Overcoming difficulties in implementing a universal newborn hearing screening program (original) (raw)
Related papers
Making universal newborn hearing screening a success
International Journal of Pediatric Otorhinolaryngology, 2006
Objective: Following a long period of pilot study, Iaso maternity hospital established a universal newborn hearing screening program based on transiently evoked otoacoustic emissions (TEOAEs). The aim of this study is to present the improvement of outcome measures of this program, comparing the results of two groups of newborns screened successively. Methods: We analyzed data from two groups of full-term newborns screened at our setting. The first group included all newborns born and screened during the initial 3 years of application of the program and the second group included all newborns born and screened during the next 2 years. TEOAEs were performed during the first days after birth. All newborns who failed the initial test underwent repeat testing with TEOAEs before hospital discharge. Newborns with absence of otoacoustic emissions were referred to follow-up test after 1 month. Results were compared between the two groups. Results: The first group included 22,195 newborns-examined during 3 years and the second group included 25,032 newborns-examined during 2 years, due to reduction of * Corresponding author. Present address: 23 Achaion Street -Ag. Paraskevi, GR-15343 Athens, Greece. Tel.: +30 210 600 4683;
Outcomes and Efficacy of Newborn Hearing Screening: Strengths and Weaknesses (Success or Failure?)
The Laryngoscope, 2008
Objective: To assess the outcomes of neonatal hearing screening with regard to the final diagnosis in a very large number of newborns and investigate related strengths and weaknesses of the program. Subjects: In this study, 76,560 newborns were assessed. Method: All neonates were assessed using transient evoked otoacoustic emissions (TEOAEs). Results: From the 76,560 neonates screened, 1,564 (2%) failed the test. According to the screening protocol, all parents of failed neonates were asked to bring their children 1 month following discharge to repeat the test. Of the 541 (34.6%) newborns who repeated the test, 303 (56%) were found normal and 238 (44%) again failed TEOAE. The latter children were referred to two special public centers for full audiology evaluation. In addition, 124 neonates were also referred due to other reasons revealed in the screening process (family history, high levels of bilirubin, etc.). Of the 362 children who were referred to the two special audiology centers, 113 (31.2%) were evaluated by these two centers. In addition, 42 children who had failed initial screening and did not show up for a follow-up appointment to repeat TEOAE were also assessed in the same centers. Of the 155 children who had a special audiologic evaluation, 56 (36.1%) were found to have hearing loss (HL) and 99 (63.9%) normal hearing. In detail, 28 had bilateral sensorineural HL greater than 40 dB, 10 had unilateral sensorineural HL greater than 40 dB, and 18 had otitis media with effusion or other conductive HL. Conclusions: Derived from the present study: 1) repeated testing of "failed" newborns in the maternity hospital and before discharge leads to an acceptable referral rate of 2%; 2) the 1-month follow-up of "failed" newborns further limits the false positive results but leads to high rate of newborns lost to follow-up; 3) a dedicated secretariat system should be implemented to follow-up each "failed" newborn and remind parents about their follow-up appointments; and 4) additional measures such as detailed educational material and parental friendly approach should also be implemented.
Neonatal Hearing Screening with Transient Evoked Otoacoustic Emissions: A Learning Curve
International Journal of Audiology, 1999
The present paper reports on the implementation of a neonatal hearing screening programme in a private hospital in Belgium. A maternity-based neonatal hearing screening project with transient evoked otoacoustic emissions (TEOAEs) was started in 1993. The cost of the test was not covered by the public health insurance, so the parents had to pay the full cost for screening their child (approximately 30 Euro). Since 1993 the programme strategies have been changed on several occasions to improve the quality and efficacy. A retrospective analysis was performed on: (1) the test pass rate; (2) the coverage; and (3) the number of children who become 'Lost to follow-up' after failing the initial test. The data show a steady learning curve with a time course of several years. They also demonstrate that it is worthwhile and feasible to run a high-quality screening programme in a private establishment.
2016
The incidence of sensorineural hearing loss ranges from 1 to 3 per 1000 live births in term healthy neonates, and 2-4 per 100 in high-risk infants, a ten-fold increase. Early identification and intervention with hearing augmentation within 6 months yields optimal effect. If undetected and without treatment, significant hearing impairment may negatively impact speech development and lead to disorders in psychological and mental behaviors.Hearing screening programs in newborns enable detection of hearing impairment in the first days after birth. Programs to identify hearing deficit have significantly improved over the 2 decades, and their implementation continues to grow throughout the world. Initially based on risk factors, these programs identified only 50-75% of infants with hearing loss. Current recommendations are to conduct universal hearing screening in all infants. Techniques used primarily include automated auditory brainstem responses and otoacoustic emissions, that provide...
Newborn hearing screening: what are we missing?
Bangladesh Medical Research Council Bulletin, 2014
The objectives of the study were to demonstrate hearing status in newborns at first screening by Transient Evoked Otoacoustic Emissions and to find out the relationship between abnormal hearing screening and known risk factors. This study was conducted in the department of neonatology of Bangabandhu Sheikh Mujib Medical University in collaboration with department of otolaryngology and department of obstetrics and gynaecology. This prospective observational study included a cohort of 168 neonates from Neonatal Intensive Care Unit and neonatal Nursery (Minimal care unit). All were screened for hearing impairment using Transient Evoked Otoacoustic Emissions in out-patient department of otolaryngology by a trained audiologist before discharge from hospital. Risk factors analysed were according to the criteria of American Academy of Pediatrics. Of the total neonates screened, Refer rate was 32.7% irrespective of presence or absence of risk factors. Small for gestational age, in-utero inf...
Success rate of newborn and follow-up screening of hearing using otoacoustic emissions
International journal of pediatric otorhinolaryngology, 2006
During the last 6 years, and after a long period of pilot study, a universal newborn hearing screening program based on otoacoustic emissions is implemented in Iaso Maternity Hospital. Our purpose is to present the success rate of otoacoustic emission testing on discharge from the hospital and 1 month later. All full-term newborns who were screened during a period of 2 years and failed testing after one or more sessions of transiently evoked otoacoustic emissions, on discharge from the hospital, were included in the study. These newborns were retested approximately 1 month after discharge. Twenty-five thousand and thirty-two newborns were examined in total. We found 534 (2.1%) 'refer' cases. Only 223 of them (41.8%) returned to retest in follow-up after 1 month. From the rescreening, 59 (2.3 per thousand) newborns failed in the test again and were referred for diagnostic audiological evaluation. The rate of referrals was small, but efforts should be made to decrease it furth...
European Archives of Oto-Rhino-Laryngology, 2011
The finding that early detection of permanent congenital childhood hearing loss produces worthwhile benefit in terms of improved speech and language provides the rationale for the universal screening of newborns. The aim of the present study is to collect the current evidence with regard to the efficacy, the results and outcomes of universal hearing screening programs. An extensive search of the literature was performed in Medline and other available database sources. Study selection was based on the evaluation of the protocols used and the assessment of their efficacy in the early diagnosis of congenital hearing impairment. The initial referral rate and the rate of false positives were also evaluated. A total of 676,043 screened children have been identified in 20 studies. The average initial referral rate in these studies was 3.89%. The initial referral rate varied from 0.6 to 16.7%. The lost-tofollow-up rates varied from 3.7 to 65%. Although universal hearing screening is now widely adopted, there are still some serious drawbacks and limitations. False positives rates remain considerably high when newborns are screened with TEOAE's. The combination of TEOAE's and a-ABR provides a significantly reduced referral rate. Close cooperation between audiological centres and maternity units and a dedicated secretariat team are of paramount importance with regard to the reliability and efficacy of universal hearing screening.
Acta otorrinolaringológica española, 2008
Cost-effectivity of universal newborn hearing screening programmes is under constant review. In this context, the aim of the present study is to evaluate the performance of brainstem response audiometry (BERA) compared to otoacoustic emissions (OAE) as screening tools. Observational and retrospective study on a universal screening programme started in 1998. We perform a comparative analysis between two groups of newborns evaluated in consecutive periods of time. We analyze outcome measures of the programme as a measure of effectivity, and dedicated resources to weight the costs. We compare a group of 862 newborns from year 2003, screened with transient evoked OAE with a clinical device, with a group of 2300 newborns from years 2005 and 2006, screened with automated BERA. We find a statistically significant difference in the percentage of pass in the first step, favoring BERA (99.7 % vs 91.8 %; P< .0005). The median of exploration time with BERA was 276 seconds. Costs evaluation p...