How can a screening program using two-stage testing minimize missing infants with hearing loss?
In order to maximize the probability of detecting children with hearing loss both the more usual cases of configured loss and the rarer cases of auditory neuropathy the ideal approach using currently available technology would be to test every baby using both the OAE and ABR screen. While in some programs this combined protocol has been implemented to great success, in many instances this is impractical for the general well-baby population due to cost or time considerations. The most cost-effective and efficacious approach is, therefore, the two-stage protocol endorsed by many leading clinicians and medical organizations, including the National Institutes of Health.25-27 A recent clinical study by Gorga et al.27 published in JAAA, following recommendations made in the 1993 NIH Consensus Statement, showed that a two-stage newborn screening program using OAE testing, followed by an ABR test of infants who do not pass, resulted in the lowest costs-per-baby tested. The NIH model presents a
