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Neonatal hearing screening using the auditory brainstem response
J J Homer1, S L Linney, D R Strachan
1Department of Otolaryngology, Bradford Royal Infirmary, UK.
Insights
A targeted screening program for infant sensorineural hearing loss (SNHL) identified only 37% of at-risk children. Improvements in referral criteria and pediatrician liaison are needed to enhance early detection of hearing loss.
Area of Science:
- Audiology
- Pediatrics
- Public Health
Background:
- A targeted auditory brainstem response screening program for sensorineural hearing loss (SNHL) has been operational since 1987.
- Infant hearing loss screening aims for early identification and intervention.
Purpose of the Study:
- To evaluate the effectiveness of a targeted SNHL screening program.
- To determine the proportion of at-risk children identified and missed by the program.
- To identify reasons for missed cases.
Main Methods:
- Analysis of a 4-year cohort (n=49) of children born between April 1991 and March 1995 with moderate to profound SNHL (>50 dB).
- Assessment of risk factors present in the cohort.
- Comparison of children identified by screening versus those missed.
Main Results:
- 92% of children had identifiable risk factors, exceeding rates in other studies.
- The program could have prospectively detected a maximum of 80% of cases.
- Only 37% of children with SNHL were actually diagnosed through the screening program.
- Children with risk factors from in utero, perinatal, or postnatal events were more likely to be missed (P < 0.01).
- The overall yield was 0.5/1000/year.
Conclusions:
- The targeted screening program demonstrated limited success in identifying at-risk infants with SNHL.
- Improvements in referral criteria and collaboration with pediatricians are crucial for better targeting.
- While universal neonatal screening may have higher yield, targeted infant tests remain important backups.
Abstract:
A targeted screen of babies at risk of having a sensorineural hearing loss (SNHL) using the auditory brainstem response has been in place since 1987 in Bradford and Airedale. The aims of this paper were to ascertain what proportion of a 4-year cohort of children with SNHL should have been identified by the programme; was identified by the programme; and the reasons for failing when children were missed. The cohort of 49 children had moderate to profound SNHL (> 50 dB) and were born between 1 April 1991 and 31 March 1995. Although 92% had at risk factors (higher than in other series), 80% was the maximum that could have been prospectively detected by the programme and only 37% were actually diagnosed as a result of the screening programme. Apart from a generalised under-recruitment, children with risk factors arising because of in utero, perinatal and postnatal events (as opposed to family history, craniofacial abnormalities and syndromes) tended to be missed (P < 0.01). The overall yield of the screening programme was 0.5/1000/year. While the yield of a universal neonatal screening programme based on otoacoustic emissions should be double this, a targeted infant distraction test later in infancy will be an essential backup. Improved liaison with paediatricians in particular as well as simplification of the referral criteria should improve targeting children at risk.