Since the incidence of sensory, as well as neural hearing loss is approximately ten times higher in the NICU versus well-baby nursery, A-ABR is the recommended screening technology for use in the NICU population (JCIH 2007).
Guidelines for conducting hearing screenings in the Neonatal Intensive Care Unit (NICU) nursery:
Select a time when the infant is medically stable.
Choose a time when the infant is not being seen by other health care professionals.
Test when infants are quiet or sleeping; optimally, one hour following feeding.
To help calm a restless infant, swaddle the infant and dim the lights.
Ensure a quiet environment for testing, away from background noise.
Follow standard precautions for infection control (e.g. hand washing, appropriate cleansing of equipment, etc).
Infants in the well-infant nursery who fail A-ABR testing should not be rescreened by OAE testing and "passed" because such infants are presumed to be at risk of having a subsequent diagnosis of auditory neuropathy/dyssynchrony.
For infants who do not pass A-ABR testing in the NICU, referral should be made directly to an audiologist for rescreening and, when indicated, comprehensive evaluation, including diagnostic ABR testing, rather than for general outpatient rescreening.