National Newborn Hearing Screening Program Research Articles

Universal newborn hearing screening program in Saudi Arabia: Current insight

Newborn hearing screening (NHS) programs are essential to identify hearing loss early in life and to improve outcomes in children. In Saudi Arabia, the national NHS program has been operational since 2016; however, few studies have evaluated its status, and none have covered all provinces across the country. This cross-sectional retrospective study provides an overview of the program's status across all provinces, focusing on screening coverage rates, referral/fail rates, and follow-up procedures. In 2021, 199,034 newborns were screened, with a coverage rate of 92.6% and an overall referral/fail rate of 1.87%. These performance measures provide a foundation for future progress and improvements. This study highlights the importance of ongoing efforts to enhance the program's effectiveness and sustainability.

Evaluation of newborn hearing screening results of infants with phenylketonuria

ObjectiveThe purpose of this study is comparing the newborn hearing screening failure rate between phenylketonuria (PKU) infants and matched healthy control infants. Patients and methodsBetween April 2021 and April 2023, data obtained from the national newborn hearing screening program were examined for patients who presented to the pediatric metabolism clinic of Konya City Hospital with a clinical and genetic diagnosis of PKU. A healthy control group, matched for age and gender, was established. The newborn hearing screening test results, demographic information, and pregnancy data of infants with PKU and the control group were compared to assess risk factors. ResultsIn the initial screening test, 23 out of 73 PKU infants (31.5%) and 12 out of 73 infants in the control group (16.4%) failed the test (p = 0.033). Among the 23 PKU infants who did not pass the first test, 9 (35%) also failed the second test and were referred. In contrast, all 12 infants in the control group who did not pass the first test passed the second test. The failure rate in the second test was significantly higher in PKU infants compared to the control group (p = 0.003). It was observed that the maternal age of PKU infants who underwent the second test was significantly higher than that of the control group (p < 0.029). Diagnostic hearing test results were found to be normal in all nine PKU patients who failed the secondary screening test and were referred to a tertiary center. ConclusionIn our study, it was determined that infants with phenylketonuria (PKU) who did not have any risk factors for hearing loss failed the hearing screening test significantly more than healthy infants.

Which stimulus should be used for auditory brainstem response in newborns; CE-Chirp® level specific versus Click stimulus.

Auditory Brainstem Response (ABR), the electrical responses in the neuronal pathways extending from the inner ear to the auditory cortex, are evaluated with auditory stimuli. ABR analysis evaluates waves I, III and V's absolute-latencies, amplitude values, interpeak-latencies, interaural-latency differences, and morphologies. This study aims to reveal the advantages of CE-Chirp® LS stimulus and its clinical uses to increase by comparing the amplitude, latency, and interpeak-latency differences of waves I, III, and V at 80dB nHL and wave V at 60, 40, 20dB nHL by using click and CE-Chirp® LS stimuli. 100 (54 boys, 46 girls) infants with normal hearing were included in the National Newborn Hearing Screening Program. With the click and CE-Chirp® LS ABR, the absolute latency and amplitude values of wave V at 20, 40, and 60dB nHL, and the absolute-latency, interpeak-latency, and amplitude values of waves I, III, and V at 80dB nHL are determined between stimuli and right-left ear. When the wave V latency and amplitudes obtained at 80, 60, 40, and 20dB nHL levels were examined between genders, and according to the risk factor, no significant difference was found between click and CE-Chirp® LS stimuli (p>0.05). Waves I, III, and V absolute-latency, amplitudes were compared at 80dB nHL and wave V absolute-latency, amplitudes at 60, 40, and 20dB nHL; the amplitudes measured with CE-Chirp® LS were significantly higher than the click stimulus (p<0.05). When two stimuli were compared for I-III and III-V interpeak-latency values at 80dB nHL level, no significant difference was found between the two stimuli (p>0.05). However, the I-V interpeak-latency value was statistically significantly decreased for two stimuli, regardless of the ear (p<0.05). It is suggested to increase the use of CE-Chirp® LS stimulus with better morphology and amplitude in clinics, believing that it facilitates clinicians' interpretation.

Delayed Cochlear Implantation in Children: A Parental Survey

Background: Untreated childhood hearing loss can adversely affect speech and language development as well as academic, social, emotional, and behavioral development. Early cochlear implantation before the age of 4 years, within the critical period for central auditory development, was found to be crucial in reducing the negative impact of auditory deprivation and appears to provide better outcomes than late implantation.&#x0D; aim: The aim of this study was to determine the reasons behind late cochlear implantation in children with congenital severe to profound sensorineural hearing loss.&#x0D; Methods: A retrospective study was conducted on all cases who received cochlear implants at Specialty Surgical Center, Benghazi, Libya between October 2017 and June 2021. Patients' medical records were reviewed and demographic and clinical data were collected. Children with other disabilities, and post-lingual and post-meningitis implantees were excluded from the study. Information about the reasons for the delay in receiving cochlear implants was obtained over the phone from parents whose children underwent cochlear implant surgery beyond the age of 4 years.&#x0D; Results: A total of 74 children were included, 38 boys and 36 girls. The mean age at implantation was 47 months. Forty-one percent (41%) of children were implanted after 4 years of age. Two-thirds of these children live outside Benghazi. Most of the children had at least one risk factor for hearing loss. The majority of parents reported more than one reason for the delayed implantation.&#x0D; Conclusion: It is found that parent decision-making for cochlear implantation is difficult and affected by many factors, including their personal beliefs (denial, social stigma and fear of surgery), lack of awareness about the existence of cochlear implant technology, and financial constraints. It is recommended that a national newborn hearing screening program is established for early detection and intervention and cost-effectiveness.

Evaluation of the effectiveness of newborn hearing screening program: A center in Turkey.

The present study aimed to analyze the effects of newborn hearing screening program in Turkey based on the age of diagnosis, amplification and initiation of education between 2000 and 2017. The study was designed as a retrospective study. The files of 997 children registered with a research and education center for children with hearing loss were analyzed. The findings indicated that the age of diagnosis, amplification and initiation of education significantly decreased after the national newborn hearing screening program was introduced throughout the years. However, the recommended universal standards were achieved only for a minority of children in terms of timely diagnosis and early intervention. Delay in amplification mostly observed in children with mild-moderate loses and late diagnosis, was found as related to the testing in more than two different clinics. The findings on late initiation of education were discussed based on the reports in relevant literature and monitoring problems after the diagnosis and the problems observed in early education system in Turkey.

Hearing loss-related knowledge and attitude toward neonatal hearing screening among Egyptian parents

BackgroundHearing loss is considered one of the most prevalent global health concerns. In Egypt, the accurate estimation of hearing loss among children is difficult to be determined owing to the absence of a national hearing screening program until now. The parents play an important role in the process of hearing screening and intervention. Their knowledge and attitude certainly influence their decisions. Their decisions toward early identification and intervention of hearing loss may have lifelong effects on the infant’s life.AimTo assess the knowledge and attitude of Egyptian parents toward risk factors of infant hearing loss and its neonatal screening and treatment.MethodsA cross-sectional study was conducted among 384 Egyptian parents through convenience sampling technique using an online questionnaire over a period of 3 months (from August 2018 to November 2018).ResultsOverall, 51.6% of the parents who participated in the study had a good knowledge about hearing loss, and 99.5% had a good attitude toward neonatal hearing screening. There was no significant association between knowledge, attitude, and sociodemographic characteristics except between the attitude toward child wearing of hearing aid and age of the parents.Conclusion and recommendationIn spite of good positive attitude toward neonatal hearing screening and infant wearing of hearing aids among the studied parents only half of them showed a good level of knowledge about hearing loss. Accordingly, the application of a national newborn hearing screening program is highly recommended.

Assessing and monitoring the impact of the national newborn hearing screening program in Israel

BackgroundThe Israeli Newborn Hearing Screening Program (NHSP) began operating nationally in January 2010. The program includes the Otoacoustic Emissions (OAE) test for all newborns and Automated Auditory Brainstem Response (A-ABR) test for failed OAE and infants at risk for auditory neuropathy spectrum disorders. NHSP targets are diagnosis of hearing impairment by age three months and initiation of habilitation by six months.Objectives(1) Review NHSP coverage; (2) Assess NHSP impact on age at diagnosis for hearing impairment and age at initiation of habilitation; (3) Identify contributing factors and barriers to NHSP success.Methods(1) Analysis of screening coverage and referral rates for the NHSP; (2) Analysis of demographic data, results of coverage, age at diagnosis and initiation of habilitation for hearing impaired infants pre-implementation and post-implementation of NHSP from 10 habilitation centers; (3) Telephone interviews with parents whose infants failed the screening and were referred for further testing.ResultsThe NHSP coverage was 98.7% (95.1 to 100%) for approximately 179,000 live births per year for 2014–2016 and average referral rates were under 3%. After three years of program implementation, median age at diagnosis was 3.7 months compared to 9.5 months prior to NHSP. The median age at initiation of habilitation after three years of NHSP was 9.4 months compared to 19.0 prior to NHSP. Parents (84% of 483 sampled) with infants aged 4–6 months participated in the telephone survey. While 84% of parents reported receiving a verbal explanation of the screening results, more than half of the parents reported not receiving written material. Parental report of understanding the test results and a heightened level of concern over the failed screen were associated with timely follow-up.ConclusionsThe findings indicate high screening coverage. The program reduced ages at diagnosis and initiation of habilitation for hearing impaired infants. Further steps needed to streamline the NHSP are improving communication among caregivers to parents to reduce anxiety; increasing efficiency in transferring information between service providers using advanced technology while ensuring continuum of care; reducing wait time for follow-up testing in order to meet program objectives. Establishment of a routine monitoring system is underway.

Universal neonatal hearing screening in a tertiary care center in South India

Objective: The aim of the study is to determine the prevalence of hearing loss among newborn infants and to assess the effectiveness and utility of otoacoustic emission (OAE) as a screening tool to detect hearing impairment in newborns and the relationship between selected risk factors and hearing loss. Study Design: This study involved 3121 newborns delivered in a tertiary care center over a 3-year period, who were subjected to distortion product OAE (DPOAE) within 24–72 h of life; failed candidates underwent repeat DPOAE after 30 days. Infants failed the second DPOAE test and then underwent DPOAE and brain stem-evoked response audiometry (BERA) at 3 months of life. Results: 20.95% newborns failed the first screening test, 11.77% failed the second test, and 61.91% of these infants failed the third OAE test. Of the 26 infants who failed the third test, 15 had abnormal results on BERA. Overall, the prevalence of hearing loss was 0.48%. Conclusion: Implementation of a national universal newborn hearing screening program in India is the need of the hour, as early detection of hearing loss will aid early rehabilitation and better outcomes.

Regional differences of Turkey in risk factors of newborn hearing loss

ObjectiveThe aim of this study was to discover Turkish regional differences in the risk factors of newborn hearing loss. MethodA multi-centered retrospective design was used. A total of 443 children, registered to the national newborn hearing screening programme, with bilateral hearing loss, from five different regions of Turkey, were evaluated in terms of the types of hearing loss, the degree of hearing loss, the types of risk factors, parental consanguinity, age at diagnosis and age of auditory intervention, respectively. ResultsThere was no significant difference in the prevalence of hearing loss between regions (χ2 = 3.210, P = 0.523). Symmetric Sensorineural Hearing Loss (SSHL) was the most common type of HL in all regions (91.8%). Profound HL was the most common degree of HL in all regions (46.2%). There were statistically significant differences between regions in terms of types of HL (χ2 = 14.151, P = 0.000). As a total, 323 (72.9%) of subjects did not have any risk factors. There were statistically significant differences between regions in terms of the types of risk factors (pre, peri and post-natal) for SSNHL (χ2 = 16.095, P = 0.000). For all regions, the age of diagnosis was convenient with the JCIH criteria. However the age of hearing aid application was prolonged in some regions. There were statistically significant differences between regions in terms of the age of diagnosis (χ2 = 93.570, P = 0.000) and the age of auditory intervention (χ2 = 47.323, P = 0.000). The confounding effects of gender, age of diagnosis, age of hearing aids applications, HL in the family, types of risk factors for HL on SSNHL were detected. ConclusionTo reach the goal of a high quality newborn hearing screening, there is a need to develop an evidence-based standard for follow up guideline. In addition, risk factors should be re-evaluated according to regional differences and all regions should take their own precautions according to their evidence based data.

The influence of newborn hearing screening on the age at cochlear implantation in children.

To evaluate the influence of the introduction of newborn hearing screening programs on the age at cochlear implantation in children. Retrospective, multicenter cohort study. All 1,299 pediatric cochlear implant users who received their implants before the age of 5 years between 1995 and 2011 in the Medical University Hannover, Germany and University Medical Center Utrecht, the Netherlands were enrolled in this study. Age at implantation and the number of children implanted within the first year of life was assessed for each center. Age at cochlear implantation gradually declined over the years in both centers. The introduction of the screening resulted in significant decline in the age at implantation in the Netherlands; simultaneously, the number of children implanted within their first year of life increased significantly. Comparing 4-year epochs immediately before and after introduction of the screening, the mean age decreased from 2.4 to 1.2 years, and the percentage of early implanted children increased from 9% to 37%. In the German population, a similar effect of the introduction of the hearing screening program was absent. The introduction of the national newborn hearing screening program has reduced the age at cochlear implantation in young children in the Netherlands but not in Germany. Correspondingly, it resulted in an increase in the number of children implanted early in life. The difference between the Dutch and German population might be due to differences in the follow-up and referral after the hearing screening.

An effective collaboration between parent associations and medical professionals: the Italian Pediatric Federation Audiology Network

In the absence of a national newborn hearing screening program in Italy, parent associations have been working with the Italian Paediatric Federation (FIMP), the Society of Neonatology (SIN) and members of the Italian Society of Audiology and Phoniatrics (SIAF) to promote guidelines, best practice and training courses in early hearing detection intervention that incorporate sensitivity training for professionals working with families of deaf children. The establishment of the Italian Paediatric Federation’s Audiology Network is the result of an international collaboration between parents and medical professionals designed to promote an effective model in developing Early Hearing Detection Intervention Programs (EHDI) that recognize the role of parents as partners in the process. Among other factors, one important component frequently underestimated in most early intervention programs, both in the USA and in other countries, involves the role of parental involvement within the EHDI process. [1] From screening to identification and intervention, families must navigate through medical institutions, government and private agencies, their own family construct and community and other dynamics when raising a child who is affected by hearing loss. Family support is the “map” that keeps this process moving effectively, with sensitivity to the social and emotional needs a family will have as it adjusts to its baby’s diagnosis. The family is the social context into which children who are deaf/hard of hearing are born. The impact of a child’s hearing loss affects not only the child, but the parents, siblings, extended family and community as well. After five years of working region by region in Italy, the network recently held its first National Pediatric Course of Audiology where the parental voice was fundamental in providing sensitivity training and in recruiting the participation of pediatricians with patients diagnosed with hearing loss. In the absence of a Regional Protocol for Newborn Hearing Screening in Sicily, the Association Io Sento offers assistance to families of children with hearing loss. The Association collaborates with health structures and agencies to offer resources that inform, educate and support families regarding diagnosis, school services, the cochlear implant, speech habilitation by using a network created by information technology.

A004 Results of national newborn hearing screening program in Erzurum between 2007–2010

A004 Results of national newborn hearing screening program in Erzurum between 2007–2010

Cochlear microphonics in sensorineural hearing loss: Lesson from newborn hearing screening

The diagnostic dilemma surrounding the presence of cochlear microphonics (CM) coupled with significantly elevated auditory brainstem response (ABR) thresholds in babies failing the newborn hearing screening is highlighted. A case report is presented where initial electo-diagnostic assessment could not help in differentiating between Auditory Neuropathy/Auditory Dys-synchrony (AN/AD) and sensorineural hearing loss (SNHL). In line with the protocol and guidelines provided by the national Newborn Hearing Screening Programme in the UK (NHSP) AN/AD was suspected in a baby due to the presence of CM at 85 dBnHL along with click evoked ABR thresholds of 95 dBnHL in one ear and 100 dBnHL in the other ear. Significantly elevated thresholds for 0.5 and 1kHz tone pip ABR fulfilled the audiological diagnostic criteria for AN/AD. However, the possibility of a SNHL could not be ruled out as the 85 dBnHL stimuli presented through inserts for the CM would have been significantly enhanced in the ear canals of the young baby to exceed the threshold level of the ABR that was carried out using headphones. SNHL was eventually diagnosed through clinical and family history, physical examination and imaging that showed enlarged vestibular aqueducts. Presence of CM in the presence of very high click ABR thresholds only suggests a pattern of test results and in such cases measuring thresholds for 0.5 and 1 kHz tone pip ABR may not be adequate to differentiate between SNHL and other conditions associated with AN/AD. There is a need for reviewing the existing AN/AD protocol from NHSP in the UK and new research to establish parameters for CM to assist in the differential diagnosis. A holistic audiological and medical approach is essential to manage babies who fail the newborn hearing screening.

Universal Newborn Hearing Screening and Early Identification of Deafness: Parents' Responses to Knowing Early and Their Expectations of Child Communication Development

This article presents results from an interview study of 45 parents/caregivers (representing 27 families) whose infants were correctly identified as deaf during the first phase of the implementation of the national universal Newborn Hearing Screening Programme in England. Average age of children when parents were interviewed was 25 weeks. Two issues are explored: (a) how parents talk about significance of knowing early that their child is deaf and (b) parents' expectations of their child's development in light of early identification. Although results demonstrate clear support from parents' perspective of knowing early, they also identify the psychological complexities of recognizing both the grief and reassurance that early knowledge brings; the risks of early knowledge-inducing timetables of expectations that create distress when not met speedily; the extent to which parental models of the developmental advantages of early identification are underpinned by notions of normal speech and the possibility of being like hearing children; and the pervasiveness of deficit and illness models associated with having identified deafness early. Implications for parental support and professional responses are also discussed.

Neonatal hearing screening: modelling cost and effectiveness of hospital- and community-based screening

BackgroundChildren with congenital hearing impairment benefit from early detection and management of their hearing loss. These and related considerations led to the recommendation of universal newborn hearing screening. In 2001 the first phase of a national Newborn Hearing Screening Programme (NHSP) was implemented in England. Objective of this study was to assess costs and effectiveness for hospital and community-based newborn hearing screening systems in England based on data from this first phase with regard to the effects of alterations to parameter values.MethodsDesign: Clinical effectiveness analysis using a Markov Model. Outcome measure: quality weighted detected child months (QCM).ResultsBoth hospital and community programmes yielded 794 QCM at the age of 6 months with total costs of £3,690,000 per 100,000 screened children in hospital and £3,340,000 in community. Simulated costs would be lower in hospital in 48% of the trials. Any statistically significant difference between hospital and community in prevalence, test sensitivity, test specificity and costs would result in significant differences in cost-effectiveness between hospital and community.ConclusionThis modelling exercise informs decision makers by a quantitative projection of available data and the explicit and transparent statements about assumptions and the degree of uncertainty. Further evaluation of the cost-effectiveness should focus on the potential differences in test parameters and prevalence in these two settings.

Cochlear implants: informing commissioning decisions, based on need

Cochlear implantation is a high cost, low volume intervention which is provided to adults and children with profound hearing impairment. Demand is increasing in the UK as a result of improved technology, changes in intervention criteria and the national newborn hearing screening programme. In order to inform commissioning policy for cochlear implantation in five English primary care trusts, we reviewed the evidence and assessed the complexities of developing needs and of service provision assessment and planning. Our results indicated that the current level of provision was well below what would be expected if the majority of people meeting current criteria were given a cochlear implant. Gaps between the clinical intervention thresholds and the level of service commissioned have widened. Long-term cost effectiveness and incidence studies are needed to assess cochlear implantation in the light of these lower clinical intervention thresholds.

Effectiveness of Population-Based Newborn Hearing Screening in England: Ages of Interventions and Profile of Cases

The objective of this study was to determine the effectiveness in routine practice of the first phase of a national population-based newborn hearing screening and follow-up program that seeks to identify infants with bilateral permanent hearing loss of > or =40-dB hearing loss. The study was a part of the independent evaluation of the 23 first phase sites (annual birth population approximately 120,000) of the national newborn hearing screening program in England. For each infant identified with the defined hearing loss, the measures of interest were degree and type of hearing loss, presence of risk factors, age of first audiologic assessment, age of identification of hearing loss, age of enrollment in an early support program, and age of hearing aid fitting. Data collection took place over the first 2 years of the program. Data were provided on 169 infants with permanent bilateral moderate or greater hearing loss identified through screening 169487 infants. Fifty-four percent of all cases were from an "at-risk" population. Three fourths of these "at-risk" infants spent > or =48 hours in the NICU. For the whole sample, the median age at first audiologic assessment was 5 weeks; the median age of identification of the hearing loss and of enrollment in early support program was 10 weeks irrespective of the degree of hearing loss; and the median age at hearing aid fitting was 16 weeks. Infants with moderate hearing loss were fitted with hearing aids significantly later than those with severe and profound hearing loss. Properly implemented, a newborn hearing screening program based on whole populations and routine service provision can deliver satisfactory outcomes in terms of age of referral, identification, and intervention. The distribution of degree and type of hearing loss and proportion with risk factors was similar to that expected. The numbers identified were such as to suggest that very few cases were missed by the screening program.

An analysis of the costs of implementing the National Newborn Hearing Screening Programme in England

The primary aim of this analysis was to prospectively assess the full economic costs associated with implementing Newborn Hearing Screening Programme (NHSP) based on a two-stage screen, transient evoked otoacoustic emissions followed, if there is no clear response, by automated auditory brainstem response. Economic data were also collected from the Infant Distraction Test Screening (IDTS) service performed by health visitors at around eight months of age, which was being phased out. A comparison of costs and outcomes associated with NHSP and IDTS was conducted. 20 NHSP sites were invited to provide detailed cost data on NHSP implementation and 14 of these sites were selected to provide costs on the IDTS service that was being supplanted. There was marked variability in the costs. Given the higher yield of NHSP sites, the average cost per case detected across NHSP sites (31,410 pounds/case) was approximately half that of IDTS sites (69,919 pounds/case). Including family costs, the average total cost per case of NHSP (34,826 pounds/case) was almost a quarter of IDTS (117,942 pounds/case). Family costs and cost per case associated with NHSP are considerably less than that with IDTS. These findings support the policy of implementation of NHSP and the phasing out of the IDTS.

The Impact of the National Newborn Hearing Screening Programme on Educational Services in England

This article presents results related to the impact on educational support services of the introduction of the first phase of the national Newborn Hearing Screening Programme (NHSP) in England. This study was funded by the Department of Health and undertaken as one element of a national evaluation of NHSP across a range of domains. It presents results from a qualitative study of 27 educational services before and after the implementation of NHSP. Key themes were identified and analysed using QSR NU…DIST 4. The analysis used case and cross case perspectives. The key areas identified included links between services, inter-agency working, changes in working practice, funding and resource implications and the perceived opportunities of NHSP. It considers the political context within which NHSP was introduced, including a range of government initiatives that sought to directly influence working practice. The results will have implications for those professionals responsible for offering support to families of early-identified deaf infants. Copyright © 2005 John Wiley & Sons, Ltd.

The impact of the national Newborn Hearing Screening Programme on educational services in England

AbstractThis article presents results related to the impact on educational support services of the introduction of the first phase of the national Newborn Hearing Screening Programme (NHSP) in England. This study was funded by the Department of Health and undertaken as one element of a national evaluation of NHSP across a range of domains. It presents results from a qualitative study of 27 educational services before and after the implementation of NHSP. Key themes were identified and analysed using QSR NU…DIST 4. The analysis used case and cross case perspectives. The key areas identified included links between services, inter-agency working, changes in working practice, funding and resource implications and the perceived opportunities of NHSP. It considers the political context within which NHSP was introduced, including a range of government initiatives that sought to directly influence working practice. The results will have implications for those professionals responsible for offering support to fami...