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Screening of hearing impairment in the newborn using the auditory response cradle
1Hillingdon Hospital Postgraduate Centre, Uxbridge, Middlesex.
Insights
The Auditory Response Cradle (ARC) effectively screens neonatal hearing, identifying severe impairments. Long-term follow-up highlights the necessity of ongoing hearing assessments beyond the neonatal period.
Area of Science:
- Audiology
- Neonatal Care
- Public Health
Background:
- Neonatal hearing screening is crucial for early detection of hearing loss.
- The Auditory Response Cradle (ARC) is an automated system for neonatal hearing assessment.
- Evaluating the efficacy and practicality of the ARC in a real-world setting is important.
Purpose of the Study:
- To evaluate the Auditory Response Cradle (ARC) for universal hearing screening in neonates.
- To determine the detection rate and false positive rate of the ARC.
- To assess the long-term outcomes of neonatal hearing screening and the need for follow-up.
Main Methods:
- A 3-year screening of 6000 full-term neonates using the Auditory Response Cradle (ARC).
- A 3-year follow-up program for all screened infants.
- Analysis of screening results, including failed screens, confirmed hearing impairments, and false positives.
Main Results:
- 1.7% of infants failed the ARC screen, with 20 confirmed hearing impairments (10 severe).
- The ARC demonstrated a false positive rate of 1.3%.
- Seven children who passed the neonatal screen developed hearing loss during the 3-year follow-up, emphasizing the need for continued monitoring.
Conclusions:
- The Auditory Response Cradle (ARC) is a practical tool for universal neonatal hearing screening, particularly for detecting severe hearing loss.
- Neonatal screening alone is insufficient; progressive and acquired hearing losses necessitate follow-up screenings throughout childhood.
- The study confirms the feasibility of using automated behavioral techniques for widespread neonatal hearing assessment.
Abstract:
The Auditory Response Cradle (ARC) is a fully automated microprocessor controlled machine that was designed for the hearing screening of full term neonates. In order to evaluate the ARC, 6000 babies were screened at a district maternity hospital over a period of three years. Every infant subsequently entered a three year follow up programme. One hundred and two babies (1.7%) failed the ARC screen (that is, they failed two ARC tests) and 20 of these were found to have some hearing impairment: in 10 it was severe (80-90 dBHL), in seven moderate (45-60 dBHL), and in three it was mild to moderate (less than 45 dBHL). In addition, of the 20 babies who failed a first test and were discharged before a second could be performed, two were confirmed to have a severe hearing loss; 79 infants failing the screen were cleared on further testing, giving the ARC a false positive rate of 1.3%. On following up all 6000 infants for three years, seven children who passed the neonatal screen were subsequently found to have a hearing loss. For two babies the aetiology was unknown but for five the hearing impairment was either due to a hereditary progressive loss or definite postnatal factors. Progressive and acquired hearing losses cannot be detected at a neonatal screen and this emphasises the need for follow up screens at other stages in the child's life. In this long term study the ARC has been found to have a high detection rate for severe hearing loss and confirms the practical possibility of using a behavioural technique for the universal screening of hearing in neonates.