Test and retest reliability of objective screening tests in neonatal hearing screening program in developing
Meghana Mohan B1, Chandni Jain2
1All India Institute of Speech and Hearing, Naimisham campus, Manasagangothri, Mysore, 570006, India. meghanamohan8@gmail.com.
Insights
Hearing screening reliability varies: Otoacoustic Emissions (OAE) are less reliable in noisy environments, while Automated Auditory Brainstem Responses (AABR) are more consistent, especially in healthy newborns.
Area of Science:
- Neonatal audiology
- Hearing screening technologies
- Public health in developing countries
Background:
- Assessing the reliability of newborn hearing screening tests is crucial, particularly in diverse hospital settings and for Neonatal Intensive Care Unit (NICU) infants.
- Developing countries face unique challenges in implementing effective neonatal hearing screening programs.
Purpose of the Study:
- To evaluate the reliability of Otoacoustic Emissions (OAE) and Automated Auditory Brainstem Responses (AABR) in healthy newborns and NICU infants.
- To compare test reliability across different hospital environments (general wards, private wards) and prolonged NICU stays.
Main Methods:
- 100 neonates were studied in three groups: healthy in government wards (G1), healthy in private wards (G2), and NICU infants (G3).
- Intra-session (within 5 minutes) and inter-session (within 1 month) OAE and AABR recordings were performed.
- Reliability was assessed using weighted Kappa and Chi-square analyses across sessions and groups.
Main Results:
- OAEs showed poor within-session reliability in G1 and G3, but good reliability in G2. Inter-session OAE reliability was poor in G1/G3, better in G2.
- AABR demonstrated consistently good intra-session reliability across all groups.
- Inter-session AABR reliability decreased in G1 and G3, with significant referral discrepancies noted, unlike in G2 where reliability remained high.
Conclusions:
- AABR is more reliable than OAE in noisy environments, though its reliability can be affected by early screening timeframes and potential threshold improvements in NICU infants.
- OAEs are less reliable in noisy settings, and their limitation in detecting mild conductive hearing loss components is noted.
- The findings underscore the importance of considering environmental factors and infant condition for accurate neonatal hearing screening.
Background:
Our study aimed to assess the reliability of screening tests in healthy newborns across diverse hospital environments and neonatal intensive care unit (NICU) infants hospitalized for over 5 days, particularly within the framework of hearing screening in developing countries.
Method:
The study comprised 100 neonates in each group: G1 (healthy infants in government general wards), G2 (healthy infants in private special wards), and G3 (infants in NICU for over 5 days). Intra-session (within 5 min) and inter-session (within a month) otoacoustic emissions (OAE) and automated auditory brainstem responses (AABR) recordings were conducted and the reliability of each test was evaluated across sessions and groups.
Results:
The weighted Kappa results showed poor within-session reliability of OAEs in G1 and G3, while G2 exhibited good reliability. AABR intra-session reliability was consistently good across all three groups. The inter-session reliability of OAEs remained poor in G1 and G3 but better in G2. Significantly, the inter-session reliability for AABR decreased in G1 and G3, with Chi-square analysis revealing a notable referral discrepancy between the initial and final assessments. Such a disparity was absent in G2, where reliability remained high.
Discussion:
The study highlights the compromised reliability of OAEs in noisy environments, while AABR maintains good reliability under similar conditions. Additionally, AABR shows poorer reliability when conducted within a specific early timeframe, emphasizing the importance of screening after this period. This issue does not affect OAE, but OAE is limited in detecting mild conductive components. The study highlights the poor reliability of AABRs in the NICU group, attributing this to the potential for improved thresholds over time within this group.
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