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Not Passing Newborn Hearing Screening and Neurodevelopment at 2 Years in Infants Born Extremely Preterm
Katsuaki Kojima1, Carla M Bann2, Chelsea Blankenship3
1Division of Neonatology and Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
Insights
Not passing newborn hearing screening in extremely preterm infants is linked to slightly lower language and cognitive scores at two years. Early hearing follow-up and developmental monitoring are recommended.
Area of Science:
- Neonatal research
- Developmental pediatrics
- Audiology
Background:
- Newborn hearing screening is crucial for early detection of hearing loss.
- Extremely preterm infants are at higher risk for hearing impairment and developmental delays.
- Understanding the long-term neurodevelopmental impact of failing newborn hearing screening is essential.
Purpose of the Study:
- To investigate the association between failing newborn hearing screening and language, cognitive, and behavioral outcomes at 2 years corrected age in extremely preterm infants.
- To identify potential developmental risks associated with hearing screening failures in this vulnerable population.
Main Methods:
- Retrospective cohort study of 4,891 infants born between 22-26 weeks' gestation or 401-1,000g.
- Utilized mixed-effects models to analyze screening results against Bayley Scales of Infant and Toddler Development (Bayley) and Child Behavior Checklist (CBCL) scores.
- Adjusted for center, clinical, and sociodemographic covariates.
Main Results:
- 14% of infants did not pass newborn hearing screening.
- Infants who did not pass had modestly lower adjusted mean language (AMD: -2.6) and cognitive (AMD: -2.4) scores.
- Higher odds of mild-to-moderate language and cognitive impairments (scores <85) were observed, but not severe impairments (scores <70).
- No independent association was found with behavioral problems (CBCL scores).
Conclusions:
- Failing newborn hearing screening in extremely preterm infants is associated with mild-to-moderate language and cognitive deficits at two years corrected age.
- These findings underscore the importance of timely audiological follow-up and ongoing developmental surveillance for these infants.
- Early identification and intervention can mitigate potential long-term impacts.
Objective:
To evaluate the association between not passing newborn hearing screening and language, cognitive, and behavioral outcomes at 2 years' corrected age among infants born extremely preterm.
Study Design:
Retrospective cohort study of infants born at 22-26 weeks of gestation or 401-1000 g at Neonatal Research Network centers from 2012-2021 who completed predischarge newborn hearing screening and neurodevelopmental follow-up at 22-26 months' corrected age. Mixed-effects models estimated associations between screening result and Bayley Language and Cognitive Composite scores and Child Behavior Checklist (CBCL) Total Problems T-scores, with secondary analyses of clinically relevant Bayley and CBCL thresholds after adjustment for center and clinical and sociodemographic covariates.
Results:
Among 4891 infants, 690 (14%) did not pass newborn hearing screening. Compared with infants who passed, those who did not pass had modestly lower Bayley language (adjusted mean difference, -2.6; 95% CI, -4.1 to -1.1) and cognitive (adjusted mean difference, -2.4; 95% CI, -3.7 to -1.1) scores. They also had higher odds of Bayley language score <85 (aOR, 1.4; 95% CI, 1.1 to 1.7) and cognitive score <85 (aOR, 1.4; 95% CI, 1.1 to 1.7), but not of scores <70. Screening result was not independently associated with CBCL Total Problems T-score or with CBCL Total Problems T-score ≥60 or ≥64, although exploratory mediation analyses suggested small indirect associations through lower Bayley scores. In a small exploratory subgroup of infants who did not pass screening but had a normal inpatient diagnostic auditory brainstem response before discharge (n = 119), adjusted Bayley language and cognitive scores were also lower than among infants who passed screening.
Conclusions:
Among extremely preterm infants, not passing newborn hearing screening was associated with modestly lower language and cognitive performance at 2 years, particularly in the mild-to-moderate range, but not with early behavioral problems. These findings support prompt audiologic follow-up and developmental surveillance.
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