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Outcomes and efficacy of newborn hearing screening: strengths and weaknesses (success or failure?)
S Korres1, Thomas P Nikolopoulos, E E Peraki
11st and 2nd Department of Otorhinolaryngology, Athens University, Athens, Greece.
Insights
Neonatal hearing screening using transient evoked otoacoustic emissions (TEOAEs) identified 2% of newborns needing follow-up. While repeat testing reduced false positives, many infants were lost to follow-up, highlighting the need for improved program management.
Area of Science:
- Neonatal care
- Audiology
- Public health screening
Background:
- Neonatal hearing loss (HL) affects 1-3 per 1000 live births.
- Early detection and intervention are crucial for language and cognitive development.
- Universal newborn hearing screening (UNHS) programs aim to identify infants with HL early.
Purpose of the Study:
- To evaluate the effectiveness of a UNHS program using transient evoked otoacoustic emissions (TEOAEs).
- To determine the outcomes of neonatal hearing screening and identify program strengths and weaknesses.
- To assess the final diagnosis of hearing loss in a large cohort of newborns.
Main Methods:
- A total of 76,560 newborns were screened using TEOAEs.
- Infants who failed the initial screen underwent repeat testing.
- Infants with persistent failures or other risk factors were referred for audiology evaluations.
Main Results:
- 2% (1,564) of newborns failed the initial TEOAE screen.
- Repeat testing identified 56% of initial failures as normal, but 44% still failed.
- Of 155 infants evaluated, 36.1% had confirmed hearing loss (sensorineural or conductive).
Conclusions:
- Initial screening with TEOAEs and repeat testing before discharge yields an acceptable referral rate.
- 1-month follow-up reduces false positives but results in a high rate of loss to follow-up.
- Implementing a dedicated follow-up system and enhancing parental engagement are recommended to improve program outcomes.
Objective:
To assess the outcomes of neonatal hearing screening with regard to the final diagnosis in a very large number of newborns and investigate related strengths and weaknesses of the program.
Subjects:
In this study, 76,560 newborns were assessed.
Method:
All neonates were assessed using transient evoked otoacoustic emissions (TEOAEs).
Results:
From the 76,560 neonates screened, 1,564 (2%) failed the test. According to the screening protocol, all parents of failed neonates were asked to bring their children 1 month following discharge to repeat the test. Of the 541 (34.6%) newborns who repeated the test, 303 (56%) were found normal and 238 (44%) again failed TEOAE. The latter children were referred to two special public centers for full audiology evaluation. In addition, 124 neonates were also referred due to other reasons revealed in the screening process (family history, high levels of bilirubin, etc.). Of the 362 children who were referred to the two special audiology centers, 113 (31.2%) were evaluated by these two centers. In addition, 42 children who had failed initial screening and did not show up for a follow-up appointment to repeat TEOAE were also assessed in the same centers. Of the 155 children who had a special audiologic evaluation, 56 (36.1%) were found to have hearing loss (HL) and 99 (63.9%) normal hearing. In detail, 28 had bilateral sensorineural HL greater than 40 dB, 10 had unilateral sensorineural HL greater than 40 dB, and 18 had otitis media with effusion or other conductive HL.
Conclusions:
Derived from the present study: 1) repeated testing of "failed" newborns in the maternity hospital and before discharge leads to an acceptable referral rate of 2%; 2) the 1-month follow-up of "failed" newborns further limits the false positive results but leads to high rate of newborns lost to follow-up; 3) a dedicated secretariat system should be implemented to follow-up each "failed" newborn and remind parents about their follow-up appointments; and 4) additional measures such as detailed educational material and parental friendly approach should also be implemented.
