Comparison of Newborn Hearing Screening in Well-Baby Nursery and NICU: A Study Applied to Reduce Referral Rate in NICU.

Pei-Chun Li,Ching-Ju Liu,Hung-Ching Lin,Chih-Ming Huang,Wei-I Chen,Hsiu-Wen Chang,Olivier Baud

doi:10.1371/journal.pone.0152028

Abstract

ObjectivesTo determine whether newborn hearing screening in a well-baby nursery (WBN) and neonatal intensive care unit (NICU) nursery: 1) meet three targeted, screening, referral, and diagnostic follow-up rates; 2) compare the average age of diagnosis for infants admitted to the WIN and NICU; and 3) determine prevalence of hearing loss in neonatal population; and 4) try to find a practical newborn hearing screening time algorithm to reduce refer rate in NICUMaterials and MethodsIt examined 15,624 newborns in the WBN (13,676) and NICU (1948) screened for congenital HL using AABR. The variables analyzed in it were the screening rate, referral rate, follow-up rate, diagnostic rate and diagnostic age, prevalence rate, degrees of congenital bilateral HL. The study was approved by the hospital’s institutional review board (13MMHISO23).ResultsThe screening rates were 99.8% and 99.6% in the WBN and NICU groups, respectively, without significant difference. The referral rates were 0.7% and 2.8% in the WBN and NICU groups, with significant difference. Furthermore, the diagnostic follow-up rates were 76.7% and 89.1% in the WBN and NICU groups, without significant difference. The average initial diagnostic ages were 1.9 months and 3.8 months in the WBN and NICU groups, with significant difference. The prevalence of congenital bilateral hearing loss were 0.27% and 1.6% in the WBN and NICU groups, with significant difference.ConclusionThe screening, referral and follow-up rate in the WBN and NICU groups were equivalent to the quality indicators. For NICU group, screening and diagnostic follow up were performed later than those in WBN group; however the lower referral rate in our NICU group was successfully achieved in this study and can be applied clinically. The prevalence of congenital bilateral hearing loss was higher in the NICU group than in the WBN group.

Highlights

The importance of universal early screening, diagnosis, and intervention in reducing the negative impact of congenital hearing loss (HL) has been described extensively all over the world [1,2,3,4,5]
The screening, referral and follow-up rate in the well-baby nursery (WBN) and neonatal intensive care unit (NICU) groups were equivalent to the quality indicators
For NICU group, screening and diagnostic follow up were performed later than those in WBN group; the lower referral rate in our NICU group was successfully achieved in this study and can be applied clinically

Summary

Introduction

The importance of universal early screening, diagnosis, and intervention in reducing the negative impact of congenital hearing loss (HL) has been described extensively all over the world [1,2,3,4,5]. The age of identification and diagnosis of as well as interventions for congenital hearing-impaired children have decreased gradually since the government established the newborn hearing screening program in Taiwan[5]. In Taiwan, the national program for UNHS by using AABR examination, free of cost for citizens, was implemented in 2012 and every Taiwanese newborn baby, including those in the well-baby nursery (WBN) and neonatal intensive care unit (NICU), should receive hearing screening before discharge from the hospital. In one study, the incidence of auditory neuropathy spectrum disorder (ANSD) in NICU babies was 24%, and screening them by using OAE examination resulted in false-negative findings[14]. The U.S NIH (1993) recommended that AABR, not OAE, examination be used as a hearing screening technique for babies with a high risk of HL according to the high risk register [16]

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