Neonatal screening is considered by far the most clinically evoluted application of otoacoustic emissions. We can divide the last 11 years into two important periods.

The first period starts with the NIH statement (1993) which recommends that all infants within the first three months of life should be screened for hearing. This statement was supported by clinical data from the Rhode Island Hearing Assessment Project (RIHAP) which from the early 90's was applying neonatal screening to newborns with otoacoustic emissions and ABR recordings. Later on in 1994 the Joint Committee on Infant Hearing (JCIH) issued another statement on screening recommending the use of technologies like Otoacoustic Emissions and ABR to be used alone or in combination. The success of the RIHAP project contributed to the creation of a solid clinical screening model which could be easily duplicated in other clinical setups.

The second period refers to the design of Early Hearing Detection and Intervention Programs (EHDI). The pre-cursor of this period was the first European consensus meeting on neonatal hearing screening , organized in 1998 in Milan within the framework of the European Concerted Action AHEAD. According to the released Consensus Statement "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." The permanent childhood hearing impairment was considered as a bilateral permanent hearing impairment greater than or equal to 40 dB averaged over the frequencies 0.5, 1, 2 and 4 kHz. The complete consensus statement can be found here.

In 1999 a statement the American Academy of Pediatrics supported the idea of implementing a universal hearing screening. Later on the Joint Committee on Infant Hearing (JCIH) released the first public statement on EHDI systems, called "Year 2000 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs". The detailed text can be found here.

In neonatal hearing screening there are two terms which are used very often :

• Targeted Neonatal screening, referring to target-populations like neonates of the Neonatal Intensive Care Unit (NICU), with particular risk-factors.
  
  
• Universal Neonatal Hearing Screening (UNHS), targeting ALL neonates born in a certain geographical area (well-babies and NICU residents).
  
  

  It should be noted that for a UNHS program to be considered successful the screening should cover at least 90% of the available population.
  
  

Early neonatal hearing screening implementation programs faced a number of obstacles mainly caused by questions such as the following : "is the hearing status of the children with congenital hearing losses improved if the hearing intervention is initiated early in their infancy than later in the children period ?"The most concrete data on this important issue come from the studies of Christine Yoshinaga-Itano and colleagues. They have shown that in children, whose hearing intervention was applied within the first six months of life, the language development is significantly better than children who intervention started later.

During an ISA round table (Phoenix September 25-29, 2004) several technical issues were discussed in a presentation by Dr. Stavros Hatzopoulos. A summary of the material can be accessed as a downloadable Powerpoint presentation in pdf format. Users interested on ASSR and screening can download also a contribution by Dr. Barbara Cone-Wesson presented at the same round table.