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Neonatal hearing loss in the indigent
John S Oghalai1, Lei Chen, Megan L Brennan
1Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences, Baylor College of Medicine, Houston, Texas, USA. oghalai@itsa.ucsf.edu
Insights
Indigent neonates have different risk factors for hearing loss (HL) and face delays in intervention compared to insured populations. Timely follow-up and treatment for hearing-impaired infants remain a significant concern.
Area of Science:
- Neonatal care
- Audiology
- Public health
Background:
- Neonatal hearing loss (HL) is a significant concern requiring early detection and intervention.
- Risk factor profiles and follow-up care for neonatal HL can vary between socioeconomic groups.
Purpose of the Study:
- To compare the risk factor profile for neonatal hearing loss (HL).
- To assess the follow-up rate of neonates identified with HL.
- To compare indigent and insured populations regarding HL risk factors and follow-up.
Main Methods:
- Retrospective review of 4526 neonates from high-risk nurseries/NICUs at two Houston hospitals.
- Comparison between a public county hospital (Ben Taub General Hospital - BTGH) serving the indigent and a private tertiary care center (Texas Children's Hospital - TCH) serving insured patients.
- Analysis of screening failures, diagnostic follow-up rates, and intervention timeliness.
Main Results:
- 133 infants failed initial screening; 48 had definite HL.
- Indigent infants at BTGH had higher screening failure rates but significantly lower follow-up rates for diagnostic testing (43% vs. 10%).
- Delays in hearing aid acquisition and higher prevalence of dysmorphic features/CNS disease were noted in the indigent group.
Conclusions:
- Significant differences exist in neonatal hearing loss risk factors between indigent and insured populations.
- A critical issue is the delayed intervention for hearing-impaired indigent neonates.
- Targeted strategies are needed to improve follow-up and timely care for this vulnerable group.
Objective:
To compare the risk factor profile for neonatal hearing loss (HL), and the follow-up rate of those identified with HL in an indigent population with those in an insured population.
Study Design:
Retrospective review.
Methods:
We studied 4526 neonates from the high-risk nursery or neonatal intensive care unit from two adjacent hospitals in Houston, Texas. Ben Taub General Hospital (BTGH) is a county public hospital that serves mainly the indigent. Texas Children's Hospital (TCH) is a private tertiary care center that serves patients with private insurance and Medicaid.
Results:
Overall, 133 infants failed the screening test. Follow-up diagnostic testing identified 48 patients with definite HL. Although nearly twice as many patients at BTGH failed screening compared with TCH (88 vs. 45), four times as many patients at BTGH did not return for diagnostic testing (43 vs. 10). When a hearing aid was needed, there was a delay in getting one at BTGH (P <.05). There was a higher prevalence of dysmorphic facial features and central nervous system disease and a lower prevalence of long-term ventilatory support at BTGH (P <.05). There were no differences between BTGH and TCH in the prevalence of low birth weight, neonatal asphyxia, syndromic stigmata, neonatal infection, family history of HL, or neonatal transfusion (P >.1).
Conclusions:
Significant differences in the risk factor profile for neonatal HL exist between the indigent and the general population. A worrisome problem exists with the timely intervention in hearing-impaired indigent neonates.