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Detecting Hearing Loss Through Targeted Surveillance: Risk Registry and Surveillance Timeframe Recommendations
E Jane Fitzgibbons1, Carlie Driscoll2, Lia Traves3
1Healthy Hearing Program, Children's Health Queensland Hospital and Health Service, Brisbane, Australia.
Insights
Identifying risk factors for postnatally identified hearing loss (PNIHL) in children is crucial. Hearing surveillance to age 1 is sufficient, except for those with a family history, who need extended monitoring.
Area of Science:
- Pediatrics
- Audiology
- Genetics
Background:
- Newborn hearing screening identifies most congenital hearing loss.
- A subset of children pass newborn screening but develop postnatally identified hearing loss (PNIHL).
- Targeted surveillance aims to identify children at risk for PNIHL.
Purpose of the Study:
- Identify risk factors predicting PNIHL in children who passed newborn screening.
- Determine if hearing surveillance beyond age 1 is necessary.
Main Methods:
- Retrospective analysis of audiological outcomes.
- Cohort included children born in Queensland (2010-2019) who passed newborn screening and had risk factors.
- Excluded children lost to follow-up.
Main Results:
- Syndromes, craniofacial anomalies, perinatal infections, and family history predicted PNIHL.
- Severe asphyxia, prolonged ventilation, hyperbilirubinemia, and meningitis did not predict PNIHL.
- Most PNIHL detected by age 1, except for 25% with family history.
Conclusions:
- Recommended risk factors for PNIHL surveillance: syndromes, craniofacial anomalies, perinatal infection, family history.
- Hearing surveillance to age 1 is adequate, with extended assessment for family history.
- Improved surveillance protocols needed to reduce follow-up loss.
Purpose:
The purpose of this study was to inform the revision of a targeted surveillance risk registry by identifying which risk factors predict postnatally identified hearing loss (PNIHL) in children who pass newborn hearing screening and to determine whether hearing surveillance beyond the age of 1 year is warranted.
Method:
We used retrospective analysis of the audiological outcomes of children born in the state of Queensland, Australia, between January 1, 2010, and December 31, 2019, who passed the newborn hearing screen with risk factors.
Results:
Approximately one third of children were lost to follow-up and could not be included in the analysis. Risk factors that predicted PNIHL in the analyzed cohort were as follows: syndromes associated with hearing loss, craniofacial anomalies, perinatal infections, and family history of permanent childhood hearing loss. Severe asphyxia did not predict PNIHL but yielded some cases of significant bilateral hearing loss. Hearing loss in children with a history of prolonged ventilation was mild and/or unilateral in nature (except in cases where the hearing loss was due to an unrelated etiology). There were no cases of PNIHL in children with hyperbilirubinemia or neonatal bacterial meningitis. For the risk factors that predicted PNIHL, nearly all hearing losses were detected by 1 year of age, except for children with family history where one quarter of hearing losses had a later onset.
Conclusions:
The four risk factors recommended for efficient postnatal identification of hearing loss are as follows: syndromes associated with hearing loss, craniofacial anomalies, perinatal infection, and family history of permanent childhood hearing loss. Hearing surveillance through to 1 year old is sufficient except for children with a family history, where a second phase assessment is indicated. Alternative targeted surveillance protocols and models of care are required to minimize loss to follow-up.
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