Neonatal screening for hearing impairment.

Scope of this discussion Hearing impairment in childhood may be conductive or sensorineural or a combination of the two (mixed) with additive eVects. Impairments aVect one or both ears, vary from mild to profound in degree, and may be congenital, acquired, transient, fluctuating, recurrent, progressive, or permanent. Screening positive for hearing impairment at any age leads firstly to the need for follow up tests, including an estimation of hearing threshold levels, and secondly, if these are elevated, to a medical evaluation to determine whether or not the hearing loss is permanent. Bilateral congenital permanent childhood hearing impairment (PCHI) of moderate or greater degree can be expected to lead to major deficits in the development of language as well as secondary eVects on the child and the family. This is largely avoidable with early intervention, thus providing the rationale for neonatal screening. Consideration of this rationale and its practical implications is the focus of this article. This is timely as Yvette Cooper, UK government minister for Public Health, announced on 22 June 2000 that the government had decided in principle to introduce universal neonatal screening (UNS) and that districts are invited to apply to be part of a 20 site pilot starting perhaps at the end of 2000.