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DURHAM, N.C. -- Ryan Yager was born on Sept. 17, 2000, a
full-term, nine-pound second son of Oxford residents MaryEllen
and Dan Yager. The pregnancy was uneventful and progressed
normally. He was a cute, chubby and happy baby.

However, what his parents could not have known was that Ryan
was born with a severe hearing impairment. If he had been born
in California when his 5year brother Garrett was born, it may
have taken the Yagers as long as two years to realize that
their son had a severe hearing impairment.

Instead, Ryan was born at Duke University Hospital, where
for more than a year, audiologists have been performing hearing
tests on all newborn babies.

"At first, when they mentioned the test, I didn't give it
much thought," MaryEllen Yager recalls. "Our first son was born
in California, and they didn't do a hearing test. It is really
a blessing to now live in a state where they do these tests.
We've been told there is a very good chance that Ryan will be
able to develop communications skills because it was detected
early."

A baby's brain undergoes key neurological developments
during the first year or so of life, allowing the child to
acquire language skills, according to the Duke experts.

At the end of 1999, Duke University Hospital began routinely
screening all newborn babies for hearing impairments. Before
then, Duke had been screening only those babies who were
considered to be at high risk for hearing disabilities those
with deaf parents, in the neonatal intensive care unit, and
born prematurely.

Beginning in October 2000, all hospitals within North
Carolina are required by state law to perform hearing screening
tests on all newborns.

"Ryan is a classic example of the type of baby this program
was designed for," said Ann Mabie, a Duke audiologist. "He and
his mother had none of the traditional risk factors. Research
has shown that more than half of children with hearing
impairments are born without any of the risk factors. Hearing
impairments usually aren't found until the age of 2, but by
that time, much of the crucial period for language development
has passed."

The test itself is called an Auditory Brainstem Response
(ABR) test. It is simple and non-invasive, and is usually
performed while the newborn sleeps. Audiologists place a tiny
set of earphones in the baby's ears and attach three electrodes
on the baby's head. Clicks are played through the headphones,
and the electrodes record the brain's activity in response to
the clicks.

The test can take between three and 20 minutes, depending on
the baby. It can be performed on newborns as young as 12 hours
after birth.

When his impairment was first discovered by ABR a day after
birth, and confirmed in the following days by additional tests,
Ryan was the first case of hearing impairment revealed by the
new program.

Since Ryan's birth in September, three more babies born at
Duke who would not have fit within the high-risk category were
also detected with varying levels of hearing impairment. Their
deficits were confirmed by further testing and audiologists at
Duke have already started treatment strategies for them.

"The good news is that if we catch the deficits early we can
begin doing things to improve these babies' chances of normal
language acquisition," Mabie said.

In Ryan's case, that means first fitting him with a hearing
aid. After the initial fitting, he will return to Duke
audiologists periodically to refine the aid's capabilities as
they learn more about his specific deficits. Depending on the
results of further tests, he will also likely have speech
therapy as well.

It is estimated that as many as 24,000 babies are born in
the United States with a hearing disability, making it the most
common disability in newborns, Mabie said. Its incidence is
higher than such conditions as cerebral palsy, cystic fibrosis
and Down's syndrome.

"It's crucial that we identify these babies early, because
depending on the reason for the impairment, there are many
strategies or therapies we can use to make sure that the baby
does not fall behind in acquiring language," Mabie said.