Authority: IC 16-19-3-4; IC 16-41-17-9

Affected: IC 16-41-17

Sec. 11. (a) Prior to the hearing screening of a newborn or infant, the hospital or birthing center shall provide information explaining the importance of newborn hearing screening and follow-up in writing to the newborn or infant's parents.

(b) The responsible physician, midwife, birthing center, or hospital shall conduct a hearing screening of the newborn or infant's ears via the recommended method or methods as accepted by the department. Hearing screening shall mean a test to detect hearing thresholds of thirty (30) decibels (dB) or greater in the speech frequency range of each ear.

(c) The newborn or infant's hearing should be screened after six (6) hours of age and prior to discharge as follows:

1. (1) Preterm newborns or infants (born prior to thirty-five (35) weeks gestational age) who stay in the nursery greater than five (5) days should have hearing screening when the newborn or infant is medically stable, but prior to discharge.
2. (2) Newborns or infants who reside for greater than five (5) days in the neonatal intensive care unit (NICU), especially those who have complicated birth factors, are considered to be at significantly greater risk for types of neural hearing loss, such as auditory neuropathy/dyssynchrony. These newborns or infants should receive hearing screening or diagnostic testing, or both, as recommended by the department.
3. (3) When possible, inpatient diagnostic testing shall be made available to long-stay newborns or infants who do not pass the initial newborn hearing screening and one (1) rescreen (for a total of two (2) hearing screenings).

(d) The only acceptable reason for not screening the hearing of a newborn or infant is if the parent of the newborn or infant objects, in writing, to the screening based on religious beliefs.

(e) If a newborn or infant is transferred to a hospital prior to receiving newborn hearing screening, the responsibility for completing the newborn hearing screening is shared between the birth and transferred facilities. If newborn hearing screening occurs at the transferred hospital, hearing screening results should be shared with the birth hospital or birthing center via the reporting method and format specified by the department's early hearing and detection intervention (EHDI) program.

(f) If a newborn or infant is not successfully screened or did not receive a newborn hearing screening prior to discharge, the hospital or birthing center shall provide an outpatient hearing screening for this newborn or infant.

(g) For newborns or infants who do not pass the initial newborn hearing screening, hearing should be rescreened one (1) additional time in both ears (regardless of previous screening results) prior to and as close to discharge as possible (for a total of two (2) hearing screenings). Preterm infants or newborns (born prior to thirty-five (35) weeks gestational age) who do not pass the initial newborn hearing screening should be rescreened one (1) additional time in both ears (regardless of previous screening results) prior to and as close as possible to discharge (for a total of two (2) hearing screenings).

(h) If a newborn or infant does not pass:

1. (1) his or her newborn hearing screening; and
2. (2) the rescreen prior to discharge;

for a total of two (2) hearing screenings, the birthing center or hospital shall contact an approved diagnostic audiology Level 1 facility to schedule an appointment for an outpatient diagnostic hearing test. The birthing center or hospital shall provide the location, date, and time of the appointment to the infant or newborn's parent, health care provider, and the department's EHDI program.

(i) Inpatient diagnostic testing shall be made available, when possible, for long-stay newborns or infants who do not pass the initial newborn hearing screening and one (1) rescreen (for a total of two (2) hearing screenings).

(j) If a newborn or infant passes the newborn hearing screening, but has risk indicators for late-onset or progressive hearing loss, the hospital shall do the following:

1. (1) Inform the newborn or infant's parent in writing of the risk indicator.
2. (2) Provide written documentation of language and hearing milestones.
3. (3) Recommend a follow-up test at an approved diagnostic audiology Level 1 facility to be done when the infant is between nine (9) and twelve (12) months of age.

This information shall also be provided in writing to the newborn or infant's health care provider and to the department's EHDI program via the reporting method and format specified by the department's EHDI program.

(k) Midwives shall follow all newborn hearing screening protocols as outlined for birthing centers and hospitals. Newborn hearing screening should be performed on all newborns prior to one (1) month of age, using portable equipment if needed.

1. (1) If midwives cannot provide direct screening for the newborns in their care, they shall have a designated referral site for these newborns to receive the hearing screening prior to one (1) month of age.

2. (2) If a newborn or infant does not pass:

   1. (A) his or her newborn hearing screening; and
   2. (B) a second hearing screening;
3. the midwife shall contact an approved diagnostic audiology Level 1 facility to schedule an appointment for an outpatient diagnostic hearing test. The midwife shall provide the location, date, and time of the appointment to the newborn or infant's parent, health care provider, and the department's EHDI program.

(l) Diagnostic audiology Level 1 facilities must meet the following requirements in order to perform diagnostic hearing evaluations on newborns or infants referred from newborn hearing screening programs:

1. (1) The audiologist or audiologists:

   1. (A) must be licensed by the state of Indiana; and
   2. (B) shall have experience in performing diagnostic audiological assessments of newborns and infants.

2. (2) The facility:

   1. (A) shall conduct the assessment in accordance with Indiana's Best Practice Guidelines For Audiologic Assessment, Pediatric Amplification, and Intervention of the Infant dated October 2010; and
   2. (B) must have and routinely use recommended equipment for newborn and infant diagnostic testing.

(Indiana Department of Health; 410 IAC 3-3-11; filed Apr 25, 2012, 3:46 p.m.: 20120523-IR-410100504FRA; readopted filed Sep 26, 2018, 2:48 p.m.: 20181024-IR-410180328RFA; readopted filed Nov 14, 2024, 1:24 p.m.: 20241211-IR-410230798RFA)