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Targeted surveillance for postnatal hearing loss: a program evaluation
Rachael Beswick1, Carlie Driscoll, Joseph Kei
1School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia. Rachael_Beswick@health.qld.gov.au
Insights
A targeted surveillance program identified postnatal hearing loss in children. However, its effectiveness is questioned due to limitations like lost contacts and delayed assessments, necessitating program revisions.
Area of Science:
- Pediatric audiology
- Public health surveillance
- Early childhood development
Background:
- Effective monitoring of early childhood hearing is crucial but lacks evidence-based methods post-newborn screening.
- A risk factor registry approach was explored to identify children with postnatal hearing loss.
Purpose of the Study:
- To describe a targeted surveillance program utilizing a risk factor registry.
- To identify children with postnatal hearing loss after initial newborn screening.
Main Methods:
- A cohort of children born in Queensland (2004-2009) with a 'pass' on newborn hearing screening and at least one risk factor were included.
- Children underwent targeted surveillance assessments throughout early childhood per diagnostic protocols.
Main Results:
- 7320 children were referred; 56 (0.77%) had postnatal hearing loss (mild and sensorineural most common).
- Syndromes, craniofacial anomalies, and severe asphyxia showed higher yields; low birth weight and meningitis had low yields.
- Program limitations included a 32.4% lost contact rate, assessment delays, and extensive testing on normal-hearing children. Indigenous children had higher lost contact rates.
Conclusions:
- The targeted surveillance program detected postnatal hearing loss but demonstrated significant limitations.
- Revisions to assessment time frames, procedures, and discharge criteria are needed for program viability.
- Further examination of individual and combined risk factors is recommended to improve postnatal hearing loss detection.
Objective:
The importance of monitoring hearing throughout early childhood cannot be understated. However, there is a lack of evidence available regarding the most effective method of monitoring hearing following the newborn screen. The goal of this study was to describe a targeted surveillance program using a risk factor registry to identify children with a postnatal hearing loss.
Methods:
All children who were born in Queensland, Australia between September 2004 and December 2009, received a bilateral 'pass' on newborn hearing screening, and had at least one risk factor, were referred for targeted surveillance and were included in this study. The cohort was assessed throughout early childhood in accordance with Queensland's diagnostic assessment protocols.
Results:
During the study period, 7320 (2.8% of 261,328) children were referred for targeted surveillance, of which 56 were identified with a postnatal hearing loss (0.77%). Of these, half (50.0%) were identified with a mild hearing loss, and 64.3% were identified with a sensorineural hearing loss. In regards to risk factors, syndrome, craniofacial anomalies, and severe asphyxia had the highest yield of positive cases of postnatal hearing loss for children referred for targeted surveillance, whereas, low birth weight, bacterial meningitis, and professional concern had a particularly low yield. Limitations of the targeted surveillance program were noted and include: (1) a lost contact rate of 32.4%; (2) delays in first surveillance assessment; (3) a large number of children who required on-going monitoring; and (4) extensive diagnostic assessments were completed on children with normal hearing. Examination of the lost contact rate revealed indigenous children were more likely to be documented as lost contact. In addition, children with one risk factor only were significantly more likely to not attend a surveillance appointment.
Conclusions:
Positive cases of postnatal hearing loss were detected through the targeted surveillance program. However, the limitations of the program question the usefulness of this service delivery model. For targeted surveillance to continue, time frames for assessment, assessments performed, and discharge criteria need to be revisited. The contribution of individual and combined risk factors in detecting postnatal hearing loss should also be examined in more detail.
