UNHS: A Decade Long Feasibility and Sustenance Study from a Tertiary Care Hospital in India
Melanie Kapadia1, Neelam Vaid1, Varada Vaze1
1KEM Hospital Pune, Pune, Maharashtra India.
Insights
This study found a 5.41 per 1000 incidence of neonatal hearing loss. Key risk factors include NICU admission and low birth weight, highlighting the need for effective neonatal hearing screening programs.
Area of Science:
- Pediatrics
- Audiology
- Neonatal Care
Background:
- Neonatal hearing loss is a significant concern, affecting development and requiring early intervention.
- Universal neonatal hearing screening programs aim to identify hearing impairment at birth.
- Tertiary care centers play a crucial role in managing high-risk neonates and implementing screening protocols.
Purpose of the Study:
- To estimate the incidence of hearing loss in neonates at a tertiary referral center.
- To identify and assess risk factors associated with neonatal hearing loss.
- To explore the challenges and feasibility of implementing a decade-long universal neonatal hearing screening program.
Main Methods:
- A prospective observational cohort study conducted over ten years (2008-2018) involving 5,540 neonates.
- Two-tier hearing screening using Otoacoustic Emissions (OAE) followed by Brainstem Evoked Response Audiometry (BERA) for referred and high-risk infants.
- High-risk criteria were based on established guidelines from the Joint Committee on Infant Hearing and American Academy of Pediatrics.
Main Results:
- The overall incidence of hearing impairment was 5.41 per 1000 neonates.
- Incidence was higher in high-risk neonates (9.11 per 1000) compared to well-babies (1.49 per 1000).
- Identified risk factors included NICU admission, intrauterine growth retardation (IUGR), low birth weight (<1500g), respiratory distress syndrome (RDS), and hyperbilirubinemia.
Conclusions:
- The incidence of neonatal hearing loss in this cohort is consistent with existing literature.
- Neonates with identified risk factors exhibit a significantly higher prevalence of hearing loss.
- Implementing a two-tier neonatal hearing screening program (OAE and BERA) in a tertiary care setting is feasible but presents challenges.
Abstract:
Objective The aim of this study is to estimate the incidence of hearing loss in neonates at a tertiary referral center, to assess the associated risk factors in those identified with hearing loss and to explore the challenges of starting and continuing a universal neonatal hearing screening programme in a tertiary care hospital over a decade. Materials and Methods It is a cohort prospective observational study conducted from January 2008 to January 2018. Five thousand five hundred and forty neonates underwent screening for hearing loss, of which 2688 were well babies and 2854 babies had one or more risk factors causing hearing loss. Otoacoustic emissions (OAE) is employed as the first level of screening within one month of birth. Brainstem evoked response audiometry (BERA) is done at 3 months of gestational age for all the well babies who were referred on OAE testing and all the high risk babies irrespective of the result of the OAE screening. The High risk criteria are based on the set criteria by the Joint Committee on Infant Hearing (2007) and American Academy of Pediatrics (1994). Results In our study the incidence of hearing impairment is 5.41 per 1000 neonates screened. In well babies and at risk babies it is 1.49 and 9.11 per 1000 respectively.The common neonatal risk factors associated with hearing loss in our study are babies admitted to neonatal intensive care units (NICU), intrauterine growth retardation (IUGR), birth weight less than 1500 g, respiratory distress syndrome (RDS) and hyperbilirubinemia. Conclusion The incidence of hearing loss in our study is comparable to that reported in literature (Bachmann KR, ArvedsonJC (1998) Early identification and intervention for children who are hearing impaired. Pediatr Rev. 1998 May; Vol. 19. No.5. pp. 155-165. http://www.ncbi.nlm.nih.gov/pubmed/9584525 Accessed from May 1998, Nagapoornima P, Ramesh A, Srilakshmi, Rao S, Patricia PL, Gore M, et al. Universal hearing screening. Indian J Pediatr. 2007 Jun 18; 74(6):545-9., Augustine AM, Jana AK, Kuruvilla KA, Danda S, Lepcha A, Ebenezer J, et al. (2014) Neonatal hearing screening-experience from a tertiary care hospital in southern India. Indian Pediatr. Vol. 51. No.3. pp 179-183. http://www.ncbi.nlm.nih.gov/pubmed/24277966 Accessed from Mar 2014). Hearing loss is more common in those babies with risk factors as reported in literature (Nagapoornima P, Ramesh A, Srilakshmi, Rao S, Patricia PL, Gore M, et al. Universal hearing screening. Indian J Pediatr. 2007 Jun 18; 74(6):545-9. http://www.ncbi.nlm.nih.gov/pubmed/21654001 Paul AK (2011) Early identification of hearing loss and centralized newborn hearing screening facility-the Cochin experience. Indian Pediatr. Vol. 48. No. 5. pp 355-359. Accessed from May 2011). Implementation of neonatal hearing screening program at a tertiary care hospital using a two tier system with OAE and BERA is a feasible but challenging service.
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