Challenges of Implementing Universal Newborn Hearing Screening at a Tertiary Care Centre from India.

Abstract

To report experience of implementing universal newborn hearing screening (UNHS) in a tertiary care neonatal unit, identify risk factors associated with failed two-step automated acoustic brainstem response (AABR) screen and evaluate cost of AABR. This was a prospective study of UNHS outcomes of all live births with two step AABR using BERAphone MB11®. Outcome measures were screening coverage, refer, pass and lost to follow up rates and cost of AABR using micro-costing method. To identify risk factors for failed screening, authors performed multivariate logistic regression with failed two-step AABR screen as dependent variable and baseline risk factors significant on univariate analysis as predictors. Screening coverage was moderate (84%), with 2265 of total 2700 eligible infants screened with initial AABR (mean gestation 37.2 ± 2.3wk; birth weight 2694 ± 588g; 305 received nursery care). A total of 273 of 2265 infants were "refer" on first screen. Second screen was done on 233, of which 58 were "refer". Of these, 35 underwent conventional ABR, of which 5 were diagnosed to have hearing impairment. Only 2 could get hearing aid. Overall, a total of 2197 (81.4%) infants passed, 496 (18.4%; excluding 2 deaths) were lost to follow up at various stages, and 5 (0.2%) were diagnosed with hearing impairment, all of whom were high risk. Average cost of AABR was INR 276 per test. No factor emerged as significant on multivariate analysis. UNHS is feasible to implement, but significant lost to follow up and non-linkage with appropriate rehabilitation services limit its utility.Cost effectiveness of UNHS compared to high risk based screening needs to be determined.