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The newborn with hearing loss: detection in the nursery
T Finitzo1, K Albright, J O'Neal
1Callier Center for Communication Disorders, University of Texas at Dallas, Texas, USA.
Insights
Early hearing loss detection in newborns is crucial for development. This study of 54,228 Texas infants found a 3.14/1000 incidence, highlighting the need for improved follow-up screening to connect at-risk infants with services.
Area of Science:
- Neonatal screening
- Audiology
- Public health
Background:
- Early detection of hearing loss is vital for infant speech, language, and cognitive development.
- Universal newborn hearing screening is a critical, multi-stage public health initiative.
- Breakdowns in screening, diagnosis, or intervention can impede developmental outcomes.
Purpose of the Study:
- To examine the effectiveness of the birth admission hearing screen for newborns.
- To evaluate factors influencing newborn hearing screening outcomes.
- To assess the incidence of hearing loss in a large newborn cohort.
Main Methods:
- Physiologic hearing tests (auditory brainstem responses or transient evoked otoacoustic emissions) were used for screening.
- Screening was conducted in newborn and intensive care nurseries prior to hospital discharge.
- Data from 54,228 Texas newborns were analyzed, evaluating screening rates, pass rates, follow-up attendance, and hearing loss identification.
Main Results:
- Over 54,000 newborns were screened, with over 50,000 passing before discharge.
- The incidence of sensorineural hearing loss was estimated at 3.14 per 1000 infants.
- 1224 infants returned for outpatient follow-up screening.
Conclusions:
- Effective nursery screening with low false-positive rates is achievable with audiology involvement, hospital support, and automated data management.
- Follow-up screening and tracking methods require enhancement to ensure timely connection to services for infants with hearing loss.
- Improved systems are necessary to connect at-risk newborns with essential intervention services.
Background:
Early detection of hearing loss coupled with appropriate early intervention is critical to speech, language, and cognitive development. These competencies serve as the foundation for later academic skills. For these reasons, many states are undertaking aggressive efforts to screen all newborns before hospital discharge. Universal detection of hearing loss in newborns is a three-stage process composed of 1) the birth admission screen, 2) follow-up and diagnosis, and 3) intervention services. Breakdown at any stage jeopardizes the entire effort. The goals of this research are to examine the birth admission screen by reviewing outcome measurements for 54 228 Texas newborns and to evaluate factors that impact outcomes positively or negatively.
Methodology:
All newborns were screened for hearing loss using a physiologic test of auditory function; either screening auditory brainstem responses or transient evoked otoacoustic emissions. Screening occurred in the newborn and intensive care nurseries, before hospital discharge in 9 sites as part of the nursery protocol. Patients. A total of 54 228 newborns were available for screening.
Outcome Measures:
Four measures were evaluated and are reported: the number of births screened, the number of newborns who passed the screen before discharge, the number of infants who returned for follow-up, and the number of infants identified with hearing loss. A Birth Screening Performance Index is also calculated.
Results:
Results are reported for calendar years 1994, 1995, 1996, and through June 1997. A total of 54 228 newborns were available for screening; 52 508 were screened before hospital discharge during their birth admission and 50 721 passed this screen. Infants returning for follow-up screen as outpatients numbered 1224. Over this 31/2-year span, 113 infants who failed the birth admission screening had hearing loss that was sensorineural in nature. From these data, the estimated incidence of hearing loss is 3.14/1000 infants.
Conclusions:
Screening in the nursery with low false-positive rates can be achieved when three elements are present: audiology involvement, hospital support, and automated data and information management. Follow-up measures need improvement. Better tracking methods may help assure that at-risk newborns are connected to services.
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