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Newborn hearing screening: 1-3-6, OAE versus AABR, screening terms and at-risk follow-up
Screening aims to find permanent hearing loss early enough to treat it in time: screen by one month, diagnose by 3 months and start intervention by 6 months. A baby who passed may still need follow-up if he has a risk factor for late-onset or progressive loss.
Why it matters in the exam
The screening terms in the bank: a "positive" result is a refer (did not pass); "negative" is a pass. True positive — referred and has a loss; false positive — referred but hears normally (for example vernix or fluid in the canal); true negative — passed and hears normally; false negative — passed despite a loss (ANSD on OAE screening, a mild loss, or a loss that develops later). Sensitivity is the share of babies with loss who are caught, and specificity the share of hearing babies who pass. Well babies may be screened with OAE or AABR, but for babies in the NICU for more than 5 days JCIH recommends AABR, because ANSD is more common there; a birth weight under 1500 grams usually signals such a stay.
Risk factors for late-onset or progressive loss: congenital CMV (the leading non-genetic cause of sensorineural loss in children; the loss may appear late, progress and fluctuate), family history, NICU stay, ECMO, exchange transfusion for jaundice, ototoxic drugs, craniofacial anomalies, syndromes, postnatal meningitis, head injury and chemotherapy. A child with congenital CMV is retested repeatedly through early childhood — in many programmes to about 5–6 years — even when screening and the first diagnosis are normal. A baby who fails AABR in the NICU is referred straight for audiological diagnosis, not rescreened with OAE. Parents worried about their child's hearing should also get a test, even if the child passed screening.
Key points
- 1-3-6: screen by one month, diagnose by 3, intervene by 6.
- Positive = refer; false negative = passed despite a loss.
- NICU over 5 days: AABR.
- Congenital CMV: the leading non-genetic cause; late and progressive loss.
- Risk factor or parental worry — follow up even after a pass.
Summary table
| Topic | Principle | Detail for the exam |
|---|---|---|
| Timeline | 1-3-6: screen, diagnose, intervene | Advanced programmes aim for 1-2-3 |
| Terms | Positive = refer; negative = pass | False positive — referred and hears; false negative — passed with a loss |
| Sensitivity and specificity | Catching babies with loss; passing hearing babies | False negatives reduce sensitivity |
| Well baby | OAE or AABR | OAE is quick, sensitive to fluid and canal debris |
| NICU over 5 days | AABR | Because of ANSD; a refer — straight to diagnosis |
| Congenital CMV | Loss may appear late and progress | Repeated follow-up in early childhood, even after a normal result |
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Sources
- Joint Committee on Infant Hearing, Journal of Early Hearing Detection and Intervention, 2019 — Year 2019 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs
- Fowler & Boppana, Journal of Clinical Virology, 2006 — Congenital cytomegalovirus (CMV) infection and hearing deficit
- World Health Organization, 2021 — World report on hearing (early identification)
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.