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Improving universal newborn hearing screening outcomes by conducting it with thyroid screening
Vida Rahimi1, Ghassem Mohammadkhani1, Farzaneh Javadi2
1Department of Audiology, School of Rehabilitation, Tehran University of Medical Science, Tehran, Iran.
Insights
Screening infants for hearing loss during the neonatal thyroid screening program significantly improves outcomes. This approach, conducted after hospital discharge, offers a better framework for early hearing detection in newborns.
Area of Science:
- Neonatal screening programs
- Auditory health assessment
- Public health initiatives
Background:
- Effective infant hearing screening is crucial for early detection and intervention.
- Neonatal thyroid screening is typically performed on the third to fifth day after birth, aligning with optimal timing for hearing assessments.
- Current hospital-based hearing screening may have suboptimal outcomes.
Purpose of the Study:
- To evaluate hearing screening outcomes, including referral and false positive rates, when conducted concurrently with neonatal thyroid screening at healthcare centers.
- To compare these outcomes with those of hearing screenings performed in hospitals before infant discharge.
Main Methods:
- A prospective exploratory cohort study involving 4729 newborns.
- Group 1: Infants screened for hearing in the hospital before discharge.
- Group 2: Infants referred to healthcare centers for thyroid screening, where hearing screening was also performed. Transient evoked otoacoustic emissions (TEOAE) and automatic auditory brainstem response (AABR) were utilized.
Main Results:
- The referral rate was 16.1% in the hospital group (Group 1) versus 7.6% in the healthcare center group (Group 2).
- The false positive rate was 15.9% in Group 1 compared to 7.6% in Group 2.
- Hearing screening at healthcare centers during the thyroid program demonstrated significantly lower referral and false positive rates, and a higher positive predictive value compared to hospital-based screening.
Conclusions:
- Conducting hearing screening concurrently with the neonatal thyroid screening program at healthcare centers significantly improves screening efficiency and outcomes.
- This integrated approach offers a viable and effective framework for newborn hearing screening in many countries.
- Coordinated screening post-hospital discharge presents an opportunity to enhance early detection of hearing impairments.
Objectives:
One of the most important factors that can improve hearing screening indicators is testing infants after 48 h of birth. The neonatal thyroid screening program is done during the third to fifth day after birth in many countries. So this screening is done at the appropriate time for hearing screening. The aim of the present study was to evaluate hearing screening outcomes (the referral rate, false positive rate, and positive predictive value) conducted with the thyroid screening at the healthcare centers and compare the results with hospital before discharge the infant.
Methods:
This was a prospective exploratory cohort study. The study population included all the newborns at a hospital (group 1) and newborns who were referred to healthcare centers for thyroid screening (group 2), except for infants with risk factors, from March 2012 to December 2017. Transient evoked otoacoustic emissions (TEOAE) and automatic auditory brainstem response (AABR) were used for the evaluation. The results were compared between the two groups.
Results:
Of the 4729 newborns, who participated in the study, 3001 were referred from a hospital (group 1) and 1728 from two healthcare centers (group 2). The referral rate in group 1 and 2 was 16.1% and 7.6%, respectively. Also, the false positive rate in group 1 and 2 was 15.9% and 7.6%, respectively. Our study showed that the referral rate and false positive rate of hearing screening in group 2 were significantly lower than that in group 1 (p < 0.001). The positive predictive value in group 1 was significantly higher than that in group 2 (p < 0.05). There was no significant sex difference in any of the variables.
Conclusions:
Our results showed that performing the hearing screening during the thyroid program, instead of the hospital could be significantly improved screening outcomes and suggest that hearing and thyroid screening together after discharge from the hospital could be a good opportunity to introduce new framework for hearing screening in many countries.
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