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Behavioral Assessment of Hearing in 2 to 4 Year-old Children: A Two-interval, Observer-based Procedure Using Conditioned Play-based Responses
Published on: January 23, 2017
Newborn hearing screening on infants at risk
Christine Ohl1, Liliane Dornier, Cécile Czajka
1ENT Department, University Hospital of Besançon, Besançon Cedex, France.
Insights
Newborn hearing screenings identified 4.55% of at-risk infants with hearing loss, enabling early management for 60 children. Improved parental education and universal screening are recommended due to significant loss to follow-up and combined risk factors.
Area of Science:
- Pediatrics
- Audiology
- Public Health
Background:
- Newborn hearing impairment affects a significant number of infants.
- Early detection and intervention are crucial for optimal developmental outcomes.
- Identifying infants at risk allows for targeted screening protocols.
Purpose of the Study:
- To evaluate the effectiveness of a targeted newborn hearing screening program for at-risk infants.
- To identify risk factors associated with hearing impairment in newborns.
- To assess the rate of diagnosis and early management of hearing loss.
Main Methods:
- A two-step screening process using automated oto-acoustic emissions (AOAE) and auditory brainstem response (ABR).
- Screening initiated on the third day of life for infants identified as high-risk.
- Referral to specialized audiologists for confirmed cases (ABR threshold ≥ 40dB).
Main Results:
- 4.55% of 1461 screened infants were diagnosed with hearing impairment.
- Severe birth asphyxia, neurological disorders, and specific syndromes were significant risk factors for sensorineural hearing loss.
- Craniofacial anomalies were significant factors for conductive hearing loss.
- Nearly 10% of infants were lost to follow-up.
Conclusions:
- The targeted screening facilitated early management for 60 deaf children.
- High rates of loss to follow-up highlight the need for better parental and paramedic education.
- Universal newborn screening is suggested to improve detection rates.
- The combination of multiple risk factors significantly increases the risk of hearing impairment.
Objectives:
This article presents the results of newborn hearing screenings on infants at risk of hearing impairment at the French University Hospital of Besançon from 2001 to 2007.
Materials And Methods:
All newborns at risk of hearing impairment were tested according to the method recommended by the Joint Committee on Infant Hearing (JCIH): a two-step automated oto-acoustic emissions (AOAE) program, completed by an auditory brainstem response (ABR) for the positive diagnosis of hearing impairment. The screening started with AOAE on the third day of life, at the earliest. If one or both ears did not have AOAE, the infant was re-tested at which time, should the AOAE again be positive, ABR was performed. When the ABR threshold was 40dB or more, the infant was referred to an audiologist specialized in infant deafness for diagnosis confirmation and management.
Results:
Over the period, 1461 infants were screened, among whom 4.55% were diagnosed as deaf or hard of hearing. Nearly 10% of the infants were lost to follow up. Forty-six children had a sensorineural hearing impairment, of which 34 were bilateral and were managed before the age of 6 months. The risk factors for sensorineural hearing loss were (in order of statistical significance): severe birth asphyxia; neurological disorder; syndromes known to be associated with hearing loss; TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes) infections; family history of deafness; age at the time of screening; and the association of 2 or more risk factors. However, birth weight inferior to 1500g and premature birth before the 34th week of pregnancy did not show a statistically significant influence on sensorineural hearing loss. Craniofacial anomalies (mostly cleft palate and ear aplasia) were a significant factor for conductive hearing loss.
Conclusion:
Our selected hearing screening on infants at risk allowed 60 deaf children access to early management. However, too many children were lost to follow up; which revealed that better information regarding risk of hearing loss must be provided to parents and paramedics and universal newborn screening needs to be performed. The most important result of this study is that in a population of hearing impaired children, with an impairment incidence close to what is commonly reported, the association of several risk factors proves to be a significant additional risk factor for hearing impairment.
