Newborn hearing screening to diagnosis: A clinical study of 15,818 cases

To analyze the epidemiological characteristics, risk factors, and follow-up outcomes of neonatal hearing loss, thereby providing a basis for optimizing screening and intervention strategies.

A total of 15,818 newborns born at Shenzhen Maternity and Child Healthcare Hospital between January and December 2022 were enrolled. Initial screening was conducted using distortion product otoacoustic emissions (DPOAE). Infants who referred underwent rescreening with a combination of DPOAE and automated auditory brainstem response (AABR), and those who failed were referred for comprehensive diagnostic evaluation at 3 months of age, including auditory brainstem response (ABR), auditory steady-state response (ASSR), and acoustic immittance testing. Pass rates and loss-to-follow-up rates at each stage were analyzed, along with the characteristics and risk factors of confirmed hearing loss.

Of the cohort, 15,643 newborns completed the initial screening, with a pass rate of 96.71 %. Forty-six cases were confirmed with hearing loss, yielding a detection rate of 2.94 per 1000. The pass rate for the right ear (97.93 %) was significantly higher than for the left ear (97.55 %) (P < 0.001). Among the diagnosed cases, hearing loss was predominantly unilateral (56.52 %), mild-to-moderate in degree (73.91 %), and conductive in type (50.00 %). The primary risk factors identified were preterm birth (30.43 %), low birth weight (17.39 %), craniofacial anomalies (15.22 %), and hyperbilirubinemia (13.04 %). Follow-up and genetic testing were completed for 42 infants. Pathogenic variants in GJB2 or SLC26A4 genes were identified in 4 cases (9.52 %). Hearing returned to normal in 10 infants (23.81 %), while the hearing status of those with severe-to-profound loss remained stable. A significant difference was observed in the distribution of hearing loss between the initial diagnosis and follow-up (P < 0.05).

This study found a neonatal hearing loss detection rate consistent with previous reports, observed a higher screening pass rate in the right ear. The hearing loss was predominantly unilateral and mild-to-moderate, with follow-up revealing a dichotomous trend of either spontaneous recovery or persistence. This pattern highlights the necessity of enhancing follow-up management during the critical window between rescreening and diagnosis, and of formulating stratified and individualized intervention and follow-up protocols.