Cost of equipment ranges from about $4,000 to $25,000 per unit. Because prices change frequently, specific figures are not listed here. Hand-held units tend to be the most inexpensive, while units which include both AABR and OAE technology tend to be the most expensive.

(Included here is the cost of all necessary supplies and reoccurring expenses (e.g., calibration) for doing screening. It does not include supplies for communicating the results of screening with parents or pediatricians, printing educational materials, or other ancillary materials. Costs are estimated per baby based on reported usage by typical programs with 1000-4000 births per year.)

(Although it is possible to start any program by reading the literature which comes with the equipment and teaching yourself, most programs find that hands-on, competency-based training by someone who is already experienced with that particular equipment and has used it successfully is the best way to begin a program. Estimated times are based on the experience of operational programs and includes only the initial training of screening technicians. Regular supervision with additional upgrading of skills should be included in addition to this initial training.

** Recently released hand-held units for OAE require only about one hour of training.

(This is often misunderstood because the term "screening time" is used by people to refer to different aspects of the screening process. As used here, it is the total amount of time devoted to screening babies and includes getting the baby ready for screening, talking to the parents if necessary, setting up the equipment, conducting the screening, recording information about the baby so results can be retrieved later, etc. "Screening time" is best computed by taking the total number of hours worked by screening technicians and dividing that time by the number of babies screened during that period. Numbers for each device are based reports of well-established programs.)

(None of the devices is a direct measure of hearing. Instead, each one measures slightly different physiological mechanisms which are related to hearing. Issues related to this are discussed below.)

(In addition to indicating whether or not a child has a hearing impairment, some people are interested in knowing at what frequencies that hearing impairment is likely to occur. Others argue that the purpose of a screening test is not to provide detailed information about the nature of the loss, but to identify those children who need further diagnostic tests, during which information about frequency and severity of hearing loss can be determined.)

(Because DPOAEs and TEOAEs produce a wave form for each infant, users must decide what constitutes a pass or a refer. Because the widespread use of these techniques is fairly recent, there is not universal agreement on what criteria should be used. In practice, however, this lack of agreement affects a very small number of infants, since in most cases emissions are clearly present or clearly absent, and it's only the relatively small number of infants around the cut point where disagreement occurs.

(Screening is designed to identify a small group of at-risk infants who will require further diagnostic testing. As in all screening programs, it is expected that some children who have normal hearing will be referred for further diagnostic testing, but the lower this number is, the better.

(Noise which interferes with screening can come from the external environment or from the baby. Because newborn nurseries can be quite noisy, many people have questions about the effects of noise on newborn hearing screening procedures [this is especially true for intensive care nurseries.])

(These children are often referred to as false negatives and reported as a measure of the test's sensitivity. It's important to minimize the number of infants in this category. While no screening test is perfect, ideally, as few children as possible should be in this group. This does not refer to children who have late onset losses, but instead is only concerned with those children who have impaired hearing at the time of the test and still pass the screen.

(Although there have been numerous reports in the literature and anecdotal reports about the cost per baby screened in newborn hearing screening programs, most of these analyses are based on gross estimates of time devoted to different tasks or have been incomplete [e.g., have ignored fringe benefit costs for personnel, indirect costs, supervisory costs, or costs associated with supplies and equipment]. How the program is organized can also have a big impact on the cost per baby. Because of such factors, people trying to interpret reported costs should be very cautious and remember that cost per baby is primarily a function of how long it takes to do the tasks, coupled with the hourly rate of people doing the work and the cost of supplies, equipment, and facilities.