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Babies who do not pass newborn hearing screening tests require immediate diagnosis and intervention, but that can be a challenge for families living in the vast expanse of rural Northern California, where a dearth of pediatric hearing specialists, geographic isolation and the topography all conspire to create obstacles.
Forty percent of rural Northern California newborns who needed additional testing for a potential hearing loss in 2007 did not receive it and were "lost to follow-up" care, giving the area the poorest rate in the state, where the overall average was 8 percent.
"Bringing these babies back for testing is imperative to optimize their development, especially the speech development critical to acquiring language and learning," said Anne Simon, AuD, senior pediatric audiologist in the UC Davis Department of Otolaryngology.
But she understands the substantial barriers that discourage families in rural communities from making the trek to the audiologist so their infant can receive additional testing. "Making the three- or four-hour-long trip with a 4-week-old baby may not be possible for many families," she said.
To meet the needs of families and improve the numbers of Northern California infants receiving follow-up care for hearing loss, UC Davis has entered into a unique partnership with the state and with Mercy Medical Center in Redding, CA, that will allow infants located throughout the region to be seen by a pediatric audiologist at UC Davis via telemedicine.
Among the first of its kind in the nation, the pilot program is funded by a three-year, $354,242 grant from the U.S. Health Resources and Services Administration Maternal and Child Health Bureau through the state Department of Health Care Services (DHCS), Children's Medical Services.
"We are thrilled to be implementing this innovative approach to more quickly identify infants with hearing loss in Northern California," said DHCS director Toby Douglas, MPH. "UC Davis is a leader in telehealth and pediatric audiology, and we are fortunate to have them as partners in this endeavor."
Early identification of hearing problems before 3 months of age and starting early intervention services before 6 months of age are the most important factors in developing age-appropriate language skills, whether families communicate using sign language or spoken language.
The program focuses primarily on infants living inland in the far northern counties in California adjacent to Shasta County, where Redding is located, such as Glenn, Butte, Trinity, Tehama, Lassen, Modoc and Siskiyou counties. Participation in the program is by referral from the state Hearing Coordination Center.
The teleaudiology program is unique because audiologists at UC Davis actually perform the hearing screening and make the diagnosis, rather than consulting with audiologists or other clinicians at the remote location, who then diagnose and treat the child.
"We are very excited about providing this program because central Northern California has the highest lost-to-follow-up rate in the state for newborn hearing screening," said James Marcin, MD, director of the UC Davis Pediatric Telemedicine Program. "But with this model, and with Redding being a central location for families in Northern California, we hope to eventually eliminate the lost-to-follow-up rate and provide the excellent care that these infants and their families deserve."
Through the program, an electroencephalogram (EEG) technician in Redding, such as Dawn Deines or Debbie Nickell, places electrodes on an infant's head and earpieces in the child's ears. Dr. Simon then controls the screening equipment remotely from Sacramento.
The telemedicine connection also allows Dr. Simon to switch camera views in order to see the infant and parent, the technician and the screening room and to view the child's ear canal and eardrum, with the information being recorded by the device during the two- to four-hour testing period.
Dr. Simon administers three tests to determine whether a child has a hearing loss and identify its source: auditory brainstem response (ABR), otoacoustic emissions (OAEs), and typanometry.
The goal is to have children return for diagnostic testing and follow-up care by the time they reach 3 months old.
"The sooner, the better," Dr. Simon said. "We find that about 6 months of age is when we start to see developmental differences between infants who have not had diagnostic testing and intervention and those who have."
She noted that she has fitted infants as young as 2 months with hearing aids.
"If we intervene by 6 months, we find that children have a much better chance of acquiring age-appropriate language," she said, "so we want to get hearing aids on them by 6 months."
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