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Universal newborn hearing screening: are we achieving the Joint Committee on Infant Hearing (JCIH) objectives?
James L Connolly1, Jeffrey D Carron, Suzanne D Roark
1Department of Otolaryngology and Communicative Sciences, University of Mississippi School of Medicine, Jackson, MS 39216, USA.
Insights
This study shows that a two-stage auditory brainstem response (ABR) Universal Newborn Hearing Screening (UNHS) protocol successfully identifies hearing loss (HL) in infants, enabling timely diagnosis and intervention within recommended timeframes.
Area of Science:
- Pediatric Audiology
- Neonatal Screening
- Public Health
Background:
- Universal Newborn Hearing Screening (UNHS) is crucial for early detection of hearing loss (HL).
- The Joint Committee on Infant Hearing (JCIH) provides guidelines for timely diagnosis and intervention.
- Auditory Brainstem Response (ABR) is a common screening method for newborns.
Purpose of the Study:
- To evaluate the effectiveness of a two-stage ABR UNHS protocol.
- To assess adherence to JCIH recommendations for screening, diagnosis, and intervention timelines.
- To determine the incidence of HL in high-risk and low-risk neonates.
Main Methods:
- A 5-year retrospective review of UNHS data from 1997-2001.
- In-hospital sequential ABR screenings with outpatient follow-up for failures.
- Calculation of screening capture rate, referral rate, false-positive rate, and cost per diagnosis.
Main Results:
- Screened 17,602 newborns; 78 (0.44%) diagnosed with HL.
- HL incidence: 1 in 811 low-risk vs. 1 in 75 high-risk infants.
- Mean age at diagnosis: 3.9 months; mean age at intervention: 6.1 months.
- Screening capture rate >99%; referral rate 4.1%; false-positive rate 3.6%.
Conclusions:
- The two-stage ABR UNHS protocol effectively screens nearly all neonates.
- The protocol facilitates timely diagnosis and intervention for infant hearing loss.
- One HL case identified for every 811 non-high-risk infants screened.
Objective:
To determine whether a two-stage auditory brainstem response (ABR) Universal Newborn Hearing Screening (UNHS) protocol at an academic medical center has been achieving the Joint Committee on Infant Hearing (JCIH) recommendations for screening all infants, diagnosing hearing loss (HL) within 3 months, and instituting intervention within 6 months.
Study Design:
Retrospective database and chart review in an academic tertiary care hospital.
Methods:
A 5-year retrospective review of all newborns screened at our medical center between 1997 to 2001 was performed. Screening was performed by multiple in-hospital postnatal sequential ABR with follow-up outpatient ABR for failures. The protocol called for each newborn to receive at least two separate ABR in-hospital screenings before discharge if the newborn failed the initial screening. For those newborns with extended hospital courses, additional ABR screening were performed randomly in attempt to decrease referral rates at time of discharge. Overall screening population capture rate, referral rate, and false-positive rate were calculated. In addition, HL risk factors, age at diagnosis of HL, and age of onset of intervention were obtained. Cost per diagnosis of HL was calculated as well.
Results:
The total number screened was 17,602. Seventy-eight (0.44%) were diagnosed with HL, with 62 (79%) in the high-risk population. The frequency of HL was 1 per 811 low-risk neonates versus 1 in 75 meeting high-risk criteria. Overall population capture rate was greater than 99%, referral rate 4.1%, and false-positive rate 3.6%. Mean age at diagnosis was 3.9 months, with mean age at intervention 6.1 months. Cost per diagnosis was estimated at US 5,074 dollars.
Conclusions:
Our current UNHS protocol using sequential ABR has been successful in screening virtually all neonates and providing timely intervention. This retrospective review has shown one HL diagnosis for every 811 babies screened without high-risk factors.
