Purpose: This manuscript discusses the importance of establishing risk indicator monitoring guidelines for state Early Hearing Detection and Intervention programs.

Method: Idaho Sound Beginnings (ISB) implemented a guideline which divided risk indicators associated with delayed-onset hearing loss into two classes (Class A and Class B). From 2012-2013, the incidence of delayed-onset hearing loss in the presence of Class A and Class B risk indicators were evaluated. For Class B risk indicators, ototoxic medication exposure and family history were analyzed.

Results: Of the 10,634 infants born, 1,175 were found to have passed the newborn hearing screening and have at least one risk indicator. Of the infants evaluated with Class A risk indicators, 21 children had an educationally significant hearing loss. Of the 345 children who received ototoxic medications, 55 children were diagnosed with educationally significant hearing loss. An educationally significant hearing loss was found in 10 children who returned for diagnostic evaluation who had family history of childhood hearing loss.

Conclusion: ISB's risk monitoring classification system has enhanced Idaho’s EHDI program by early identification of children who are at higher risk for delayed-onset hearing loss. Early identification has ultimately lead to early intervention.