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Infant hearing screening: program implementation and validation
Insights
Congenital hearing loss affects 6.1% of Intensive Care Nursery graduates. Early screening using Crib-O-Gram and behavioral tests is crucial for timely detection and intervention in infants.
Area of Science:
- Neonatal screening
- Pediatric audiology
- Developmental pediatrics
Background:
- Congenital and early-onset hearing loss (HL) affects a significant proportion of infants.
- Intensive Care Nursery (ICN) graduates are at higher risk for hearing impairments.
- Early detection is critical for speech and language development.
Purpose of the Study:
- To determine the incidence of congenital and early-onset hearing loss in ICN graduates.
- To evaluate the effectiveness of neonatal screening methods (Crib-O-Gram and high-risk register) combined with behavioral hearing tests.
- To assess the diagnostic performance of screening strategies for significant hearing loss.
Main Methods:
- A 7-year longitudinal study of 975 ICN graduates.
- Neonatal screening using Crib-O-Gram (COG) and a high-risk register.
- Repeated behavioral hearing tests at 1-3 years, with 84% follow-up.
- Defined significant hearing loss as >45 dB HL average loss (1000-8000 Hz) bilaterally.
Main Results:
- 6.1% of ICN graduates had congenital/early-onset hearing loss.
- Significant hearing loss (interfering with speech/language) was found in 4.3% of infants.
- COG combined with behavioral screening showed high sensitivity (missing only one child).
- COG alone had 79.3% sensitivity; behavioral screening had 82.6% sensitivity for significant losses.
- Confirmation age varied by loss severity; progressive losses required continued follow-up.
Conclusions:
- Combined neonatal screening (COG) and behavioral testing is an effective strategy for detecting significant hearing loss in ICN graduates.
- Early identification and intervention are essential for optimal speech and language development.
- Ongoing audiological surveillance is necessary to identify progressive or delayed-onset hearing impairments.
Abstract:
Congenital and early-onset hearing losses were discovered in 6.1% of 975 Intensive Care Nursery (ICN) graduates. The methods used were neonatal screening by Crib-O-Gram (COG) and high risk register, in combination with repeated behavioral hearing tests at 1 to 3 years. This 7-year longitudinal study had follow-up hearing evaluations for a remarkably high 84% of all subjects. Significant losses that interfered with speech and language development (1000 to 8000 Hz average loss greater than 45 dB HL bilaterally) were found in 4.3% of infants. COG in combination with subsequent behavioral hearing screening was a sensitive strategy for detecting significant hearing loss: only one child was missed with this combination. Alone, COG sensitivity to significant hearing losses was 79.3%, but would have been higher had a stricter passing criterion been adopted. Behavioral hearing screenings detected bilateral hearing losses of even mild (greater than 20 dB HL) degree. Sensitivity to significant hearing losses was 82.6% and would have been improved if test frequencies greater than 3000 Hz were included in the screen. Even if screening failure occurred at 1 year of age, the age of actual confirmation of hearing loss depended on severity of the loss and ear involvement. Significant hearing losses were confirmed earlier than less severe or unilateral losses. Although behavioral screenings could be done during the first year of life, continued follow-up was required to detect progressive hearing losses.