Infant, Maternal, and Hospital Factors' Role in Loss to Follow-up After Failed Newborn Hearing Screening
Maureen Cunningham1, Vickie Thomson2, Erica McKiever3
1Department of Pediatrics, University of Colorado Denver, Aurora, Colo; Children's Hospital Colorado, Aurora, Colo.
Insights
Delays in newborn hearing screening (NBHS) follow-up are common. Factors like maternal education and payer influence timely screening completion, but guideline adherence needs further study to overcome barriers.
Area of Science:
- Pediatrics
- Public Health
- Audiology
Background:
- Newborn hearing screening (NBHS) is crucial for early detection of hearing loss.
- Delays and loss to follow-up (LTF/LTD) after failed NBHS are significant challenges.
- Hospital guidelines exist to mitigate LTF/LTD, but their effectiveness requires investigation.
Purpose of the Study:
- Identify maternal and infant factors associated with LTF/LTD after failed NBHS.
- Determine if adherence to hospital guidelines correlates with timely follow-up screening completion.
Main Methods:
- Retrospective study of infants failing NBHS in Colorado (2007-2012).
- Cross-sectional survey of NBHS coordinators at birthing hospitals.
- Logistic regression analysis of electronic birth records, infant hearing data, and survey responses.
Main Results:
- 82% of infants had documented follow-up screening; 76% completed it by 1 month.
- Maternal factors (age, education, smoking, birth country) and infant factors (payer, race, birth order, population density) were associated with completion.
- Birth in a facility with a rescreening fee was the only guideline-associated factor linked to follow-up completion.
Conclusions:
- Low-income, rural, and minority infants face higher risks of LTF.
- Further research is needed to ascertain if guideline adherence can surmount follow-up barriers.
Objective:
Completion of newborn hearing screening (NBHS) is recommended by 1 month old. Delays and loss to follow-up and documentation (LTF/LTD) after failed NBHS are common. Committees of experts have established hospital guidelines to reduce LTF/LTD. We aimed to identify maternal and infant factors associated with LTF/LTD and determine if adherence to hospital guidelines is associated with timely completion of follow-up screening.
Methods:
We conducted a retrospective study of all infants born in Colorado hospitals who failed the newborn admission hearing screening from 2007 to 2012 and a cross-sectional survey of NBHS coordinators at Colorado birthing hospitals. Neonatal intensive care unit infants were excluded. Outcomes included documented completion of the follow-up NBHS and completion by 1 month. Data sources comprised the electronic birth record, infant hearing integrated data system, and NBHS coordinator survey. Data were analyzed by logistic regression.
Results:
A total of 13,904 newborns did not pass the newborn admission hearing screening from 2007 to 2012, and 11,422 (82%) had documentation of a completed follow-up screening. A total of 10,558 (76%) completed follow-up screening by 1 month. All 53 NBHS coordinators completed the survey. Maternal age, education, smoking, and birth country; and payer, race, birth order, and population density were associated with completion of follow-up hearing screening. Maternal education, payer, population density, birth weight, and cleft lip were associated with completion by 1 month of age. Only birth in a facility that charges a rescreening fee was associated with completion of follow-up screening.
Conclusions:
Low-income, rural, and minority infants are at risk for LTF. Further studies are needed to determine if adherence to guidelines can overcome barriers to follow-up.
