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Newborn hearing screening programme in Belgium: a consensus recommendation on risk factors
Bénédicte Vos1,2,3, Christelle Senterre4, Raphaël Lagasse5
1Research Center Epidemiology, Biostatistics and Clinical Research, Université libre de Bruxelles (ULB), School of Public Health, Route de Lennik 808, Brussels, 1070, Belgium. benevos@ulb.ac.be.
Insights
Updated guidelines identify key risk factors for newborn hearing loss, including congenital infections and family history, to improve the Belgian screening program. Experts recommend including even weakly evidenced factors to prevent unidentified hearing loss.
Area of Science:
- Neonatal care
- Audiology
- Public health
Background:
- Understanding neonatal risk factors for hearing loss is crucial for effective newborn hearing screening programs.
- Current scientific knowledge necessitated an update of these risk factors for the Belgian newborn hearing screening program.
Purpose of the Study:
- To update recommendations for clinical management and follow-up of newborns with neonatal risk factors for hearing loss.
- To inform the Belgian newborn hearing screening program with current evidence-based guidelines.
Main Methods:
- A comprehensive literature review was conducted.
- The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was utilized to assess evidence quality and recommendation strength.
- A three-round Delphi consensus process, including online questionnaires and a face-to-face meeting, was employed.
Main Results:
- Congenital infections, family history, consanguinity, malformation syndromes, and fetal alcohol syndrome were identified as high-evidence risk factors.
- Hyperbilirubinemia was classified as a moderate-evidence risk factor.
- Very low birth weight, low Apgar scores, NICU hospitalization, and ototoxic drugs showed very low to low evidence levels, potentially due to improved management and methodological limitations.
Conclusions:
- Revised recommendations for managing and following up newborns with hearing loss risk factors were established using an evidence-based approach and expert consensus.
- The findings will be implemented into the Belgian newborn hearing screening program to prevent unidentified hearing loss.
Background:
Understanding the risk factors for hearing loss is essential for designing the Belgian newborn hearing screening programme. Accordingly, they needed to be updated in accordance with current scientific knowledge. This study aimed to update the recommendations for the clinical management and follow-up of newborns with neonatal risk factors of hearing loss for the newborn screening programme in Belgium.
Methods:
A literature review was performed, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system assessment method was used to determine the level of evidence quality and strength of the recommendation for each risk factor. The state of scientific knowledge, levels of evidence quality, and graded recommendations were subsequently assessed using a three-round Delphi consensus process (two online questionnaires and one face-to-face meeting).
Results:
Congenital infections (i.e., cytomegalovirus, toxoplasmosis, and syphilis), a family history of hearing loss, consanguinity in (grand)parents, malformation syndromes, and foetal alcohol syndrome presented a 'high' level of evidence quality as neonatal risk factors for hearing loss. Because of the sensitivity of auditory function to bilirubin toxicity, hyperbilirubinaemia was assessed at a 'moderate' level of evidence quality. In contrast, a very low birth weight, low Apgar score, and hospitalisation in the neonatal intensive care unit ranged from 'very low' to 'low' levels, and ototoxic drugs were evidenced as 'very low'. Possible explanations for these 'very low' and 'low' levels include the improved management of these health conditions or treatments, and methodological weaknesses such as confounding effects, which make it difficult to conclude on individual risk factors. In the recommendation statements, the experts emphasised avoiding unidentified neonatal hearing loss and opted to include risk factors for hearing loss even in cases with weak evidence. The panel also highlighted the cumulative effect of risk factors for hearing loss.
Conclusions:
We revised the recommendations for the clinical management and follow-up of newborns exhibiting neonatal risk factors for hearing loss on the basis of the aforementioned evidence-based approach and clinical experience from experts. The next step is the implementation of these findings in the Belgian screening programme.
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