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Practice and challenges of newborn hearing screening: analysis of a five-year database in Italy
Davide Coraci1, Marta Fantoni2, Eleonora Tonon3
1Istituto Universitario di Studi Superiori IUSS Pavia, Pavia, Italy.
Insights
Effective newborn hearing screening requires optimizing Level 3 diagnostic and management processes. This study reveals organizational coordination issues impacting timely diagnosis and treatment for pediatric hearing loss.
Area of Science:
- Pediatric Audiology
- Public Health Programs
- Healthcare Management
Background:
- Universal newborn hearing screening (UNHS) is crucial for early intervention in children.
- International guidelines exist, but procedural and data management inconsistencies persist globally.
- Level 3 (diagnostic confirmation and therapeutic management) of UNHS is under-researched yet vital for program success.
Purpose of the Study:
- To investigate clinical and organizational aspects of Level 3 in a regional neonatal hearing screening program.
- To analyze patient flow, diagnostic timelines, and management practices within the screening pathway.
- To identify organizational factors influencing the efficiency and effectiveness of pediatric hearing loss care.
Main Methods:
- Retrospective analysis of data from 106 children in the Friuli-Venezia Giulia Region's UNHS program (2019-2023).
- Examination of the regional protocol, roles of healthcare facilities (birthing centers, hospitals, Regional Center), and pediatricians.
- Subdivision of Level 3 into four phases (A-D) to assess organizational and diagnostic functions, including patient flow and loss to follow-up.
Main Results:
- Organizational factors, especially coordination between local and specialized facilities, significantly impact diagnostic timelines.
- Inefficiencies in patient flow and management practices within Level 3 lead to delays in diagnosis and treatment initiation.
- Analysis revealed issues with false positives, loss to follow-up, and documentation affecting overall program quality.
Conclusions:
- Strengthening coordination between healthcare facilities is essential for improving the efficiency of pediatric hearing loss diagnosis.
- Addressing organizational weaknesses in Level 3 can enhance the accuracy and timeliness of care for newborns with hearing impairments.
- The study provides critical insights for optimizing UNHS program effectiveness and improving patient outcomes.
Abstract:
Early identification and treatment of hearing impairments are essential for children's development. International guidelines recommend a stepwise approach to conduct hearing screening in newborns. However, while the majority of countries worldwide implemented universal newborn hearing screening, inconsistencies remain in procedures and data management. In particular, Level 3 of the screening pathway-comprising diagnostic confirmation and therapeutic management-has received limited attention in the literature, despite its central role in determining program effectiveness and patient outcomes. This study investigates the clinical and organizational aspects of Level 3 within the neonatal hearing screening program of the Friuli-Venezia Giulia Region in Italy, analyzing data from 106 children enrolled between 2019 and 2023. The analysis considers the regional protocol, the roles of birthing centers, pediatricians, hospitals, and the Regional Center for Pediatric Hearing Loss Care, and subdivides Level 3 into four Phases (A-D) reflecting both organizational and diagnostic functions. By examining patient flow, false positives, loss to follow-up/documentation, and management practices, the study highlights how organizational factors-particularly the coordination between local and specialized facilities-produce "cascade" outcomes directly affecting diagnostic timelines and treatment initiation. Findings provide critical insights into weaknesses of the current system and propose directions for improving program efficiency, accuracy, and overall quality of care.
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