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Published on: January 23, 2017
Universal newborn hearing screening follow-up in two Georgia populations: newborn, mother and system correlates
1Emory University, 5455 Meridian Mark Road, Atlanta, GA 30342, USA. ntodd@emory.edu
Insights
Nearly half of babies failing newborn hearing screening lack follow-up. Programmatic factors like prenatal education and integrated public health reporting are key to improving newborn hearing screening follow-up rates.
Area of Science:
- Pediatrics
- Public Health
- Audiology
Background:
- Many infants who "fail" newborn hearing screening do not receive recommended follow-up care.
- Explanations for this gap in care are varied and require further investigation.
Purpose of the Study:
- To examine medical, socio-demographic, and screening-related factors influencing follow-up after newborn hearing screening in two distinct Georgia populations.
- To test hypotheses regarding the correlation of follow-up with specific patient characteristics, screening performance, and program policies.
Main Methods:
- Analysis of data from newborns who failed both ears' screening at Piedmont Hospital and Waycross Health District between July 2001 and June 2003.
- Comparison of follow-up rates and associated factors across the two sites with differing demographic and healthcare contexts.
Main Results:
- Follow-up rates varied significantly: 57% at Piedmont (low Medicaid) versus 100% at Waycross (high Medicaid).
- Maternal race (White) and age (≥30) correlated with follow-up at Piedmont, but not Waycross. Private insurance and marriage also trended positively.
- Follow-up was not linked to screening refusal, missed screenings, or failure rates, nor to mother's witnessing screening or receiving in-person explanations.
Conclusions:
- Socio-demographic factors like poverty, non-white race, and young maternal age, while considered, were less critical than programmatic elements.
- Key factors for improved follow-up include comprehensive prenatal education on newborn hearing screening and seamless integration of hospital hearing data with public health systems.
Background:
Nearly half of babies who "fail" their newborn hearing screening do not receive appropriate follow-up. Various explanations have been suggested.
Objective:
To investigate, in two contrasting populations of newborns in Georgia, contemporaneous medical, socio-demographic and screening correlates of follow-up after newborn hearing screening. Three hypotheses were addressed: (1) follow-up correlated with particular medical, social and demographic features; (2) screening performance indicators correlated with follow-up; and (3) screening policies and procedures correlated with follow-up.
Methods:
The studied babies, born July 2001 through June 2003 at Atlanta's Piedmont Hospital and Waycross Health District, had failed screening in both ears. Each site had about 4000 births per year, and a plan for outpatient follow-up of in-patient "fail" babies.
Results:
At Piedmont, where Medicaid funded less than 7% of the births, 57% (130/230) had known follow-up to outpatient screening. In contrast, at Waycross, where Medicaid funded 89.6% of the births, 100% (38/38) had follow-up. The first study hypothesis was only partially supported by the data-from Piedmont, but not Waycross. White race and maternal age 30 years or older correlated with following-up: odds ratios 2.07 (95% CI 1.17, 3.68) and 1.83 (1.05, 3.17), respectively. Private health insurance and marriage trended with following-up. Follow-up rates did not correlate with the rates of screening refusal, missed screening and "fail" rates. Follow-up was unrelated to mothers witnessing the screening, receiving in-person explanations and having appointments arranged for them. The Piedmont and Waycross programs were quite different. Piedmont's began in 2001, mothers typically learned about screening when it was done and "fail" babies were reported to many public health entities. In contrast, the Waycross program was more than 20 years old, prenatal care included teaching about screening and reporting was to one public health entity.
Conclusions:
Though maternal socio-demographic features (poor, non-white, young) and access problems have been considered factors for non-follow-up, this study found two program characteristics most important: the lack of prenatal education about newborn hearing screening, and the lack of functionally integrated hospital hearing information with Public Health.
