Well-baby Nursery Research Articles

Use of early pulse oximetry in the detection of cardiac lesions among asymptomatic term newborns

Background and objectivesCardiovascular malformations are the commonest form of congenital defects and could result in significant morbidity. Antenatal and early postnatal detection is still unreliable, especially in developing countries and low-income communities. The aim of the study was to assess the value of early pulse oximetry in the detection of cardiac lesions among asymptomatic term newborns with subnormal oxygen saturation. Patients and methodsA cross-sectional study was conducted at the well-baby nursery of a community hospital, between March and August 2013. A total of 120 asymptomatic, apparently healthy term newborns who had persistent postductal SpO2<95% in the initial and repeat tests within the first 24h after birth were consecutively enrolled. Pulse oximetry testing was performed after the age of 2h and confirmed 2h later. Cases with persistent saturation below 95% underwent echocardiography. ResultsSignificant cardiac lesions were detected in 38 newborns (31.6%); they had significantly lower oxygen saturation compared to those with insignificant lesions (n=41, 34.2%) and normal hearts (n=41, 34.2%). Repeat testing after 2h was more reliable. Using cut-offs lower than 95% missed a significant number of lesions. ConclusionPulse oximetry can be used as a tool in apparently healthy term newborns for the early detection of cardiac lesions that might necessitate specialized follow-up and care. An initial test after the age of 2h followed by a confirmatory test 2h later, with a cut-off value of <95% is proposed. A comprehensive study is necessary to validate the results of this study. This might be of significant importance in low-income communities.

Longitudinal development of wideband reflectance tympanometry in normal and at-risk infants

PurposeThe goals of this study were to measure normal characteristics of ambient and tympanometric wideband acoustic reflectance, which was parameterized by absorbance and group delay, in newborns cared for in well-baby and Neonatal Intensive Care Unit (NICU) nurseries, and to characterize the normal development of reflectance over the first year after birth in a group of infants with clinically normal hearing status followed longitudinally from birth to one year of age. MethodsInfants were recruited from a well-baby and NICU nursery, passed newborn otoacoustic emissions (OAE) and automated auditory brainstem response (ABR) tests as well as follow-up diagnostic ABR and audiometry. They were tested longitudinally for up to one year using a wideband middle ear acoustic test battery consisting of tympanometry and ambient-pressure tests. Results were analyzed for ambient reflectance across frequency and tympanometric reflectance across frequency and pressure. ResultsWideband absorbance and group delay showed large effects of age in the first 6 months. Immature absorbance and group delay patterns were apparent in the low frequencies at birth and one month, but changed substantially to a more adult-like pattern by age 6 months for both ambient and tympanometric variables. Area and length of the ear canal estimated acoustically increased up to age 1 year. Effects of race (African American and others compared to Caucasian) were found in combination with age effects. Mean and confidence intervals are provided for use as a normative longitudinal database for newborns and infants up to one year of age, for both well-baby and NICU infants.

Evaluating cost and resource use associated with pulse oximetry screening for critical congenital heart disease: Empiric estimates and sources of variation

Newborn screening for critical congenital heart disease (CCHD) using pulse oximetry is being implemented in the United States and internationally; however, few data are available on the associated in-hospital costs and use of resources. Time and motion study in well-baby nurseries at two large urban hospitals in Utah using different approaches to pulse oximetry screening. Two observers recorded the time for each screening step together with provider and equipment characteristics. Structured questionnaire provided additional information on labor and equipment costs. Fifty-three CCHD screens were observed. At site A (n = 22), screening was mostly done by medical assistants (95%) using disposable probes (100%); at site B (n = 31), screening was mostly performed by certified nursing assistants (90%) using reusable probes (90%). Considering only first screens (n = 53), the median screen time was 8.6 min (range: 3.2-23.2), with no significant difference between sites. The overall cost ($ in 2014) of screening per baby was $24.52 at site A and $2.60 at site B. Nearly all the variation in cost (90%) was due to the cost of disposable probes; labor costs were similar between sites. CCHD screening by means of pulse oximetry is reasonably fast for most babies, leading to relative small labor costs with little variation by provider type. The main driver of costs is equipment: in a high throughput setting, reusable probes are currently associated with considerable cost saving compared with disposable probes. As programs expand to universal screening, improved and cheaper technologies could lead to considerable economies of scale.

Air and Bone Conduction Click and Tone-Burst Auditory Brainstem Thresholds Using Kalman Adaptive Processing in Nonsedated Normal-Hearing Infants.

To study normative thresholds and latencies for click and tone-burst auditory brainstem response (TB-ABR) for air and bone conduction in normal infants and those discharged from neonatal intensive care units, who passed newborn hearing screening and follow-up distortion product otoacoustic emission. An evoked potential system (Vivosonic Integrity) that incorporates Bluetooth electrical isolation and Kalman-weighted adaptive processing to improve signal to noise ratios was employed for this study. Results were compared with other published data. One hundred forty-five infants who passed two-stage hearing screening with transient-evoked otoacoustic emission or automated auditory brainstem response were assessed with clicks at 70 dB nHL and threshold TB-ABR. Tone bursts at frequencies between 500 and 4000 Hz were used for air and bone conduction auditory brainstem response testing using a specified staircase threshold search to establish threshold levels and wave V peak latencies. Median air conduction hearing thresholds using TB-ABR ranged from 0 to 20 dB nHL, depending on stimulus frequency. Median bone conduction thresholds were 10 dB nHL across all frequencies, and median air-bone gaps were 0 dB across all frequencies. There was no significant threshold difference between left and right ears and no significant relationship between thresholds and hearing loss risk factors, ethnicity, or gender. Older age was related to decreased latency for air conduction. Compared with previous studies, mean air conduction thresholds were found at slightly lower (better) levels, while bone conduction levels were better at 2000 Hz and higher at 500 Hz. Latency values were longer at 500 Hz than previous studies using other instrumentation. Sleep state did not affect air or bone conduction thresholds. This study demonstrated slightly better wave V thresholds for air conduction than previous infant studies. The differences found in the present study, while statistically significant, were within the test step size of 10 dB. This suggests that threshold responses obtained using the Kalman weighting software were within the range of other published studies using traditional signal averaging, given step-size limitations. Thresholds were not adversely affected by variable sleep states.

Comparative Study of Hearing Impairment among Healthy and Intensive Care unit Neonates in Mashhad, North East Iran.

According to World Health Organization (WHO) 2001 statistics, hearing disorders are the most common congenital disease, and the incidence rate among high-risk newborns is as much as ten times as high as that in healthy neonates. However, 78% of screening test failures are well-baby nursery babies. The Joint Committee on Infants' Hearing (JCIH) has emphasized the importance of early diagnosis and treatment in neonates with hearing impairments in order to preserve their maximum linguistic skills. The aim of our study was to compare the prevalence of hearing loss among babies in the neonatal intensive care unit (NICU) and the rooming-in unit (RIU). Neonates born in three hospitals in Mashhad between 2008 to 2010 were studied prospectively and screened for auditory disorders using the oto acoustic emission (OAE) test at the time of discharge and 3 weeks later. To confirm hearing loss, the auditory steady state response (ASSR) test was used among those participants who failed both OAE tests. Two-thousand and sixty-three neonates from the NICU were screened and compared with a control group consisting of 8,724 neonates from the RIU or the well-baby nursery. At the end of the study, hearing impairment as confirmed by failure in the ASSR test was diagnosed in 31 neonates (26 in the control group [0.30%] and five in the NICU group [1.94%]). In our study, the prevalence of hearing disorders among NICU neonates was 6.5-times greater than that among babies from the RIU or well-baby unit. This observation demonstrates the importance of universal screening programs particularly for high-risk population neonates.

Evaluation of Early Transcutaneous Bilirubinometry to Predict Subsequent Hyperbilirubinemia in Neonates Admitted to a Well-Baby Nursery.

The aim of this study is to determine whether a transcutaneous bilirubin (TcB) value obtained within 6 hours of birth (early transcutaneous bilirubin [ETcB]) either alone, or used to calculate an early rate of rise (E-ROR) in TcB, will identify those neonates who are at a higher risk for subsequent jaundice. ETcB values were obtained from a convenience sample of neonates admitted to the newborn nursery. E-ROR was calculated as the average hourly increase between ETcB and subsequent TcB obtained at 18 to 36 hours of age. TcB percentile values at various ages were obtained from a previously published and cross-validated nomogram. The predictive values relating ETcB, E-ROR, and TcB at 18 to 36 hours of age to TcB at 42 to 66 hours of age were determined, and receiver-operator characteristic curves were compared. A total of 516 late preterm and term neonates were studied. ETcB was higher (p = 0.003) in those neonates who subsequently received phototherapy (n = 15), and negative predictive value was always ≥ 0.96; positive predictive value (PPV) ranged from 0.04 to 0.06. Compared with ETcB, TcB at 18 to 36 hours was more likely to predict significant jaundice at 42 to 66 hours of age. Given the observed low PPV, ETcB is not useful in identifying infants who develop subsequent hyperbilirubinemia. However, it may be helpful in identifying those neonates at a low risk of subsequent hyperbilirubinemia.

Maternal non-compliance in a well-baby nursery: family characteristics and other reasons

Objective: Neonatal recommendations include medical follow-up, metabolic screening, vitamin K, eye drops/ointment and vaccinations. Most but not all parents follow these recommendations. This study aimed to characterize the non-adherent mothers in order to understand the reasons behind that non-adherence. Study design: All mothers who refused any routine treatment of their infant or who asked for early discharge of their infant were included. They completed a questionnaire on socio-economic items, previous births and those children’s health status, current pregnancy and delivery and their beliefs. Results: Three non-adherent subgroups emerged according to the responses: Muslim mothers requesting early discharge to care for children at home, Jewish mothers requesting early discharge because they disliked the hospital environment, Sabbath/holiday and children at home and Jewish mothers who rejected guidelines because they believed the treatments were unnecessary or possibly harmful to their infants. Conclusion: Socio-economic factors could influence maternal adherence to care guidelines in a well-baby nursery. Several interventions to enhance maternal adherence to medical recommendations are proposed in order to increase the child and family centeredness of clinical and social care.

PO-0622 Maternal Non-compliance In A Well-baby Nursery: Family Characteristics And Other Reasons

Objective Neonatal recommendations include medical follow-up, metabolic screening, vitamin K, eye drops/ointment, and vaccinations. Most but not all parents follow these recommendations. This study aimed to characterise the non-compliant mothers in order to understand the reasons behind that non-compliance. Study design All mothers who refused any routine treatment of their infant or who asked for early discharge of their infant were included. They filled-in a questionnaire on socioeconomic items, previous births and those children’s health status, current pregnancy and delivery, and their beliefs. Result Three non-compliant subgroups emerged according to the responses: Muslim mothers requesting early discharge to care for children at home, Jewish mothers requesting early discharge because they disliked hospital environment, Sabbath/holiday, and children at home, and Jewish mothers who rejected guidelines because they believed the treatments were unnecessary or possibly harmful to their infants. Conclusion Several interventions to enhance maternal compliance to medical recommendations are proposed, including more education, better quality of patient-staff interaction, understanding and encouraging social support, and awareness of patient’s beliefs and attitudes, as well as renovation of the maternity department’s physical structure, to make the stay more pleasant (quieter, more privacy), and to also make it possible to properly celebrate the Sabbath as well as holidays on the ward itself. Regarding the Islamic and Jewish mothers who asked for early discharge because of the other children at home, maybe we should try to understand the exact reason for this – perhaps the father works far away from home and there is nobody else to guard these children; and then we may be able to help these families find a better solution.

The Big Screen Difference

The Big Screen Difference

Cardiology patient page. Screening for critical congenital heart disease in newborns.

We have come a long way in our ability to treat critical congenital heart conditions, which affect about 3 of every 1000 live births and account for 30% of all infant fatalities in the United States annually.1 Prenatal sonograms can often identify structural heart disease; however, the sensitivity of congenital heart disease (CHD) detection is highly variable, depending on operator expertise, gestational age, fetal position, and the type of cardiac defect. As a result, prenatal sonography will miss some patients with critical CHD and is known to miss many newborns with simple CHD. Newborns who might benefit from early treatment can often be identified in their first days of life through pulse oximetry screening—a painless, readily available noninvasive examination that is easy to incorporate into newborn assessments. This noninvasive test measures the percentage of hemoglobin in the blood that is saturated with oxygen and pulse rate. The addition of pulse oximetry to fetal ultrasound and physical examination as a screening tool can reduce the chance of overlooking critical congenital heart disease (CCHD) in newborns.2 Oxygen breathed in through the lungs attaches to the red blood cell protein hemoglobin. The newly oxygenated blood then circulates to the tissues. Arterial hemoglobin saturated with oxygen is bright red, and venous hemoglobin with less oxygen is darker. Pulse oximetry uses the principles of spectrophotometry and …

Impact of breastfeeding self-efficacy and sociocultural factors on early breastfeeding in an urban, predominantly Dominican community.

Latinas have high breastfeeding initiation rates that decrease significantly in the first postpartum months. Little is known about the effects of self-efficacy and sociocultural factors on early breastfeeding among low-income Latinas. This study quantifies early breastfeeding rates and identifies factors associated with breastfeeding at 4-6 weeks postpartum in our community. Mothers were recruited from a newborn clinic (NBC) in the first postpartum week. Questionnaires in the NBC and 4-6 weeks later assessed feeding practices, breastfeeding self-efficacy, and sociocultural factors. Feeding practices in the well baby nursery (WBN) were obtained by chart review. A scale from "1" (exclusive formula feeding) to "5" (exclusive breastfeeding) characterized feeding practices. Paired-sample t tests assessed change in feeding practices, and regression analysis assessed the impact of factors on breastfeeding at 4-6 weeks. We interviewed 209 women: 86.1% Latina, 47.3% foreign-born, and 94.2% Medicaid-recipients. Breastfeeding increased from WBN to NBC (2.6±1.2 to 2.9±1.4; p<0.05) and then decreased by 4-6 weeks (2.9±1.4 to 2.5±1.44; p<0.05), without significant change between WBN and 4-6 weeks. Higher levels of education [β=0.21 (0.08, 0.56)], breastfeeding a previous child for ≥6 months [β=0.35 (0.57, 1.8)], foreign birth [β=0.2 (0.06, 1.07)], and higher breastfeeding self-efficacy scores [β=0.38 (0.02, 0.05)] were associated with more breastfeeding. Higher breastfeeding self-efficacy scores were associated with exclusive breastfeeding [adjusted odds ratio=1.18 (1.05, 1.32)]. Breastfeeding self-efficacy was the sole, modifiable factor associated with exclusive breastfeeding. Efforts to improve breastfeeding self-efficacy may serve to support breastfeeding in this population.

Safe Sleep Practices and Sudden Infant Death Syndrome Risk Reduction

Our primary objective was to compare parents of infants cared for in newborn intensive care units (NICUs) and infants cared for in well-baby ("general") nurseries with regard to knowledge and practice of safe sleep practices/sudden infant death syndrome risk reduction measures and guidelines. Our secondary objective was to obtain qualitative data regarding reasons for noncompliance in both populations. Sixty participants (30 from each population) completed our survey measuring safe sleep knowledge and practice. Parents of NICU infants reported using 2 safe sleep practices-(a) always placing baby in crib to sleep and (b) always placing baby on back to sleep-significantly more frequently than parents of well infants. Additional findings and implications for future studies are discussed.

Targeted versus Universal Neonatal Hearing Screening in a Single Egyptian Center

Aim. To compare targeted neonatal hearing screening (TNHS) and universal neonatal hearing screening (UNHS) since many developing countries, including Egypt, implement selective screening for high-risk neonates. Methods. 150 neonates were assessed; 50 full terms consecutively admitted to the well-baby nursery and 100 neonates consecutively admitted to neonatal intensive care unit (NICU), Ain Shams University. Patients were further subdivided into high-risk group which included 50 neonates with multiple risk factors for hearing loss and low risk group which included 50 neonates with only one risk factor. Transient evoked otoacoustic emissions (TEOAEs) were used for hearing screening. Auditory brain response (ABR) was performed 3 months later for failed TEOAEs. Results. The most frequent risk factor was consanguinity (46%). In the well-baby population, 16% failed TEOAEs. In the NICU, 30% of the low risk and 38% of the high risk groups failed TEOAEs. Regarding ABR, failed results were 12%, 10%, and 8% in the high-risk, low-risk, and healthy groups, respectively. Conclusion. The use of TNHS would have missed 8% of neonates from the well-baby group who actually had PCHL (permanent congenital hearing loss). The use of UNHS would identify all cases with PCHL, allowing for early intervention and follow-up.

Early Readmission of Newborns in a Large Health Care System

Early readmissions of apparently healthy newborns after discharge from well baby nurseries (WBN) may reflect an inadequate assessment of the newborn's readiness for discharge. To determine the frequency, causes, costs, and variations in rates of early rehospitalization of newborns discharged from 21 WBNs in 1 health care system. We queried the Enterprise Data Warehouse of Intermountain Healthcare (IH), a large Utah health care system, to identify newborns with gestational ages of 34 to 42 weeks discharged from an IH WBN between 2000 and 2010. We identified all newborns admitted to an IH hospital within 28 days of discharge and recorded their birth hospital, age, reason(s) for admission, length of stay, and inpatient costs. During the study period, 296 114 infants were discharged from IH hospital WBNs. Of these, 5308 (17.9/1000) were readmitted within 28 days of discharge. Of the 5308 infants who were readmitted, 41% had feeding problems, 35% had jaundice, and 33% had respiratory distress. The majority of newborns with feeding problems and jaundice were admitted in their first 2 weeks of life. Late preterm and early term newborns had higher rates of readmission than term infants. There were significant variations in readmission rates of newborns born at the 21 hospitals in the IH system. Potentially preventable conditions, including feeding problems and jaundice, account for most early readmissions of newborns. Late preterm and early term newborns have higher rates of readmission and should be assessed for other factors associated with early readmission.

Tissue Doppler, strain, and strain rate measurements assessed by two-dimensional speckle-tracking echocardiography in healthy newborns and infants

To evaluate cardiac maturational and haemodynamic alteration in healthy newborns and infants and determine reference values in this period using tissue Doppler, strain, and strain rate echocardiography. The study included 149 healthy subjects. Babies from 1 day to 3 months were selected from the well-baby nursery department, and infants were selected from paediatric clinics during routine visits for health maintenance. Subjects were allocated to four groups: preterm (36-37 weeks, n = 32), term (≥ 38 weeks, n = 32), 1 month of age (n = 47), and 3 months of age (n = 38). Standard echocardiographic evaluations, pulsed wave Doppler, tissue Doppler echocardiography, strain, and strain rate studies were applied by the same person using a MyLab50 echo machine. Longitudinal and circumferential systolic strain and strain rate measurements were assessed by two-dimensional speckle-tracking echocardiography in all subjects. The longitudinal systolic velocity, strain, and strain rate values derived from left ventricle apical four-, three-, and two-chamber images, and circumferential systolic velocity, strain, and strain rate values derived from left ventricle short-axis images decreased from the base to the apex in all subjects (p < 0.001). Significant cardiac haemodynamic alterations occurred during the newborn and early infancy periods and were detected by tissue Doppler, strain, and strain rate echocardiography. Although two-dimensional speckle-tracking echocardiography is useful and can produce improved, reliable results in clinical practice, it has some limitations. Therefore, more studies on this issue are required.

Early feeding and neonatal hypoglycemia in infants of diabetic mothers.

Objectives:To examine the effects of early formula feeding or breast-feeding on hypoglycemia in infants born to 303 A1-A2 and 88 Class B-RF diabetics.Methods:Infants with hypoglycemia (blood glucose < 40 mg/dL) were breast-fed or formula-fed, and those with recurrences were given intravenous dextrose.Results:Of 293 infants admitted to the well-baby nursery, 87 (30%) had hypoglycemia, corrected by early feeding in 75 (86%), while 12 (14%) required intravenous dextrose. In all, 98 infants were admitted to the newborn intensive care unit for respiratory distress (40%), prematurity (33%) or prevention of hypoglycemia (27%). Although all newborn intensive care unit patients received intravenous dextrose, 22 (22%) had hypoglycemia. Of 109 hypoglycemia episodes, 89 (82%) were single low occurrences. At discharge, 56% of well-baby nursery and 43% of newborn intensive care unit infants initiated breast-feeding.Conclusions:Hypoglycemia among infants of diabetic mothers can be corrected by early breast-feeding or formula feeding.

Neonatal Transcutaneous Bilirubin Measurements: An Opportunity to Enhance Laboratory Utilization and Improve Patient Care

By far the most common clinical problem addressed by family practitioners and pediatricians in the first weeks of an infant's life is hyperbilirubinemia. With the exception of the standard metabolic screen, the measurement of a total serum bilirubin (TSB)2 concentration is the most common laboratory test ordered for a newborn infant. That is not surprising because the clinical sign, jaundice, is seen in approximately 80% of infants in a well-baby nursery during the first few days (1). The process of observation, clinical monitoring, and laboratory testing that continues throughout the infant's first week of life has a single objective—to prevent extreme hyperbilirubinemia [a TSB concentration >25–30 mg/dL (>428–513 μmol/L)] and its rare but dreaded consequence, bilirubin encephalopathy. Data from most of the Western world suggest that chronic bilirubin encephalopathy, or kernicterus, is currently occurring at an incidence of approximately 0.5–2 per 100 000 live births (2). Thus, of approximately 4 × 106 infants born annually in the US, perhaps 20–40 will develop kernicterus, a permanently disabling condition characterized by athetoid cerebral palsy, severe sensorineural hearing loss, paralysis of upward gaze, and dental dysplasia. For decades practitioners have relied on the appearance and intensity of jaundice as a means of deciding when to obtain a TSB measurement, but recognizing that estimating TSB by eye is difficult and on occasion grossly misleading (3) has prompted the development of transcutaneous bilirubinometry. The instruments that measure the transcutaneous bilirubin (TcB) concentration operate by transmitting light that penetrates the blanched skin and transilluminates the subcutaneous tissues. The …

Tub Bathing Improves Thermoregulation of the Late Preterm Infant

To compare body temperature of the late preterm infant after 24 hours of life at three time points before and after immersion tub bathing or sponge bathing. We hypothesized that late preterm infants achieve significantly improved thermoregulation when bathed by immersion tub bath compared to traditional sponge bathing. This study was a randomized controlled trial. A large metropolitan teaching hospital in the northeastern United States. Late preterm infants (100) born between 35 and 36 6/7 weeks gestation, bathed in the well-baby nursery of a 30-bed mother/baby unit. Infant participants were identified and informed consent was obtained from the parent. Infants were randomized into two groups: 50 bathed by sponge and 50 bathed by immersion tub. Infant body temperature was measured at three time points: 10 minutes prior to bathing, 10 minutes following bathing, and 30 minutes following bathing. Infants who were tub bathed experienced significantly less variability in body temperature and overall were warmer 10 minutes and 30 minutes following the bath compared to infants who were sponge bathed (p = .024). The study findings support the hypothesis that late preterm infants who are tub bathed experience significantly less body temperature variability and an overall higher body temperature following the bathing procedure.

ABR-based newborn hearing screening with MB11 BERAphone® using an optimized chirp for acoustical stimulation

ObjectiveAt our center, the Maico MB11 BERAphone® device is used for newborn hearing screening based on Auditory Brainstem Responses (ABR). In 2006, an optimized chirp stimulus was implemented in the device to increase the reliability and quality of the screening method. In 2002, an automated response detection algorithm had been implemented. This study analyzes the screening results using the MB11 BERAphone® device with the implemented chirp stimulus and automated response detection method. MethodsThe data presented were collected in the well-baby nursery as part of the newborn hearing screening program following a two stage screening protocol. To focus the study on the typical routine screening, data from at-risk babies were not included. Overall, data from 6866 babies (3604 males and 3262 females) screened from March 2006 to April 2011 were analyzed in this study. ResultsOut of the 6866 babies screened, 6607 passed bilaterally prior to hospital discharge (defined as 1st stage in this hearing screening program). Therefore, the pre-discharge pass rate of the hearing screening with the MB11 BERAphone® device was 96.2%. The resulting referral rate was 3.8%. The median test time per ear (excluding time for preparation and data reporting) was 28s with a range of 15–112s (5–95th percentile).The number of infants referred for 2nd stage, post-discharge re-screening was 259. Of this group, 71 passed bilaterally and 188 failed the re-screening in one or both ears. Therefore, including both the pre-discharge and post-discharge screening results, the bilateral pass rate was 97.3% and 2.7% were referred for diagnostic evaluation.Diagnostic testing was performed on all of the 188 infants who were referred. Results showed that 47 of these babies had hearing loss. This equates to a positive predictive value for a refer result of 25%. The observed prevalence of hearing impairment in our population was 0.684%.Diagnostic results for 141 of the referred newborns proved that they had normal hearing. That is, 141 out of 6866 newborns had a false-positive result with the MB11 BERAphone® screening. Therefore, the device had a specificity of 97.9%. During the time period of this study, no baby who passed the hearing screening was later found to have hearing impairment, suggesting a sensitivity of 100%. However, due to the limited number of newborns and the short time period after screening for the more recently screened babies, a reliable estimate of the sensitivity cannot be yet made from our program statistics. The theoretical sensitivity of the MB 11 device is 99.9%. ConclusionsThe Maico MB11 BERAphone® is a reliable device for auditory brainstem response newborn hearing screening and it provides results within a very short time. Due to the implemented method for automatic detection of ABR, the use of the device does not require an experienced examiner, allowing it to be used by trained technicians in locations outside the department of audiology such as the well-baby nursery.

Audiological Follow-up Results after Newborn Hearing Screening Program

ObjectivesTo investigate the validity of newborn hearing screening protocol using automated auditory brainstem response (AABR) with a confirmation method using click auditory brainstem response (ABR) and to evaluate changes in hearing status of infants with confirmed congenital hearing loss.MethodsNeonates in the well-baby nursery were screened by staged AABR. Subjects whose final AABR result was "refer" were tested by diagnostic click ABR and 226 Hz tympanometry within 3 months of age. Changes in hearing status of subjects with confirmed hearing loss were analyzed by follow-up ABR at 3-6 month intervals.ResultsOf the 12,193 healthy babies born during this period, 10,879 (89.22%) were screened by AABR. Of 10,879 neonates screened by AABR, 148 (1.36%) were "referred"; of these, 45 subjects showed ABR thresholds over 30 dB nHL in at least one ear. Thirty-four subjects underwent serial follow-up ABR tests, with 11 (32.4%) found to have normal ABR thresholds. Most subjects with mild to moderate hearing loss were found to be normal before 1 year of age, whereas all infants with severe or profound hearing loss were identified as having congenital hearing loss.ConclusionThe referral rate and the positive predictive value of our protocol were acceptable. We have also found here that substantial temporary hearing loss can be included in the first confirmative diagnosis. Temporary hearing loss of our study on follow-up give emphasis to need of further differentiation using the testing for bone conduction and middle ear status.