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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Mass newborn screening for hearing impairment
Roy Joseph1, Henry Kun Kiaang Tan, Kah Tzay Low
1Department of Pediatrics, National University of Singapore, Singapore.
Insights
Early hearing screening for newborns using Transient Evoked Oto Acoustic Emissions (TEOAE) is effective. This study found a 1 in 1,096 incidence of severe hearing impairment, highlighting the need for improved false positive reduction strategies.
Area of Science:
- Neonatal care
- Audiology
- Public health
Background:
- Significant hearing impairment in newborns can impede communication development.
- Early detection is crucial for timely intervention and management.
- Universal newborn hearing screening programs aim to identify infants at risk.
Purpose of the Study:
- To evaluate the effectiveness of a newborn hearing screening program utilizing Transient Evoked Oto Acoustic Emissions (TEOAE).
- To determine the incidence of significant hearing impairment in a hospital-based cohort.
- To assess the performance metrics (sensitivity, specificity, predictive value) of the TEOAE screening protocol.
Main Methods:
- Screening of 4,387 newborns within 24 hours of birth using TEOAE.
- Repeated screening at 2 and 6 weeks for infants who initially tested positive.
- Referral to Otolaryngology for formal audiological evaluation for persistent positive screens.
- Calculation of screening rate, incidence of hearing impairment, and diagnostic accuracy metrics.
Main Results:
- A screening rate of 97.2% was achieved.
- 8 out of 312 infants with initial positive screens were diagnosed with significant hearing impairment.
- The incidence of severe hearing impairment requiring binaural amplification was 1 in 1,096.
- Sensitivity was 100%, specificity 93%, and positive predictive value 26%.
Conclusions:
- The TEOAE screening strategy is reliable and sensitive for detecting significant hearing impairment in newborns.
- The screening protocol enabled early diagnosis and intervention, typically by 7 months of age.
- A need exists to develop strategies for reducing the high false positive rate in TEOAE screening.
Abstract:
Significant hearing impairment is common and impairs communication potential if not detected early. Babies born at the National University Hospital from March 1999 to February 2001 were screened at birth using the strategy of measuring Transient Evoked Oto Acoustic Emissions with the ILO 88 Otodynamics Echoport. The screening was conducted within 24 hours of birth in the majority of patients. Those testing positive were re-screened at about 2 weeks and at 6 weeks if still testing positive. Those who tested positive at 6 weeks were referred to Otolaryngology for formal evaluation of hearing. A total screening rate of 97.2% (4,387 out of 4,514 livebirths) was achieved. Of the 312 testing positive at 6 weeks, 8 were subsequently proven to have significant hearing impairment. Four of them required binaural amplification, giving a 1 in 1,096 incidence of severe hearing impairment. A specificity, positive predictive value and sensitivity of 93%, 26% and 100% respectively were obtained. In all but one, the diagnosis was made by 7 months of age and interventions set in place within 2 months of diagnosis. The screening strategy was reliable and sensitive. A strategy to reduce the high false positive rate needs to be developed.
