Timing of Newborn Hearing Screening Effects on Passing Rates: A Prospective Cohort Study
Wongsathon Seehiranwong1, Pichada Saengrat1
1Department of Pediatrics, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Insights
Newborn hearing screening with transient evoked otoacoustic emissions (TEOAEs) is most accurate when performed after 48 hours of age. Optimizing TEOAE screening timing improves early detection of hearing impairment in neonates.
Area of Science:
- Neonatal care
- Audiology
- Public health
Background:
- Newborn hearing screening is crucial for early detection of hearing loss.
- Transient evoked otoacoustic emissions (TEOAEs) are a common screening method.
- Optimal timing for TEOAE screening in neonates is not well-defined.
Purpose of the Study:
- Determine the optimal timing for TEOAE screening in low-risk neonates.
- Identify perinatal factors influencing TEOAE screening pass rates.
Main Methods:
- Sequential TEOAE screening at different postnatal ages (<24, 24-36, 36-48, >48 hours).
- Statistical analysis including Fisher's exact test and Cox/Laplace regression.
- Follow-up at 1 month for persistent failures.
Main Results:
- Pass rates significantly improved with later screening, reaching 99.3% after 48 hours.
- Screening after 48 hours showed a significant improvement (OR: 5.26, p=0.0153).
- Cesarean delivery, prematurity, and small for gestational age influenced passing times.
Conclusions:
- Screening neonates at or after 48 hours significantly enhances TEOAE pass rates.
- Tailored follow-up protocols are needed for preterm and C-section infants.
- Optimizing screening timing improves accuracy and clinical efficiency in early hearing loss detection.
Abstract:
Newborn hearing screening using transient evoked otoacoustic emissions (TEOAEs) is essential for early detection of hearing impairment. The Joint Committee on Infant Hearing recommends screening near hospital discharge but does not specify an optimal timing. To determine the optimal timing for TEOAE screening in neonates at low risk of hearing impairment and to identify perinatal factors influencing pass rates.Neonates underwent sequential TEOAE screening based on postnatal age at the time of testing: less than 24, 24 to 36, 36 to 48, and more than 48 hours, with follow-up at 1 month for persistent failures. Statistical analyses included Fisher's exact test to compare pass rates across time intervals and multivariate Cox's proportional hazards regression and Laplace regression to assess factors associated with screening outcomes.Among 408 neonates, the median passing age was 23.8 hours (interquartile range: 14.3). Pass rates improved with later screening: 53.7% at less than 24 hours, 80.1% at 24 to 36 hours, 92.6% at 36 to 48 hours, and 99.3% at more than 48 hours. A significant improvement was observed only at more than 48 hours (odds ratio: 5.26; p = 0.0153). Cesarean delivery was associated with delayed passing compared with vaginal delivery (p = 0.036). Late preterm neonates demonstrated a significantly delayed passing time of approximately 12.9 hours (p < 0.01), whereas small for gestational age neonates passed earlier by 8.2 hours (p = 0.021).Screening at greater than or equal to 48 hours significantly improved pass rates. An older age at successful screening was observed among preterm neonates and those delivered by cesarean section, underscoring the need for tailored follow-up protocols. These findings highlight the importance of optimizing screening strategies to enhance early detection and intervention. · The ideal timing for newborn hearing screening remains unclear, affecting accuracy and follow-up rates.. · Early TEOAE screening may lead to high false positives due to residual ear fluid, increasing unnecessary follow-ups.. · Optimizing timing of the hearing screening window can enhance accuracy, reduce false positives, and improve clinical efficiency..
