Newborn hearing screening — branching viva

Station opening

Examiner: "The screen says refer. The baby looks perfect. What do you tell the parents?" [8]

Strong candidate (must-hit)

• Refer means more testing, not proven deafness. [1]
• Books diagnostic audiology against a 1-3-6 clock. [1]
• Does not use startle or feeding to cancel the pathway. [7]
• Names an owner and contact plan. [8]

Weak candidate

• "Your baby is deaf." [8]
• "He jumped, so ignore the machine." [7]

Branch A — Why the clock matters

Examiner: "Why are you rushing a well baby into audiology?" [3]

Strong

• Early confirmation supports better language trajectories. [2] [3]
• States screen by 1 month, diagnose by 3 months, intervene by 6 months. [1]
• Links later literacy benefits of earlier confirmation. [5]

Weak

• "It is only paperwork." [3]
• Invents device cut-offs instead of explaining developmental urgency. [1]

Branch B — NICU modality

Examiner: "Would your answer change if this were a NICU graduate?" [1]

Strong

• Many NICU pathways prefer AABR because neural pathway risk is higher. [1] [7]
• Residual-risk surveillance may still be needed after a pass. [15]

Weak

• "OAE-only is always enough for everyone." [7]

Branch C — High-risk pass and cCMV

Examiner: "The baby later passes, but congenital CMV is confirmed. Are you finished?" [11]

Strong

• No. Progressive hearing loss can still occur after a newborn pass. [11] [12]
• Plans surveillance and caregiver-concern open access. [11]

Weak

• "A pass clears CMV hearing risk forever." [11]

Branch D — Lost to follow-up at 8 months

Examiner: "They never attended diagnostic audiology. The infant has no words." [8]

Strong

• Treats as urgent recovery of the EHDI pathway plus developmental assessment. [8] [18]
• Avoids waiting for school-entry screening or assuming another label first. [17]

Weak

• "Late talker; review next year." [3]