Early Program, developed by the Centers for Disease Control and Prevention (CDC) aims to improve early identification of children with autism and other developmental disabilities so children and families can get the services and support they need. From birth to 5 years, children should reach milestones in how they play, learn, speak, act, and move. This program helps parents track their child’s development and act early if they have concern. To learn about the program, go to: https://youtu.be/9Ithxd5KWhw or https://youtu.be/uD68lmY9TWI (in ASL).

Listening and Spoken Language Knowledge Center for children and adults with hearing loss, their families and the professionals who support them.

National Association of the Deaf (NAD) is the nation's premier civil rights organization of, by and for deaf and hard of hearing individuals in the United States of America.

National Center for Hearing Assessment and Management (NCHAM) serves as the National Resource Center for all Early Hearing Detection and Intervention (EHDI) systems. Every state and territory in the United States has now established an EHDI program. Program staff can help you locate services in their state. State EHDI Program website addresses can be found at this link.

National Center on Deaf-Blindness is a national technical assistance center funded by the federal Department of Education, NCDB works to improve the quality of life for children who are deaf-blind and their families.

National Cued Speech Association supports effective communication, language development and literacy between individuals, families, infants and children alike through the use of Cued Speech.

Signing Time was created to help all parents and children better communicate. Our vision of the world is one in which all children -- regardless of their abilities -- can express themselves, feel valued and understood, and be supported in achieving their full potential.

The Laurent Clerc National Deaf Education Center is a federally funded program on the campus of Gallaudet University that provides information, training, and technical assistance for parents and professionals to meet the needs of children birth to age 21 who are deaf or hard of hearing.

Social Media: There many social media support groups that exist. Find the ones that best meet the needs of your family and request to join.

Disclaimer: The NC EHDI Program makes no warranty of the accuracy, completeness or timeliness of this information, and shall not be liable for any decision made in reliance on this information. It is the user's responsibility to verify this information.