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Updated: Jul 26, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Prediction of auditory brainstem reflex screening referrals in high-risk infants
Judith E Cho Lieu1, Gretchen Champion
1Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA. lieuj@wustl.edu
Insights
This study identified key risk factors for congenital hearing loss (HL) in infants, including bronchopulmonary dysplasia (BPD). Findings aid in developing a system to predict the likelihood of hearing impairment in newborns.
Area of Science:
- Neonatal care
- Pediatric audiology
- Public health
Background:
- Congenital hearing loss (HL) is a significant concern in newborns.
- Identifying risk factors is crucial for early detection and intervention.
- Existing risk factor assessments may not fully capture the spectrum of HL predictors.
Purpose of the Study:
- To quantify the significance of known congenital HL risk factors.
- To discover additional risk factors for congenital HL.
- To develop a predictive model for infant congenital HL.
Main Methods:
- Retrospective cohort study of 1,863 infants undergoing auditory brainstem reflex (ABR) screening (1998-1999).
- Validation cohort of 437 infants screened in 2002.
- Medical record review to identify risk factors and hearing screening outcomes (referral for mild to profound loss).
Main Results:
- Established risk factors like craniofacial abnormalities, cytomegalovirus infection, maternal ethanol use, syndromes, hydrocephalus, and hyperbilirubinemia were significant predictors.
- Bronchopulmonary dysplasia (BPD) emerged as a significant risk factor in this high-risk infant population.
- The study provides data for a prognostic system to predict HL risk.
Conclusions:
- Established risk factors remain important for congenital HL.
- Bronchopulmonary dysplasia (BPD) is highlighted as a key predictor in high-risk infant populations.
- Further research is needed to determine causality versus association for identified risk factors in congenital HL.
Objectives/Hypothesis:
The objectives of this study were to 1) quantify the relative importance of established risk factors for congenital hearing loss (HL), 2) identify other risk factors for congenital HL, and 3) create a prognostic system that can predict the chance of an infant having HL.
Methods:
The authors conducted a retrospective cohort study with validation of a prognostic system. The authors used a medical record review on 1,863 infants admitted to level II and level III nurseries who underwent auditory brainstem reflex (ABR) hearing screening from 1998 to 1999 (derivation cohort). The primary outcome was hearing screening referral (i.e., hearing screening failure) classified as mild to moderate, moderate to severe, and severe to profound loss. To validate the prognostic system, a medical record review of a separate cohort of 437 infants admitted to a level III nursery who underwent ABR hearing screening in 2002 (validation cohort) was performed.
Results:
In the derivation cohort, 1,513 infants (81%) passed the ABR screen at 30 dB, 77 (4%) had a unilateral referral, 243 (13%) had a bilateral referral, and 30 (1.6%) did not have a complete screening. In multivariable analysis, the following risk factors were clinically and statistically significant: craniofacial abnormalities, cytomegalovirus infection, bronchopulmonary dysplasia (BPD), maternal ethanol use, syndromes, hydrocephalus, and hyperbilirubinemia.
Conclusions:
Our results reaffirm the importance of several established risk factors for congenital HL, but suggest that BPD is an important predictor in high-risk populations. Whether these risk factors are causal or merely associated in congenital HL remains to be determined.
