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Updated: May 26, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Hearing Screening in Newborns: Bridging the Gap Between Normal and High-Risk Infants
Bhanuprakash Pn1, Poonam Saidha1, Swetha Lakshmi M1
1Otolaryngology, MVJ Medical College and Research Hospital, Bengaluru, IND.
Insights
High-risk newborns show significantly higher hearing loss prevalence. Universal newborn hearing screening is crucial for early detection in all infants, including those without risk factors.
Area of Science:
- Pediatrics
- Audiology
- Neonatal Care
Background:
- Auditory perception is vital for early language and social development.
- Undetected hearing impairment negatively impacts cognitive and developmental outcomes.
- Universal newborn hearing screening (UNHS) facilitates early identification and intervention.
Purpose of the Study:
- Compare hearing loss prevalence in healthy versus high-risk neonates.
- Evaluate sequential screening effectiveness (OAE followed by BERA).
- Identify risk factors for hearing loss in high-risk neonates.
Main Methods:
- Prospective observational study of 1,460 neonates (945 healthy, 515 high-risk).
- Initial otoacoustic emissions (OAE) screening within 48 hours, repeat testing after two weeks.
- Brainstem evoked response audiometry (BERA) for confirmation within three months for non-passers.
Main Results:
- Prevalence of confirmed hearing loss: 5.3/1,000 healthy neonates vs. 23.3/1,000 high-risk neonates.
- BERA confirmed hearing impairment in 17 infants, primarily in the high-risk group.
- Sequential OAE and BERA screening demonstrated effectiveness.
Conclusions:
- High-risk neonates have a significantly higher prevalence of confirmed hearing loss.
- Hearing impairment occurs even in infants without identifiable risk factors, underscoring UNHS importance.
- Sequential OAE and BERA screening is effective for early and accurate diagnosis of neonatal hearing loss.
Abstract:
Background and objectives Auditory perception is essential for language acquisition and social communication in early life. Undetected hearing impairment can adversely affect cognitive and developmental outcomes. Universal newborn hearing screening (UNHS) enables early identification and timely intervention. The primary objective of this study was to compare the prevalence of confirmed hearing loss between healthy and high-risk neonates. Secondary objectives included evaluating the effectiveness of sequential screening using otoacoustic emissions (OAE) followed by brainstem evoked response audiometry (BERA), assessing referral rates at different stages of the screening protocol, and identifying risk factors associated with confirmed hearing loss among high-risk neonates. Methods This prospective observational study was conducted over a period of 12 months at a tertiary care center, including 1,460 neonates: 945 classified as healthy and 515 as high-risk based on established clinical criteria. All infants underwent initial OAE testing within 48 hours of birth. Those who did not pass were retested after two weeks. Infants who failed both screenings underwent BERA within three months for confirmation. Results Among 945 healthy neonates, 87 failed the initial OAE, with 13 remaining as referral cases after repeat testing. In the high-risk group (n = 515), 147 failed the first OAE, and 36 continued to fail after repeat testing. BERA confirmed hearing impairment in 17 infants, predominantly in the high-risk group. The prevalence of confirmed hearing loss was 5.3 per 1,000 in healthy neonates and 23.3 per 1,000 in high-risk neonates. Conclusions A significantly higher prevalence of confirmed hearing loss was observed among high-risk neonates compared to healthy infants. However, the presence of hearing impairment in infants without identifiable risk factors supports the need for UNHS. Sequential screening using OAE followed by confirmatory BERA is effective for early and accurate diagnosis.
