Newborn hearing screening is reliable: OAE finds around 85–100% with ~91–95% specificity; AABR finds around 95–100% with ~96–98% specificity.
Every baby gets a quick check of hearing soon after birth. The check is safe, fast, and it catches most hearing problems that need early care. A “pass” means no red flags today. A “refer” means your baby needs a second look, not that hearing loss is confirmed.
If a screen points to a problem, programs follow the 1–3–6 steps: screen by 1 month, diagnose by 3 months, and start help by 6 months. Hitting those steps gives babies the best start with speech, listening, and social bonds.
What “Accurate” Means In Baby Hearing Checks
Accuracy has two parts. Sensitivity is how many babies with hearing loss are flagged. Specificity is how many babies with normal hearing are told everything is fine. The two screening tools used today are OAE and AABR. Both do well, and each has strengths.
| Measure | OAE | AABR |
|---|---|---|
| Sensitivity | ~85–100% | ~95–100% |
| Specificity | ~91–95% | ~96–98% |
| False-positive rate (first hours) | ~2–8% (can be higher very early) | ~1–3% when done well |
Those ranges reflect real programs in hospitals, birthing centers, and clinics. Numbers shift with timing, staff skill, and the baby’s status. In the NICU, teams favor AABR because it also checks the nerve pathway and can flag auditory neuropathy.
Two Screening Methods: OAE And AABR
OAE (otoacoustic emissions): a tiny ear tip plays soft clicks. A healthy inner ear “echoes” back. The device listens for that echo. The test is quick and quiet. Fluid behind the eardrum, a bit of vernix in the canal, or a fussy baby can block the echo and lead to a “refer.”
AABR (automated auditory brainstem response): soft clicks go to the ear; small stickers on the head pick up brainstem activity. The device decides pass or refer. AABR picks up neural issues like auditory neuropathy that OAE can miss. It takes longer than OAE and needs the baby to be still.
Many nurseries use a two-step plan: OAE first, then AABR for babies who do not pass. NICUs often start with AABR for all babies in their care. Both paths work when follow-up is tight.
Newborn Hearing Screen Accuracy: What Parents Should Expect
Most babies who get a “refer” on day one pass on the repeat check. Early life is messy for ears. Fluid clears. Vernix comes out. Babies settle. For that reason, teams repeat the screen once before ordering a full diagnostic test.
False positives can happen. That means the screen flags a risk, but later testing shows normal hearing. Rates are low in well-run programs, and they drop when the test happens after the first 24–48 hours. False negatives are less common. They can occur with very mild loss, loss in just one ear, or with loss that starts later in infancy.
Well-Baby Nursery vs NICU
In the well-baby unit, either OAE or AABR works. A clean, quiet room and a sleepy baby help. In the NICU, AABR is the go-to tool because it checks the nerve pathway, which matters for fragile babies and those with risk factors.
Timing Matters
Screening in the first few hours can raise the chance of a “refer.” Waiting until 24–72 hours improves pass rates and reduces repeats. If discharge is early, an outpatient rescreen within the first weeks is fine.
Which Babies May Be Missed
Mild hearing loss, loss at a single pitch, or loss that starts after the newborn period may not be picked up. Babies who pass the birth screen still need routine hearing checks at well-child visits. If you ever worry about hearing, speech, or responses to sound, ask for a test. Do not wait for the next scheduled screen.
Why A “Refer” Happens
A “refer” is a signal to look closer. Many short-term factors can block sound or add noise to the test. Those are not permanent problems. The second table lists the usual suspects and simple ways to improve the next screen.
| Reason | Why It Triggers “Refer” | What Helps |
|---|---|---|
| Vernix or ear canal debris | Echo is blocked or muffled | Gentle ear check by staff before the next screen |
| Middle ear fluid | Sound doesn’t move well through the eardrum | Wait a day or two; rescreen when fluid clears |
| Baby is restless or crying | Movement creates noise in the signal | Feed, swaddle, and test while sleeping |
| Room noise | Device can’t “hear” the response clearly | Use a quiet space; limit traffic |
| Electrode or probe fit | Poor contact reduces signal quality | Re-fit stickers or ear tip; recheck cables |
What Happens After A “Refer”
Programs avoid delays. If your baby still doesn’t pass the rescreen, the next step is a full diagnostic evaluation with an audiologist. That visit may include diagnostic ABR and other tests that map hearing across pitches and ears. Results guide next steps and family care.
Rescreening and diagnosis follow a tight clock. Many teams point families to clear next-step guides that explain the path. Keep appointments and ask for help with scheduling or transport if needed.
How Accurate Are The Numbers You See Online?
Ranges come from studies and program reports. Some quote perfect sensitivity for AABR in select groups. Real-world programs vary. Staff training, ambient noise, device model, and baby factors change outcomes. Look for numbers that come from programs like yours: well-baby nursery vs NICU, screen timing, and whether the site uses OAE only, AABR only, or a two-step plan.
Tips To Get The Best Rescreen
Set Up The Session
Plan the visit when your baby usually sleeps. Feed just before the test. Bring a swaddle and a fresh diaper. Ask for a quiet room with dim lights.
Work With The Tester
Share any risk factors you know about, such as a family history of childhood hearing loss, infections during pregnancy, or NICU care. Ask which tool will be used and why. If your baby is in NICU follow-up, ask for AABR.
Ask About Follow-Up
If the rescreen still shows a “refer,” ask for a diagnostic appointment before you leave. Also ask how you’ll get the results and who will call if a slot opens sooner.
Screening Limitations You Should Know
No screen can rule out every kind of hearing loss. AABR can catch neural issues that OAE misses. OAE may catch very mild cochlear changes a bit better in some babies. Neither test can predict late-onset loss. That’s why the birth screen is a first gate, not the last word. Pediatric visits include ongoing hearing checks, and you can ask for formal testing any time.
Understanding Results: Pass, Refer, And Next Steps
Pass: today’s screen did not raise concern. Your baby may still need checks later at well-child visits, school screens, or sooner if you notice speech or listening delays.
Refer: the device did not get a clear response in one or both ears. A rescreen is booked. At the rescreen, both ears are tested again in one session. If the result is “refer” again, your baby goes to a pediatric audiologist for a full work-up.
Did not test: sometimes the test can’t be done before discharge. The team will set an outpatient screen soon.
Evidence At A Glance
Studies and program reports show both tools perform well. OAE is fast and uses an ear tip. AABR takes longer, adds electrodes, and can find neural issues. Testing after the first day lowers false positives. If discharge is early, an outpatient rescreen keeps results on track.
Programs track pass rates, referral rates, and time to diagnosis. Many states share EHDI data so sites can fine-tune their process.
Well-Chosen Follow-Up Makes Accuracy Real
Good follow-up turns a screen into care. Before you leave, ask how you will get the rescreen, what to bring, and who to call if your baby is ill that day. Ask for the result in writing and share it with your baby’s doctor each time.
Unilateral, Mild, And Late-Onset Hearing Loss
Some babies pass the birth screen yet later show hearing loss. That can happen when only one ear has loss, when the loss is very mild, or when it develops after a few months. Watch how your baby startles, turns to voices, and begins to babble. If those steps stall, ask for a full hearing test. Screening is a net; your instincts still matter.
Why Programs Choose Different Paths
Hospitals tailor their plan to their setting. A busy well-baby unit may use an OAE-first approach because it is quick and quiet. A neonatal unit may use AABR for all babies to check the nerve pathway. Some sites run both tests on day one to reduce repeats. There isn’t one single “best” path. The best plan is the one that gets every baby screened, gets clear results, and moves families to follow-up without delay.
Quick Recap
- Both OAE and AABR are solid screening tools for newborns.
- AABR is preferred in the NICU; many well-baby units use OAE then AABR if needed.
- Accuracy is strong, with low false-positive rates after the first day.
- Most “refers” on day one turn into passes on a repeat check.
- If a baby still doesn’t pass, a fast referral for diagnostic ABR keeps care on track with 1–3–6 goals.