Universal newborn hearing screening program in Bulgaria

The design of a Universal Newborn Hearing Screening Program (UNHSP) depends on many factors unique to each hospital. The goal of any UNHSP is to perform a valid hearing screening on all newborn infants prior to hospital discharge. Ultimately hearing screening of all infants should decrease the age at which intervention is initiated in these who require it. It is clear that there is no "one" model for UNHSPs. Each program must carefully consider what type and severity of hearing loss it wishes to identify. Then, based on available screening tools, program philosophy, prior experience, personnel, typical maternity length of stay, etc., an appropriate protocol must be developed. We present our protocol for detection and confirmation of hearing loss, and for habilitation of deaf children. For detection the hearing loss we used the automated auditory brainstem response (ABR) delivery system (A-ABR), and we confirm this with conventional non-automated ABR delivery system (BERA). The healthy babies we screen after 6h of age using a simultaneous 35-dB nHL screening option available on the Newborn Hearing Screener ALGO-2. The neonatal intensive care unit (NICU) babies we screen prior to discharge using all options of the ALGO-2. The "refer" ALGO-2 results are immediately retested. Infants in need of an outpatient screen are recalled at age 3-4 weeks. The diagnosis "hearing loss" is determinate only by BERA and the neonatal hearing screening is the first part of program of habilitation of hearing-impaired children. The cost for UNHSP in Bulgaria is 1407 euro per case identified.