European Consensus on Neonatal Screening, Milan 1998


  • Permanent childhood hearing impairment (PCHI) is a serious public health problem affecting at least one baby in one thousand. Intervention is considered to be most successful if commenced in the first few months of life. Therefore, identification by screening at or shortly after birth has the potential to improve quality of life and opportunities for those affected. 
    PCHI is defined as a bilateral permanent hearing impairment greater than or equal to 40 dB averaged over the frequencies 0.5, 1, 2 and 4 kHz
  • Effective programmes of intervention are well established. 

  • Methods for identification of PCHI in the neonatal stage are now accepted clinical practice. They are effective and can be expected to identify at least 80% of cases of PCHI whilst incorrectly failing 2-3% of normally hearing babies in well-controlled programmes. 

  • Neonatal testing in maternity hospitals is more effective and less expensive than behavioural screening conventionally carried out at 7-9 months. 

  • Targeting neonatal testing on only the 6-8% of babies at increased risk of PCHI reduces costs but cannot identify more than 40-50% of cases*. Targeted neonatal hearing screening in parallel with 7-9 month behavioural testing is more expensive and less effective than universal neonatal screening.
    * Examples include neonatal intensive care and family history of hearing impairment
  • Hearing screening in the neonatal period cannot identify acquired or progressive hearing loss occurring subsequently. Surveillance methods are required to identify those cases, which may be 10-20% of all permanent childhood hearing impairment. 

  • Risks associated with neonatal hearing screening include anxiety from false positive results and possible delayed diagnosis from false negative results, but these risks are acceptable in view of the expected benefits. 

  • Neonatal hearing screening should be considered to be the first part of a programme of habilitation of hearing impaired children, including facilities for diagnosis and assessment.

  • A system of quality control is an essential component of a neonatal hearing screening programme. Quality control includes training of personnel and audit of performance. The person responsible for quality control should be identified. 

  • Although the healthcare systems in Europe differ from country to country in terms of organisation and funding, implementation of neonatal hearing screening programmes should not be delayed. This will give new European citizens greater opportunities and better quality of life into the next millenium.