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Updated: Aug 7, 2026
Behavioral Assessment of Hearing in 2 to 4 Year-old Children: A Two-interval, Observer-based Procedure Using Conditioned Play-based Responses
Published on: January 23, 2017
Identification of neonatal hearing impairment: recruitment and follow-up
R C Folsom1, J E Widen, B R Vohr
1Multicenter Consortium on Identification of Neonatal Hearing Impairment, Seattle, Washington, USA.
Insights
Recruitment for infant hearing follow-up was lower than expected, especially for high-risk infants. Sociodemographic factors like low socioeconomic status predicted poor compliance, impacting study retention.
Area of Science:
- Pediatric audiology
- Neonatal care
- Public health
Background:
- Infant hearing screening is crucial for early detection and intervention.
- Follow-up assessments are vital for validating screening results and ensuring developmental outcomes.
- Understanding factors influencing study participation is key to improving pediatric research.
Purpose of the Study:
- To detail recruitment and retention strategies for infants undergoing neonatal examinations and follow-up behavioral audiometric testing.
- To analyze sample demographics and identify predictors of follow-up compliance.
- To compare data from participants with infants lost to follow-up.
Main Methods:
- Prospective, randomized clinical study design.
- Targeted high-risk infants from neonatal intensive care units (NICU) and well-baby nurseries with risk indicators.
- Included well babies who failed newborn hearing tests, with evaluation of factors predicting follow-up return.
Main Results:
- Enrolled 4911 high-risk infants and 2348 well-baby nursery infants.
- Achieved 64% recruitment for high-risk infant follow-up, below the 80% projection.
- Identified sociodemographic factors predicting noncompliance: nonwhite race, lack of insurance, substance abuse, young maternal age, multiple children, and late prenatal care.
Conclusions:
- Low socioeconomic status and social risk factors strongly predicted poor study compliance.
- Despite retention challenges, 64% of high-risk infants completed the 8- to 12-month behavioral hearing assessment.
Objective:
The purpose of this study is to describe the recruitment and retention strategies as well as the sample demographics for families with infants completing the neonatal examination and returning for follow-up. These data are compared to those infants inactivated from the study.
Design:
This study was a prospective, randomized clinical study. All infants who were confined to the neonatal intensive care unit (NICU) and well babies with at least one risk indicator were targeted for behavioral audiometric follow-up testing. In addition, infants without risk factors from the well-baby nursery, but who failed a newborn test, were also followed. Several variables were evaluated to determine those factors, if any, that might predict which families returned for follow-up testing.
Results:
Recruitment was achieved as per study design with 4911 high-risk infants and 2348 well-baby nursery infants (without risk indicators for hearing) enrolled. Of the 4911 high-risk infants enrolled, 64% were successfully recruited into the follow-up portion of the study. This was less than the projected rate of 80%. Factors predicting noncompliance with the study protocol for follow-up were predominantly sociodemographic and included nonwhite race, no insurance, substance abuse, young maternal age, more than two children at home, and late onset of prenatal care.
Conclusions:
Factors related to low socioeconomic status and increased social risk were the strongest predictors of poor study protocol compliance. Despite retention challenges, 64% of the targeted, high-risk infants subsequently returned for the 8-to 12-mo behavioral hearing assessment protocols for validation purposes.
