Hospital-based Universal Newborn Hearing Screening Research Articles

Community Health Worker Intervention for Newborns Not Passing Initial Universal Hearing Screening.

Universal newborn hearing screening (UNHS) is effective in identifying newborns with possible hearing loss (HL). Outpatient follow-up for newborns referred after hospital-based screening remains a potential area of improvement. In this study, we evaluate the efficacy of a community health worker (CHW) intervention in promoting adherence to outpatient rescreening for newborns referred after initial UNHS. A mixed prospective-retrospective cohort study was performed to evaluate a CHW intervention at an academic medical center. Caregivers of referred newborns were contacted by CHWs prior to discharge and educated about HL and the importance of follow-up screening. The CHW outreach intervention was performed for 297 referred newborns between May 2020 and June 2021 and compared to a cohort of 238 newborns without the CHW intervention between March 2019 and June 2021. Statistical analyses were conducted using 2 × 2 Chi-square tests, two-tailed unpaired t-tests, multinomial logistic regression, and multiple linear regression. In the intervention group, 236 of 297 newborns (79.5%) completed their outpatient follow-up rescreening; in the comparison group, 170 of 238 newborns (71.4%) completed their follow-up rescreening (P = .031, OR = 1.55 with regression P = .04). In the intervention group, the average time to follow-up was 13.4 days versus 12.5 days for the comparison group (P = .449, multiple R2 = .02 with P = .78). CHW outreach intervention may increase adherence to outpatient follow-up rescreening for newborns referred after initial, hospital-based UNHS. Expansion of nursery teams to include CHWs may thus improve completion of recommended follow-up hearing screens.

Identifying Quality Improvement Opportunities in a Universal Newborn Hearing Screening Program

Hospital-based universal newborn hearing screening (UNHS) programs are encouraged to maintain quality assurance protocols, but many hospitals lack the time and resources to initiate this process. We studied a practical approach to measuring baseline quality indicators and identifying improvement opportunities in UNHS programs. We determined screening processes and quality indicators for UNHS programs at 4 hospitals through site visits and a 2-year retrospective review of nursery and audiology records. Nurses, audiologists, and otolaryngologists met for feedback of hospital-specific quality indicators. The sessions identified improvement opportunities and proposed system changes for immediate implementation. Hospitals screened 21 957 newborns for hearing loss. Screening rates were >99% at all hospitals. Rates of referral and diagnostic testing varied significantly between hospitals. Low referral rates prompted 2 hospitals to adjust screening processes to reduce potential false-negative screening results. Two other hospitals addressed poor diagnostic follow-up by changing the referral process to include additional family contact information. Hospitals also increased referrals to Early Intervention Child Find services on the basis of our finding that these referrals increased the likelihood of diagnostic follow-up fourfold. We could not fully assess indicators of hearing aid eligibility and enrollment in early intervention services due to insufficient documentation. Review of nursery and audiology records successfully established most quality indicators for the UNHS programs we studied. Feedback of quality indicators identified multiple improvement opportunities and facilitated endorsement of immediate system changes. This study demonstrates a practical and data-driven approach to quality improvement that can be used by any UNHS program.

Quality Improvement in Universal Newborn Hearing Screening

Objective: Hospital-based universal newborn hearing screening (UNHS) programs are encouraged to maintain quality improvement protocols, but many hospitals lack the time and resources to initiate this process. A practical approach to measuring baseline quality indicators and identifying improvement opportunities in UNHS programs was studied. Method: Screening processes and quality indicators for UNHS programs at 4 hospitals were determined through site visits and a 2-year retrospective review of nursery and audiology records. Nurses, audiologists, and otolaryngologists met for feedback of hospital-specific quality indicators. Improvement opportunities were discussed, and system changes were proposed for immediate implementation. Results: Hospitals screened 21,957 newborns for hearing loss. Rates of screening were greater than 95% at all hospitals. Rates of referral and diagnostic testing varied significantly between hospitals. Low referral rates prompted 2 hospitals to adjust inpatient screening processes to reduce potential false-negative screening results. Two other hospitals addressed poor diagnostic follow-up by changing the referral process to include additional family contact information. Hospitals also recognized that referral to Early Intervention Child-Find services increased the likelihood of diagnostic follow-up four-fold ( P = .03). Documentation of hearing aid eligibility and enrollment in Early Intervention services was insufficient for retrospective determination of these quality indicators. Conclusion: Review of nursery and audiology records successfully established most quality indicators for the UNHS programs studied. Feedback of quality indicators identified multiple improvement opportunities and led to immediate system changes. This study demonstrates a practical and data-driven approach to quality improvement that can be used by any UNHS program.

Is discordance in TEOAE and AABR outcomes predictable in newborns?

Objective To determine the perinatal predictors of discordant screening outcomes based on a two-stage screening protocol with transient-evoked otoacoustic emissions (TEOAE) and automated auditory brainstem response (AABR). Methods A cross-sectional study of infants tested with TEOAE and AABR under a hospital-based universal newborn hearing screening program in Lagos, Nigeria. Maternal and infant factors associated with discordant TEOAE and AABR outcomes were determined with multivariable logistic regression analyses adjusting for potential confounding factors. Results Of the 4718 infants enrolled under the program 1745 (36.9%) completed both TEOAE and AABR. Of this group, 1060 (60.7%) passed both TEOAE and AABR (“true-negatives”); 92 (5.3%) failed both TEOAE and AABR (“true-positive”); 571 (32.7%) failed TEOAE but passed AABR (“false-positives”) while 22 (1.3%) passed TEOAE but failed AABR (“false-negatives”). Infants with false-positives were likely to be admitted into well-baby nursery ( p = 0.001), belong to mothers who attended antenatal care ( p = 0.010) or who delivered vaginally ( p < 0.001) compared to infants with true-negatives while infants with true-positives were also more likely to be delivered vaginally ( p = 0.002) or admitted into well-baby nursery ( p = 0.035) compared to infants with false-negatives. Infants with true-positives were significantly more likely to be delivered vaginally ( p < 0.001) and have severe hyperbilirubinemia ( p = 0.045) compared with infants with true-negatives. No association was observed between false-negatives and true-negatives. Antenatal care status, mode of delivery and nursery type were useful predictors of discordant outcomes among all infants undergoing screening ( c-statistic = 0.73). Conclusions Given the available screening technologies, discordant TEOAE and AABR may be inevitable for some categories of hearing loss among apparently healthy newborns whose mothers received prenatal care. The potential limitations of perinatal morbidities as basis of targeted screening for such cases therefore merit further consideration.

The universal newborn hearing screening in Brazil: From identification to intervention

Objective The objective of the study is to investigate the results of the newborn hearing screening program carried out in a Public Hospital in Brazil, in the first 3 years regarding: (1) the prevalence of hearing impairment; (2) the influence of the universal hearing screening program on the age at which the diagnosis of hearing loss is defined; (3) the cost effectiveness of the program; (4) the outcomes, in terms of the age in which the hearing rehabilitation started. Methods A descriptive study of the first 3 years after starting the universal newborn hearing screening in a Public Hospital of Bauru, São Paulo state, Brazil. The screening method consists of a two-stage screening approach with transient otoacoustic emissions (TOAE), conducted by an audiologist. If the outcome in the second-stage screening is REFER, the infant is submitted to diagnostic follow-up testing and intervention at the Audiology and Speech Pathology Clinic at the University of São Paulo, campus of Bauru. The evaluation of the costs of the universal newborn hearing screening program per each screened newborn (around 4000/year) was done based on a proposal by the National Center for Hearing Assessment and Management, of the Utah State University, United States of America. Results 11,466 newborns were submitted to hearing screening, corresponding to 90.52% of the living newborns. The prevalence of sensorineural hearing loss was 0.96:1000. Of the 11 children with sensorineural hearing loss, eight children received hearing aids and five started the therapeutic process before the age of 1. Currently, four children between the ages of 11 months and 2 years old were submitted to cochlear implant surgery. The cost of hearing screening was US$7.00 and the annual cost of the universal newborn hearing screening program was US$26,940.47. Conclusion The hospital-based universal newborn hearing screening carried out through the Brazilian National Health System is viable, with promising results. However, in a country such as Brazil, which presents large socio-economic differences, the same type of analyses should be performed in several regions, so as to take into account specific aspects, to implement the newborn hearing screening along with the Public System.

Use of Transitory Evoked Otoacoustic Emission and Distortion Product Otoacoustic Emission in a Newborn Hearing Screening Program in West Crete

Background and Aim: Permanent congenital hearing loss is a very serious, usually underestimated and misdiagnosed condition that influences the normal development of newborns. The aim of the study is to determine the accuracy and effectiveness of a hospital-based universal newborn hearing screening program for the early detection of permanent congenital hearing loss in West Crete using both TEOAEs and DPOAEs.

Hospital-based universal newborn hearing screening for early detection of permanent congenital hearing loss in Lagos, Nigeria

To determine the feasibility and effectiveness of hospital-based universal newborn hearing screening programme for the early detection of permanent congenital or early-onset hearing loss (PCEHL) in Lagos, Nigeria. A cross-sectional pilot study based on a two-stage universal newborn hearing screening by non-specialist health workers using transient evoked otoacoustic emissions (TEOAE) and automated auditory brainstem-response (AABR) in an inner-city maternity hospital over a consecutive period of 40 weeks. The main outcome measures were the practicality of screening by non-specialist staff with minimal training, functionality of screening instruments in an inner-city environment, screening coverage, referral rate, return rate for diagnosis, yield of PCEHL and average age of PCEHL confirmation. Universal hearing screening of newborns by non-specialist staff without prior audiological experience is feasible in an inner-city environment in Lagos after a training period of two-weeks. Notwithstanding excessive ambient noise within and outside the wards, it was possible to identify a test site for TEOAE screening within the hospital. The screening coverage was 98.7% (1330/1347) of all eligible newborns and the mean age of screening was 2.6 days. Forty-four babies out of the 1274 who completed the two-stage screening were referred yielding a referral rate of 3.5%. Only 16% (7/44) of babies scheduled for diagnostic evaluation returned and all were confirmed with hearing loss resulting in an incidence of 5.5 (7/1274) per 1000 live births or a programme yield of 5.3 (7/1330) per 1000. Six infants had bilateral hearing loss and the degree was severe (> or =70 dB nHL) in three infants, moderate (40 dB nHL) in one infant and mild (<40 dB nHL) in two infants. The age at diagnosis ranged from 46 days to 360 days and only two infants were diagnosed within 90 days. Hospital-based universal hearing screening of newborns before discharge is feasible in Nigeria. Non-specialist staff are valuable in achieving a satisfactory referral rate with a two-stage screening protocol. However, a more efficient tracking and follow-up system is needed to improve the return rate for diagnosis and age of confirmation of hearing loss.

A pilot project on hospital-based universal newborn hearing screening: Lessons learned

This paper reports the performance of a newly implemented hospital-based universal newborn hearing screening programme and the challenges to the effective implementation. Data of 4437 babies screened from April 2003 to February 2004 at Hospital Universiti Kebangsaan Malaysia was analyzed to measure the performance of the newborn hearing screening programme. Quality indicators, which include the coverage rate, initial refer rate, return for follow-up rate, ages of diagnosis and intervention were calculated. Factors contributing to poor compliance for follow-up were examined through questionnaire survey of 341 parents who did not bring their babies for the initial screening follow-up. The findings of this study revealed unsatisfactory performance of the hearing screening programme compared to the Joint committee of Infant Hearing recommendation [Joint Committee on Infant Hearing Year 2000 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs, Pediatrics 106 (4) (2000) 798-817]. The coverage rate, initial refer rate, and return for follow-up rate were 84.64, 11.97 and 56.97%, respectively. The average age of diagnosis was 3.56 months (S.D. 1.33). Only 1 of the 16 babies identified as having hearing loss through the screening programme has been fitted with hearing aids. Delay in coming to audiological certainty was one of the reasons hampering early intervention of these children. The commonly cited reasons for not returning for screening follow-up reflect the need to create public awareness of the importance of early diagnosis and intervention of hearing loss. The implementation of the present screening programme needs to be reviewed. Factors contributing to its unsatisfactory performance must be identified and steps must be taken to resolve them so that early identification and intervention of permanent congenital hearing loss can become a reality.

Advances in the Hearing Sciences: Current Research and Clinical Applications

Advances in the Hearing Sciences: Current Research and Clinical Applications

The feasibility of hospital-based universal newborn hearing screening in the United Kingdom.

Current hearing screening programmes in the United Kingdom are performing unacceptably poorly. Davies et al. (1997) suggested that universal newborn hearing screening (UNHS) would be more effective and cheaper to run. However, there is concern that hospital-based UNHS would not be feasible because of early postnatal discharge, and thus babies not staying in hospital long enough to be screened. Two studies were designed to determine the viability of hospital-based UNHS in a district general hospital in the United Kingdom. Study 1 retrospectively determined the discharge age and time of discharge of all 3021 well babies born at St Helier hospital, Carshalton, and the number of babies born at home in the area, from 19 October 1997-18 October 1998. Most well babies were found to pass through hospital at a convenient time for predischarge hearing screening, and the optimal protocol was screening from 9 am-2 pm, 7 days a week. The predicted maximal screening coverage was 92.68%. Study 2 tested the calculated optimal protocol over 1 week. It was found that UNHS with otoacoustic emissions on the maternity ward from 9 am-2 pm, 7 days a week, achieved a coverage of 89.06%, with an acceptable false positive rate of 6.2%. It is likely that a similar protocol with slight modifications could be implemented successfully in other hospitals in the United Kingdom.

Implantación de un programa para la detección precoz de hipoacusia neonatal

AbstractPermanent childhood hearing impairment is a serious public health problem. Identification by screening in the first few months of life has the potential to improve affected children development. Neonatal hearing screening programs endorse the WHO requirement for a cost efficient screening. This paper shows the implementation of a medium- size hospital-based universal newborn hearing screening program using transient evoked otoacoustic emissions. Operational procedures and requirements are discussed. Quality control and results are showed.

FACTORS INFLUENCING THE EFFICACY OF UNIVERSAL NEWBORN HEARING SCREENING

The debate surrounding the issue of universal hearing screening is being carried out on several levels. Although little disagreement exists over the educational, vocational, and quality-of-life benefits that would result from early identification and timely intervention of congenital hearing loss, the pragmatic issues, such as the effectiveness and the cost benefits associated with universal screening, cannot be ignored. This means that sensitivity, specificity, prevalence, and predictive value remain important factors. Determining the number of infants born with hearing loss in the United States each year, the prevalence issue is key to calculating the predictive value of newborn hearing screening. Emerging from current studies is that estimates of prevalence in the universal newborn population vary from 0.9 in 1000 for permanent bilateral hearing loss of more than 35 dB, to 3.24 in 1000 for bilateral hearing loss, to 5.95 in 1000 when unilateral and moderate hearing loss infants are counted. By comparison, the incidence of hearing loss in the NICU or at-risk population is accepted as high, somewhere between 2% and 4% or 20 to 40 in 1000. Incidence in the NICU varies depending on admission policies and level of care. In general, however, by screening the NICU and targeted at-risk populations, estimated to make up 10% to 16% of the newborn population, half or more of all newborns with severe to profound educationally disabling hearing loss are identified. Data from several well-conducted clinical studies, dating back to the first studies on the use of ABR to screen in the NICU, provide ample justification for the recommendation that all infants admitted to an NICU for longer than 24 hours should be screened for hearing impairment regardless of whether they have any of the at-risk indicators for hearing loss. In the author's opinion, screening in the NICU should be modeled on the operator-controlled ABR protocol outlined by Galambos and colleagues, with the addition that every ABR fail be screened by OAE before discharge. Unlike the targeted NICU population, the question remains for well infants, is sufficient clinical data or evidence available to justify screening all well newborns, specifically those with none of the at-risk for hearing loss indicators cared for in the well-infant nursery and who are discharged home within 24 or 48 hours? With the steady increase in the number of hospital-based universal newborn hearing screening programs implemented since the NIH Consensus Statement, additional data should become available to help resolve several outstanding issues, including prevalence and the predictive value of the various test protocols currently in use or proposed.