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The New York State universal newborn hearing screening demonstration project: outpatient outcome measures
Insights
Newborn hearing screening follow-up improved over time, with higher return rates for infants who failed initial tests. Outpatient screening identified hearing loss prevalence differently in neonatal intensive care units versus well-baby nurseries.
Area of Science:
- Audiology
- Public Health
- Pediatrics
Background:
- Universal newborn hearing screening (UNHS) is crucial for early detection of hearing loss.
- Effective outpatient follow-up is essential for accurate diagnosis and intervention.
Purpose of the Study:
- To evaluate outpatient outcomes of a state-wide universal newborn hearing screening program.
- To assess factors influencing follow-up rates and hearing loss prevalence.
Main Methods:
- Multi-center study across eight hospitals over three years.
- Infants failing or missed in-hospital screening were offered outpatient rescreening.
- Data analyzed by year, nursery type (NICU/WBN), and region.
Main Results:
- 72% of infants who failed in-hospital screening returned for outpatient testing.
- Return rates increased annually and varied by hospital and region.
- Prevalence of hearing loss was 1.96/1000 overall (8/1000 in NICU, 0.9/1000 in WBN).
- Positive predictive value for outpatient rescreening was 22%.
Conclusions:
- Newborn hearing screening programs demonstrate improvement over time.
- Outpatient outcomes differ significantly between NICU and WBN populations.
- Further research is needed to understand regional variations in follow-up rates.
Objective:
To investigate outpatient outcome measures of a multi-center, state-wide, universal newborn hearing screening project.
Design:
Eight hospitals participated in a 3-yr, funded project. Each hospital designed its own protocol using common criteria for judging whether an infant passed a hearing screening. Infants were tested in the hospital, and those either failing the in-hospital screening or who were not tested in the hospital (missed) were asked to return 4 to 6 wk after hospital discharge for outpatient rescreening. Those infants failing the outpatient rescreening were referred for diagnostic auditory brain stem response testing. Each hospital used its own audiological equipment and criteria to determine whether a particular infant had a hearing loss. All data were collected and analyzed for individual hospitals, as well as totaled across all hospitals. Data were analyzed in terms of year of program operation, nursery type, and geographic region.
Results:
Seventy-two percent of infants who failed the in-hospital screening returned for outpatient testing. The percentage of in-hospital fails returning for retesting was significantly higher than the percentage of in-hospital misses returning for retesting. The percentage of infants returning for retesting increased with successive years of program operation. Some differences were noted in the percentage of infants returning for retesting among hospitals and geographic regions of the state. Some differences in outpatient outcome measures also were noted between infants originally born into the neonatal intensive care unit (NICU) and the well-baby nursery (WBN). The percentage of infants from the NICU who returned for retesting was slightly higher than that for infants from the WBN. The percentage of infants from the WBN passing the outpatient rescreening was higher than that for the NICU infants. The overall prevalence of hearing loss was 1.96/1000, with that in the NICU being 8/1000 and that in the WBN being 0.9/1000. Positive predictive value for permanent hearing loss based on inpatient screening was approximately 4% and based on outpatient rescreening was approximately 22%.
Conclusions:
Several outpatient outcome measures changed with successive years of program operation, suggesting that programs improve over time. Also, some outpatient outcome measures differ between NICU and WBN populations. The differences noted across regions of the state in the percentage of infants returning for outpatient retesting require further research to determine whether differences are due to demographic and/or procedural differences.