Remarks

• In making this recommendation, regardless of gestation or risk factors, the Guideline Development Group agreed that although evidence on the effects originated from high-income countries, the evidence on resources, cost effectiveness, values, equity, acceptability and feasibility demonstrate that UNHS could be successfully implemented in low- and middle-income countries.
• PBHL is defined as bilateral permanent conductive or sensorineural hearing loss of 35 dB or greater in the better ear.
• If UNHS indicates possible PBHL, a follow-up definitive test must be done as soon as possible after screening. This involves testing by an audiologist with a more detailed diagnostic auditory brainstem response in a highly-controlled environment. It takes 30–60 minutes to complete the diagnostic test.
• The principles for screening programmes (87)must be implemented throughout UNHS introduction and scale-up. In settings where principles for screening are not met, implementation of universal screening may be considered unethical.
• Parents and caregivers of all children should be informed about age-appropriate hearing and language development and communication skills regardless of the screening results.