Deafness in newborns

Delivery/life with the baby, Postnatal

The Quebec newborn hearing screening program aims to detect hearing loss present at birth early on and then undertake the necessary therapeutic and rehabilitation interventions before the age of 6 months. Hearing screening tests for newborns have been in place in Quebec since 2021 in most regions (gradual implementation).

Statistics on deafness in newborns

According to public health data, 4 to 6 babies out of every 1,000 births will have a hearing-related problem. In Quebec, one baby in 1,000 is believed to have permanent hearing loss, and 90% of cases detected with a hearing impairment have no family history of the condition.

Given that hearing disorders cannot be detected with the naked eye at birth and are not very easy to detect at a very young age, it is imperative that all newborns be screened systematically, including those who are healthy and have no risk factors.

Types of hearing loss

There are different types of hearing loss, and the more severe the hearing impairment, the greater the potential impact on the baby’s development.

  • Neonatal hearing loss: hearing loss present at birth.
  • Sensorineural hearing loss: this type of hearing loss can affect either the auditory nerve, the inner ear and its functioning, or the brain itself, specifically the part responsible for interpreting hearing, called the auditory cortex.
  • Conductive hearing loss: this refers to a conduction disorder in the middle and outer ear that prevents sounds from following the expected path in a properly functioning ear.
  • Mixed hearing loss: This is a combination of different problems in the auditory system.

Why screen for hearing loss?

The answer is very simple: the sooner we know, the sooner we can intervene and minimize the negative impacts on the overall development of affected children.

Children who are screened for hearing problems will greatly benefit from receiving prompt care and services tailored to their situation to ensure their quality of life.

According to the protocol governing Quebec’s hearing screening program, the goal is to test newborns before they are 1 month old (always using corrected age if the child was born prematurely) in an outpatient clinic. The test may also be performed during the stay in the maternity ward, taking care to wait at least 24 hours after birth. Fluid and debris may still be present in the child’s ear canals, which could skew the results.

Screening is always done with the free and informed consent of the parents. A form must be signed after receiving information about the program in order to obtain authorization to proceed with screening.

Available tests

Quebec’s newborn hearing screening program recommends two specific tests as a first step.

  • The otoacoustic emissions test, also known by the acronym OAE-A. For a full-term, healthy baby with no apparent risk factors, this is the first test performed on the newborn, on both ears. If the result is positive, it means that everything is fine and the screening ends there. If the result is incomplete, the same test will be repeated as a second attempt within a short period of time. After this second attempt, if the results are still abnormal or unclear, the next test will be performed: the automated brainstem auditory evoked potential test.
  • The automated brainstem auditory evoked potential test, also known as Peatc-A. This test is usually used on full-term, healthy babies who do not have any risk factors and whose results remain unclear or incomplete in the otoacoustic emissions test (EOA-A). This test is more specific and allows a diagnosis to be made.

Both tests send brief, regular, low-intensity sound stimuli through an earpiece placed directly in the baby’s ear canal. The physiological responses are then recorded. These tests are painless for the baby, pose no risk to them, and are performed while they are asleep and calm.

Babies with risk factors

For newborns who have risk factors for hearing loss (see list below), the screening program involves a different procedure. For these babies specifically, the Peatc-A test will be prescribed from the outset.

  • If the results are good: Given the risk factors, the child will still be monitored for a few months, usually by an audiologist, with a few follow-up tests during the first year of life (usually at 8 and 10 months).
  • However, if the results remain inconclusive, a second Peatc-A test will be requested. If the results of this second test are still inconclusive, a referral will be made to a specialist to confirm the diagnosis, and follow-up will be arranged according to the problem identified.

Risk factors for hearing loss in newborns

Although the hearing screening program is intended for all newborns, it appears that some are at greater risk of hearing impairment and hearing loss.

Here are a few:

  • Certain infections contracted during pregnancy by the mother, such as toxoplasmosis, rubella, and cytomegalovirus (CMV). These infections can be transmitted to the baby in utero and cause damage to the auditory center or malformations of the auditory system.
  • Certain infections contracted by the baby during the neonatal period, such as meningitis.
  • Babies born very prematurely and in intensive care may be at greater risk of hearing problems and deafness due to their immaturity.
  • A family history of deafness.
  • A syndrome that can affect hearing as a side effect.

The newborn hearing screening protocol can change the life of a baby with a hearing problem. Knowing early on about a baby’s hearing condition can lead to a very quick response and care from the healthcare system. As parents, we always want to maximize our child’s potential, and these tests can help.

If you have questions about your family history or anything that might cause you concern about hearing loss in your unborn baby, don’t hesitate to ask your doctor to evaluate the situation with you.

Related articles:

Marie Fortier
The baby expert

Updated: April 2025.

References:

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