One of the most important decisions in implementing a screening program is the choice of screening method. Any screening method chosen should measure a physiological response, not a behavioral one.

Transient or Distortion Product Otoacoustic Emissions (OAE) or Auditory Brainstem Evoked Response (ABR) are the methods of choice for universal newborn hearing screening programs for infants in the Well-Baby Nursery.

The Joint Committee on Infant Hearing Position Statement 2007 recommends that infants with a stay of 5 days or longer in the NICU be tested with ABR due to a higher risk of auditory neuropathy/dys-synchrony.



Your Hospital Hearing Screening Program Supervisor should research the various equipment options based on the following: Initial cost, anticipated refer rates, on-going costs, ease of use, availability of customer service and support, warranty and service contracts available.

Other considerations for technology choices include the following:

  • Use of more than one technology- (OAE then ABR in a two-stage testing system or in different hospital units) 
  • Average length of stay 
  • Anticipated staffing patterns and personnel who will be using the equipment 
  • Birth census 
  • Demographics of the community 
  • Screening and rescreening protocols
  • Several different types of screening equipment are available. Each of them can be part of a successful program although some characteristics may suit one program better than another. 
  • The per patient disposable costs are generally less for OAE's but they often have a higher initial refer rate, especially if the length of stay is less than 24 hours. Hospitals in remote areas where distance and transportation is an issue may need to implement procedures to ensure a very low initial refer rate, such as using ABR as the screening technology. 
  • Some equipment may be easier to learn how to operate. Ease of use can be an important consideration in staffing patterns, especially for hospitals with low birth rates or those who choose to train large numbers of staff as screeners.