Failed Hearing Screening Research Articles

How Audiologists Can Support EHDI Goals

How Audiologists Can Support EHDI Goals

Communities Helping the Hearing of Infants by Reaching Parents (CHHIRP) through patient navigation: a hybrid implementation effectiveness stepped wedge trial protocol

IntroductionAs the most common neonatal sensory disorder in the USA, infant hearing loss has an incidence of 1.7 per 1000 births. The consequences of delayed diagnosis and failure to obtain...

Global Data on Ear and Hearing Screening in an Intellectual Disability Population.

Intellectual disability (ID) and hearing loss are frequent comorbid conditions, although otological problems often go unnoticed until picked up by screening. In the hearing program of Special Olympics (SO), athletes with ID are screened for otological problems. By retrospective analysis of all SO meetings between 2007 and 2017, more than 100,000 screenings could be included. Cerumen impaction was found in 40.7%, middle ear problems in 29.5% of those who failed hearing screening, and hearing loss confirmation in 26.9%. Prevalences for different world regions and country income groups are provided. The results emphasize the high prevalence of hearing loss in this ID population. Awareness among health care workers and active screening are required to reduce health disparities among this disadvantaged population.

Prevalence of hearing screening failures in low-risk childhood cancer survivors.

We sought to estimate the frequency of hearing screening failures in pediatric cancer survivors at low risk for hearing loss and evaluate the feasibility of administering screenings in this population. Survivors in the St. Louis Children's Hospital Late Effects Clinic were recruited. Eligibility included (a) diagnosis of a pediatric cancer treated without platinum chemotherapy or cranial radiation, (b) at least 6months from completion of therapy, (c) between the ages of 7 and 18years, (d) cognitively/behaviorally able to participate, and (e) English speaking. Behavioral hearing screenings from 1000 to 8000Hz were performed by trained personnel using a calibrated audiometer. A failed screen was defined by a participant not responding to two or more of the three screening attempts for at least one frequency in at least one ear. One hundred nine patients met eligibility criteria with 78 enrolled (71.5%). Diagnoses included leukemia (57.7%), sarcoma (11.5%), Wilms tumor (14.1%), lymphoma (12.8%), and other solid tumors (3.9%). The median age was 13.2years (Q1-Q3: 9.6-15.4) and the median time from treatment completion was 3.7years (Q1-Q3: 2.3-7.4). Eighteen patients (23%) failed the hearing screen (95% CI: 14%-34%). No demographic or treatment-related variables were significantly correlated to screening failure. Six screen failures (33%) underwent formal audiology assessments, with three demonstrating unilateral hearing loss: two conductive and one sensorineural. A significant fraction of pediatric cancer survivors at low risk for hearing loss failed hearing screening. Broader use of hearing screening should be considered.

Tympanic membrane reconstruction of a persistent perforation associated with massive myringosclerosis in a girl with achondroplasia – case report

Achondroplasia is a genetic disease connected with improper function of fibroblast growth factor receptor 3 (FGFR3) resulting in musculoskeletal disorders. Apart from characteristic musculoskeletal abnormalities (short statute with short proximal limb segments, prominent forehead, midface hypoplasia and a depressed nasal bridge) and generalized hypotonia it also affects otolaryngological field in a form of sleep-related upper respiratory tract disorders (obstructive and central apnea) and conductive hearing loss. This is the result of anatomical phenotype, together with Eustachian tube dysfunction. Interestingly, up to 25% of children with achondroplasia may fail hearing screening in one or both ears. In most cases laryngological disorders require surgical procedures, usually adenotomy, adenotonsillectomy, tonsillectomy or tube placement. Such surgical interventions increase the risk of complications, especially when repeated. We would like to present a case of a girl with achondroplasia that was qualified for myringoplasty because of persistent tympanic membrane perforation due to surgical extrusion of persistent ventilation tube, with associated massive myryngoslerosis.

Discussion on timing and method of surgical treatment for infants with middle ear effusion

Objective:To investigate the timing and method of surgical intervention for neonates diagnosed with middle ear effusion after hearing screening failure. Methods:① A total of 103 children were enrolled in this study and received follow-up evaluations for every month. ② After the first follow-up period for 3 months, the uncured cases were divided into three groups according to the course of the illness. Group Ⅰ is the group of improvement, group Ⅱ is the group of relapse, and the group Ⅲ is the persistent group. The infants will receive symptomatic treatment if necessary. After 6 months, surgical treatment would be recommended in the persistent cases and aggravation, the cases of improvement and cases that the parents don't receive the operation would continue to be observed. All patients were observed till they were cured or operated. The operation was performed with tympanostomy and ventilation tube insertion if necessary. ③The distribution of self-healing time was analyzed. Compare the difference of the number of the cases who followed up for 3 months, 6 months and finally recovered naturally. The self-healing rates of different influencing factors were compared. The final operation rate of group Ⅰ, groupⅡ and group Ⅲ were compared. Results:① The median distribution of self-healing time（month age） in 103 cases was 7.00[5.76, 8.24], and the number of self-healing cases decreased significantly after 9 months of age. There were 43 cases（41.75%）, 67 cases（65.5%） and 81 cases（78.64%） recovered naturally after 3 months, 6 months and follow-up in the end, and the difference was statistically significant. ②The self-healing rate of maxillofacial deformities was the lowest（8.33%）, and the difference was statistically significant compared with other factors. ③The final 22 cases underwent surgical treatment, including 1 case in group Ⅰ（3.45%）, 4 cases in group Ⅱ（30.77%）, and 17 cases in group Ⅲ（94.45%）, with statistically significant difference. ④17 children underwent tympanoplasty, 1 patient underwent tympanoplasty and adenoidectomy, and 4 children only underwent tympanotomy. The hearing of 22 cases returned to normal after operation, but 4 cases of patients with tympanotomy had recurrent tympanic effusion, among which 2 cases had serious effusion and had to be operated again. Conclusion:The infants diagnosed with tympanic effusion can be observed for more than 6 months before surgical intervention is considered. The characteristics of disease course and influencing factors during the follow-up period are of great significance to determine the time of surgical intervention for tympanic effusion in infants. Due to the long observation period, the operative method is suggested to perform tympanotomy tubes, and the possibility of recurrence after tympanotomy is high.

Congenital syphilis associated with hearing screening failure in southern Brazilian newborns

ObjectiveTo estimate the association between congenital syphilis and neonatal hearing screening failure in the state of Santa Catarina between 2017 and 2019. MethodsThis is a cross-sectional, retrospective, analytical study with secondary data of neonates from the state of Santa Catarina born between January 2017 and December 2019. We used logistic regression analysis to estimate the association between the main exposure (congenital syphilis) and the study outcome (failure in the Neonatal Hearing Screening). ResultsThe study included 21,434 newborns evaluated in a Brazilian hearing health care service. A total of 351 (1.6%) newborns failed the Neonatal Hearing Screening, and 364 (1.7%) had congenital syphilis. In the adjusted analysis, newborns with congenital syphilis were 3.25 times as likely to fail the Neonatal Hearing Screening as neonates without this disease (95% CI: 2.01; 5.26). As for maternal age, the sample had a higher prevalence (53.5%) of mothers aged 20–29 years. ConclusionThere was an association between congenital syphilis and failure in Universal Neonatal Hearing Screening in the sample studied. There is a need for investments in public policies to value and strengthen the hearing screening program in the state to provide early diagnosis and intervention. Level of evidence5

Proper Follow-up After Failed Hearing Screen in Newborns

Proper Follow-up After Failed Hearing Screen in Newborns

Early Hearing Detection and Intervention for Children with Craniofacial Anomalies

Early Hearing Detection and Intervention for Children with Craniofacial Anomalies

Twelve years of neonatal hearing screening: audiological and etiological results

Most developed countries have implemented some form of universal newborn hearing screening program. Early identification and rehabilitation of congenital hearing loss is important in functional outcome, and the need to identify the cause of hearing impairment has become clear. We aimed to evaluate audiological and etiological outcomes in a large group of patients with failed neonatal hearing screening. We performed a retrospective chart analysis of patients who were referred to our tertiary referral center after failing neonatal hearing screening during a 12-year period (2007-2019). Screening was based on automated auditory brainstem response (AABR) or a combined approach of AABR and auditory steady-state response (ASSR) with chirp stimulus. Extensive audiometric testing was performed to confirm and determine the type and degree of hearing loss. In case of permanent hearing loss, a standardized etiological protocol was followed to determine the cause. Of the 802 referred newborns, hearing loss was confirmed by diagnostic ABR in 78%. Main causes of hearing loss included otitis media with effusion (56%, higher in patients screened by AABR/ASSR compared to AABR), a genetic disorder (12%), congenital cytomegalovirus infection (cCMV, 5%) and atresia/stenosis of the external ear canal (5%). Of the patients with permanent hearing loss, 15% showed changes in hearing loss severity over time. In the majority of newborns referred after failing universal neonatal hearing screening, hearing loss could be confirmed. The leading cause was reversible hearing loss due to otitis media with effusion, but hearing loss proved permanent in about 35% of referred newborns, with genetics as predominant cause. Follow-up of congenital hearing loss patients is important as deterioration as well as improvement was observed over time.

Antimicrobial Resistance and Predictors of Adverse Outcomes in Neonates with Bacterial Meningitis: A Retrospective Study from a Tertiary Care Hospital of Northern India

AbstractThis study aimed to determine antimicrobial resistance pattern and predictors of adverse outcome in neonatal meningitis. A retrospective study by analyzing case files of 134 cases of neonatal meningitis. We noted an alarming degree of multidrug resistance (MDR) among both gram-negative (Klebsiella spp., 50%; Escherichia coli, 100%; and and Acinetobacter spp., 50%), as well as positive (Enterococcus, 100%) isolates in cerebrospinal fluid (CSF) culture. The incidence rate of adverse outcome (i.e., mortality and abnormal neurological examination at discharge) was 8.2 and 17.2%, respectively. On univariate analysis, delayed seeking of medical care, bulging anterior fontanelle, vomiting, positive sepsis screen, shock during hospital course, ventriculitis, diversion procedures for raised intracranial pressure, central line placement, low CSF sugar, and failed hearing screening test at discharge were associated with increased risk of adverse outcome. Further, delayed seeking of medical care, shock during hospital course, positive sepsis screen, thrombocytopenia, and MDR infections were independently found to be associated with adverse outcomes. An alarming degree of antimicrobial resistance among the CSF isolates necessitates the need to understand the pathogenesis of resistance and curtail the irrational prescription of antibiotics in neonatal meningitis. Further, delayed seeking of medical care, shock during hospital course, positive sepsis screen, thrombocytopenia, and MRD infection may have prognostic value in neonatal meningitis

Expanding the Role of Educational Audiologists After a Failed Newborn Hearing Screening: A Quality Improvement Study.

Purpose Lack of timely and proximal access to diagnostic hearing evaluation using auditory brainstem response (ABR) testing hampers the effectiveness of Early Hearing Detection and Intervention (EHDI) programs in the United States. This study measured the impact of a state-based quality-improvement (QI) project that provided diagnostic ABR equipment and training to educational audiologists distributed throughout Iowa in regional special education centers. Method We used de-identified administrative data generated by the state EHDI program to analyze markers of access to early hearing health care for infants in a preproject condition ("Baseline") compared to the implementation of diagnostic ABRs at the regional special education centers ("QI Project"). Results Our findings revealed that the QI Project was associated with improvements in timeliness of first hearing evaluation, distance traveled for first hearing evaluation, and likelihood of receiving on-guideline audiology care during the first hearing evaluation. Conclusions Following the onset of the QI Project, infants and their families had greater access to initial hearing evaluation after failed newborn hearing screening. This improvement could have cascading effects on timeliness of later intervention among those with confirmed permanent childhood hearing loss.

Congenital and Neonatally Acquired Sensorineural Hearing Loss.

Hearing loss is one of the most common congenital diagnoses, recognized in large part by a robust newborn hearing screening program. Ensuring appropriate follow-up of failed newborn hearing screening is crucial to avoid delay in initiation of treatment for hearing loss. The most common etiology for congenital hearing loss is genetic, but some cases can be acquired. Understanding of the etiology aids in counseling for the family and in direction of treatment. Early diagnosis and treatment results in dramatically improved speech and developmental outcomes for affected children. Treatment including amplification, speech therapy, adaptations in the classroom, and family support leads to gains in academic performance, parental satisfaction, and quality of life. Early cochlear implantation has been shown to be beneficial in obtaining speech and language skills in patients with severe to profound sensorineural hearing loss and should be considered in the appropriate patient population. [Pediatr Ann. 2021;50(7):e292-e296.].

#49: Management and Outcomes of Infants Born to Mothers with SARS-CoV-2 Infection in Pregnancy

BackgroundSARS-CoV-2 infections during pregnancy continue in this ongoing pandemic. Care of mother-infant dyads affected by SARS-CoV-2 infection in pregnancy has evolved. Perinatal viral transmission is rare. However, there remain few detailed reports on characteristics and management of these infants during neonatal hospitalization. Our objective was to investigate management and outcomes of infants born to women with laboratory-confirmed SARS-CoV-2 infection in pregnancy including resuscitation, NICU care, separation, and breastfeeding.MethodsThis is a study of mother-infant dyads with SARS-CoV-2 in pregnancy at Prentice Women’s Hospital in Chicago, IL (3/2020-11/2020). Dyads were tracked prospectively with data obtained by review of electronic medical records including demographics, maternal clinical history, COVID symptoms, and neonatal course. Women were universally screened with SARS-CoV-2 PCR at admission. Mothers were categorized as 1) acute infection (-14–0 days from delivery) vs. previous infection (>14 days), and 2) symptomatic vs. asymptomatic (defined by CDC criteria). Infants of mothers with acute infection were tested for SARS-CoV-2.ResultsWe report a diverse cohort of 210 women with SARS-CoV-2 in pregnancy, 114 acute and 96 previous infection (range 0–229 days between positive PCR and delivery) [Table 1]. Over half (56%) of women were symptomatic, 29/114 (25%) with acute infection, 89/96 (93%) with previous infection. Of 211 infants, one asymptomatic infant tested positive for SARS-CoV-2. The overall rate of preterm birth was 10.9% in this cohort. The rate of preterm birth was 26.6% (8/30) in the symptomatic acute infection group (p=0.055) and birthweight was significantly lower (p=0.03). There was no apparent increased need for resuscitation at delivery. APGARs were 8 (8–9) and 9 (8–9) at 1 and 5 minutes, respectively. Six percent of infants >35 weeks had respiratory distress. About 7% had failed hearing screen (historic Prentice rate ~4%). Separation of infants from mothers with acute infection decreased over time due to policy changes based on available safety data for rooming in (Cuzick’s test for trend p<0.001). Most infants (75%) received breastmilk in the hospital over this timeframe; this was low initially and increased over this timeframe (p<0.001). For example, 45% of mothers with acute infection provided breastmilk in May compared to nearly 100% in November. Twelve women were diagnosed with chorioamnionitis due to fever in labor and also had acute SARS-CoV-2 infection.ConclusionInfants of mothers with SARS-CoV-2 in pregnancy had favorable short-term outcomes, with decrease in separation and increase in breastfeeding over this timeframe. Complex factors likely contribute to differences in birthweight and prematurity in the acute symptomatic group. Isolated fever in the setting of acute SARS-CoV-2 presents a dilemma regarding maternal chorioamnionitis, resulting in antibiotic exposure. Longitudinal follow-up is needed to determine infant outcomes (true hearing loss, development) following maternal SARS-CoV-2 infection.Table 1:Characteristics and Outcomes of Infants of Women with SARS-CoV-2 Infection in PregnancyTotal N=211 1 twinAcute Infection(n= 115)Previous Infection(n = 96)Symptomatic# Acute Infection(n = 30)Symptomatic# Previous Infection(n = 89)p-value*Agemean (std)30.5 (6.2)29. 8 (6.1)31.4 (6.2)30.5 (6.3)31.7 (6.1)0.06 0.36Maternal Racen (%)<0.01 0.20Black/African American45 (21%)35 (30%)10 (10%)7 (23%)10 (11%)White61 (29%)30 (26%)31 (32%)7 (23%)29 (33%)Asian8 (4%)5 (4%)3 (3%)2 (7%)3 (3%)American Indian or Alaskan Native1 (0.5%)1 (1%)01 (3.5%)0Other96 (46%)44 (38%)52 (54%)13 (43%)47 (53%)Latina/Hispanicn (%)110 (52%)51 (44%)59 (62%)15 (50%)53 (60%).03 .39Days between test and delivery0 - 3 days91 (43%)91 (79%)14 (47%)4 - 14 days24 (11%)24 (21%)15 (50%)15 - 60 days49 (23%)49 (51%)49 (55%)61 - 120 days31 (15%)31 (32%)28 (32%)121+16 (8%)16 (17%)15 (17%)Vaginal delivery147 (70%)79 (69%)68 (71%)18 (60%)63 (71%)0.81 0.38Gestational age at birth0.67^ 0.055^<32 weeks2 (1%)1 (1%)1 (1%)1 (4%)1 (1%)32–36 weeks21 (10%)11 (10%)10 (10%)7 (23%)8 (9%)37+ weeks188 (89%)103 (90%)85 (89%)22 (73)80 (90%)Birth weight (g) mean (std dev)3263 (550)3264 (583)3263 (511)2997 (640)3260 (517)0.88 0.03NICU admission39 (18%)23 (20%)16 (17%)10 (31%)15 (17%)0.53 0.06ResuscitationDry and Stimulation151 (72%)96 (83%)55 (57%)24 (79%)52 (58%)<0.01 0.04Oxygen/Positive pressure19 (9%)9 (7%)10 (10%)5 (14%)10 (11%)0.46 0.74Intubation4 (2%)3 (2%)1 (1%)1 (4%)1 (1%)0.62 0.43Volume Expansion1 (0.5%)1 (1%)000Hearing screen failed196 (93%)109 (96%)87 (91%)28 (97%)80 (90%)0.26 0.58Respiratory distress17 (8%)12 (8%)5 (5%)7 (21%)5 (6%).21 .01Infants >35 weeks gestation12/199 (6%)7/108 (7%)5/87 (6%)4/27 (15%)5/84 (6%)1 0.21Administration of antibiotics30 (14%)20 (17%)10 (10%)9 (30%)9 (10%)0.15 <0.01Maternal chorioamnionitis20 (10%)12 (10%)8 (8%)2 (7%)8 (9%)0.64 0.99#Symptomatic infection was defined as any symptom consistent with SARS-CoV-2 infection/COVID-19 including fever, upper or lower respiratory symptoms, nausea, vomiting, diarrhea, myalgia/fatigue, anosmia*The top p-value listed comapres pregnancies affected by acute vs. previous infection. Bottom p-value listed compares only symptomatic acute vs. symptomatic previous infection. Comparisons were by Chi-square and Fisher’s exact tests.^Comparing dichotomized preterm (<37 weeks) vs full term

Loss to follow up of failed hearing screen and missed opportunities to detect congenital cytomegalovirus are better identified with the implementation of a new electronic health record system protocol

IntroductionCongenital CMV (cCMV) is the leading cause of non-genetic sensorineural hearing loss. Babies with cCMV can present with hearing loss any time but failing the initial hearing screen should trigger cCMV testing. cCMV must be identified within 3 weeks after birth to differentiate congenital from acquired CMV, yet follow-up hearing screens may not occur until after 21 days. A new electronic health record protocol to test cCMV in babies who fail their initial hearing screen was established at our institution in 2013. The purpose of this study is to evaluate adherence and deviations from this protocol. MethodsAll term infants born in 2013–2016 who failed initial hearing screen were included. The records were reviewed retrospectively. Demographic data, dates of hearing screens, CMV testing results and follow-up hearing test results were collected. ResultsA total of 19,069 newborn babies were screened between 2013 and 2016. Babies who were in the neonatal intensive care unit whether premature or not were excluded as these infants are often in the hospital longer than 3 weeks so audiologic diagnostic testing may be delayed. Among term newborns screened, 1358 failed initial screen and 444 failed subsequent hearing testing prior to discharge. We identified 60 babies who did not follow up and 59 underwent additional audiologic testing. Overall 38 babies were tested for cCMV with 2 positives. We found an increase in cCMV testing over time and a significant decrease between physical distance from birth hospital and outpatient audiologic follow-up testing within 21 days of birth. DiscussionOur results are consistent with a 0.4% rate of cCMV in full-term babies who failed their newborn hearing screen. From 2013 to 2016, more babies received CMV tests, but post-screening follow up was still delayed. Further research is necessary to address factors affecting follow up. Use of electronic health record eased identification of results and improved tracking.

Association between Hyperbilirubinemia and Hearing Screen Failure in the Neonatal Intensive Care Unit in Infants Born Preterm

To characterize the association between hyperbilirubinemia and a failed newborn hearing screen in infants born at 22-32weeks of gestation. We included infants with gestational ages of 22-32weeks who were discharged from neonatal intensive care units in the US from 2002 to 2017 with available newborn hearing screen results obtained after 34weeks postmenstrual age. We excluded infants with severe birth asphyxia or craniofacial abnormalities. We identified 95 672 infants from 313 neonatal intensive care units. We used multivariable logistic regression to examine the association between maximum total bilirubin at <21days postnatal age with failed hearing screen, adjusting for important demographic and clinical risk factors. The median gestational age and birth weight were 30weeks (IQR, 28-32weeks) and 1330g (IQR, 1010-1630g), respectively. The median maximum total bilirubin was 8.3mg/dL (IQR, 6.7-10.0mg/dL), and 5275 infants (6%) failed their newborn hearing screen. On adjusted analysis, each 1mg/dL increase in maximum total bilirubin was associated with a small, but significant, increase in odds of a failed hearing screen (OR, 1.03; 95% CI, 1.02-1.04). An increased maximum total bilirubin level was independently associated with hearing screen failure. Further prospective studies are needed to understand whether this increased risk of hearing screen failure translates to increased risk of hearing loss.

Assessment of Risk Indicators for Targeted Cytomegalovirus Screening in Neonates

Background: In the absence of universal screening for congenital cytomegalovirus (cCMV) infection, the aim of this study was to assess the outcomes of a targeted screening protocol based on maternal and neonatal risk indicators. Methods: The medical records of 2,623 neonates born in our maternal hospital between June 2016 and December 2018 and screened for cCMV infection were reviewed. Among those of the included neonates, the records of 380 CMV-negative and 19 CMV-positive neonates were randomly assigned to obtain additional comparative data. Results: During the study period, a total of 63 neonates were identified as positive for cCMV, comprising 0.2% of the total birth cohort (63/28,982) and 2.4% of all neonates screened for cCMV (63/2,623). The comparative data analysis showed that suspected or confirmed CMV infection during pregnancy, maternal age, and maternal diabetes mellitus were found to be significantly associated with a positive cCMV diagnosis. Although symmetric small for gestational age and hearing screening failure contributed to the detection of some of the CMV-positive infants, these factors were not specific to this group. The results of the logistic regression model showed that the only factor that was significantly associated with an increased risk for a cCMV diagnosis was maternal serology suspected of CMV infection during pregnancy, with a regression coefficient estimate of 2.657 (adjusted p < 0.001). Conclusions: A targeted neonatal screening protocol based on multiple maternal and neonatal risk indicators is feasible but provides limited information. Our study emphasizes the importance of universal neonatal screening for the detection of neonates with cCMV.

Hearing Screening Failure Among Students With Reading Impairment: Rate and Relation to Specific Reading Deficits

Background The purpose of this preliminary study was to explore one potential underlying factor that may contribute to poor reading outcomes: minimal hearing loss. Additionally, we compared decoding and comprehension deficits in students who passed or failed the hearing screening. Method Forty-three school-age students completed a hearing screening and a literacy assessment. Results Fifty-four percent of children with reading impairments failed the hearing screening, compared to only 21% of children with typical reading. Additionally, students who failed the hearing screening were more likely to exhibit decoding deficits; comprehension skills between the hearing screening groups did not differ. Conclusions Thus, children with reading impairments are more likely to fail hearing screenings than children with typical reading, and the deficits of those who fail hearing screenings appear to center on decoding rather than comprehension skills. Supplemental Material https://doi.org/10.23641/asha.12818252

La prima infezione urinaria febbrile in bambini di età compresa tra 2 mesi e 3 anni

Conductive, mild-moderate hearing impairment in children is a very frequent condition after newborn hearing screening that easily leads to misdiagnosis. Conductive hearing impairment needs an accurate differential diagnosis to avoid inadequate treatments. The paper reports a case of bilateral, sensorineural hearing impairment of moderate degree in a 5-month male infant that was diagnosed after the failure of newborn hearing screening and because of a family history of hearing loss. His parents asked for an advice about the need of hearing aids at the Audiological and Otolaryngology Department. The diagnostic and audiological assessment recognised a conductive, moderate hearing loss associated with tympanic effusion and velar-tube dysfunction. After two months, in the follow-up, the child’s hearing threshold was normal. The case underlines the importance of early identification of hearing impairment and of a complete evaluation programme before indicating any treatment.

Timing of newborn hearing screening in the neonatal intensive care unit: implications for targeted screening for congenital cytomegalovirus infection.

To determine when infants in the neonatal intensive care unit (NICU) have the first hearing screen performed, and thus inform targeted testing for cytomegalovirus (CMV)-related hearing loss. Retrospective review of electronic health records of infants admitted to a Level 4 outborn NICU and had a first hearing screen performed from 8/2016-8/2018. Among 1498 infants, 546 (36%) had a first hearing screen performed at age >21 days when a positive CMV PCR test cannot distinguish congenital from postnatal CMV acquisition. While most infants tested at >21 days of age were <34 weeks' gestational age (71%), 18% (n = 100) and 11% (n = 59) were ≥34 and ≥37 weeks' gestation, respectively. Targeted CMV testing for failed hearing screen in the NICU is problematic as 36% of infants did not have a hearing screen performed before 21 days of age, supporting the need for CMV screening at NICU admission.