Hearing Screening in Newborns: Bridging the Gap Between Normal and High-Risk Infants

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.