Elsevier

Journal of Pediatric Health Care

Volume 25, Issue 6, November–December 2011, Pages 399-404
Journal of Pediatric Health Care

Department
Case Study—Primary Care
Infant With Failed Hearing Screening: Considerations for the PNP in Primary Care

https://doi.org/10.1016/j.pedhc.2011.06.002Get rights and content

Section snippets

Case Presentation

A 14-day-old Hispanic boy presents to the clinic for his 2-week health maintenance examination. His mother denies any concerns. She states that the infant failed his hearing test while he was in the newborn nursery; however, she perceives that he “hears just fine.” She reports that he does not cry very often and does not startle in response to loud noises or family activities. She denies concerns about his growth and development.

The infant failed three oto-acoustic emission (OAE) screenings in

Prenatal/Maternal Information

The child’s mother (gravida 3, para 3, abortus 0) obtained prenatal care within the first trimester of her pregnancy. Prenatal laboratory tests were negative for drugs, alcohol, group B streptococcus, and the TORCH complex: toxoplasmosis, other infections (such as hepatitis B, syphilis, and herpes zoster), rubella, cytomegalovirus (CMV), and herpes simples. The mother did not have gestational diabetes, preeclampsia, or any hospitalizations prior to delivery. A 36-week fetal ultrasound confirmed

Differential Diagnosis

Many differential diagnoses may be considered for an infant who has failed a hearing screening. Hearing loss is categorized by conductive hearing loss (CHL), sensorineural hearing loss (SNHL), and mixed CHL and SNHL. CHL is caused by physical anomalies of the outer and inner ear, as well as by diseases (e.g., otosclerosis and osteogenesis imperfecta) and craniofacial malformations (e.g., Pierre-Robin sequence and branchial-oto-renal [BOR] spectrum disorders) (American Academy of Pediatrics, 2007

Patient Follow-up

The parents took the infant to an audiologist within a week of the 2-week well-child check appointment. An unsedated auditory brainstem response (ABR), a distortion product, and transient evoked OAE testing were performed. This revealed absent responses at all frequencies tested, confirming abnormal outer hair cell function bilaterally. It was determined that this infant was not hearing speech sounds at all. Bilateral hearing aids were recommended, pending otolaryngology recommendations and

Case Study Questions

  • 1.

    When an infant who has failed a hearing screening presents for an initial examination, what information should the PNP elicit with regard to the prenatal, perinatal, and postnatal history?

  • 2.

    What components must the PNP include in the physical examination of this infant?

  • 3.

    In this scenario, what is the significance of the infant’s preauricular pit?

  • 4.

    In addition to the aforementioned findings, why would the PNP be concerned about the presence of a supernumerary nipple?

  • 5.

    What additional tests should be

Case Study Answers

1. When an infant who has failed a hearing screening presents for an initial examination, what information should the PNP elicit with regard to the prenatal, perinatal, and postnatal history?

Genetics, developmental anomalies, and intrauterine infections and exposures are common prenatal causes of deafness.

The timing of deafness can be classified according to the onset in relation to the child’s birth: prenatal, perinatal, and postnatal. Genetics, developmental anomalies, and intrauterine

Long-term Follow-up and Implications For the PNP

This patient will need continual follow-up with the audiologist, otolaryngologist, and cochlear team (if cochlear implants are performed). He also will need aggressive and consistent follow-up with speech and sign language therapy. Additional appointments with the pediatric cardiologist and ophthalmologist will be determined on the basis of genetic findings. This patient will receive state early intervention services for the first three years of his life.

This family is beginning a long journey

Robin J. Henson, Adjunct Faculty DNP Program, Texas Woman’s University, Dallas, TX.

First page preview

First page preview
Click to open first page preview

References (28)

  • T.D. Goode et al.

    Family-centered, culturally, and linguistically competent care: Essential components of the medical home

    Pediatric Annals

    (2009)
  • J. Haddad

    Hearing loss

  • A.D. Harlor et al.

    Clinical report- hearing assessment in infants and children: Recommendations beyond neonatal screening

    Pediatrics

    (2009)
  • A. Kochhar et al.

    S1X1 mutation screening in 247 branchio-oto-renal syndrome families: A recurrent missense mutation associated with BOR

    Human Mutation

    (2008)
  • Cited by (0)

    Robin J. Henson, Adjunct Faculty DNP Program, Texas Woman’s University, Dallas, TX.

    Karla McHughes, Family Nurse Practitioner Student, Texas Woman’s University, Dallas, TX.

    Conflicts of interest: None to report.

    View full text