Universal newborn hearing screening: are we achieving the Joint Committee on Infant Hearing (JCIH) objectives?

James L Connolly, Jeffrey D Carron, Suzanne D Roark
Laryngoscope 2005, 115 (2): 232-6

OBJECTIVE: To determine whether a two-stage auditory brainstem response (ABR) Universal Newborn Hearing Screening (UNHS) protocol at an academic medical center has been achieving the Joint Committee on Infant Hearing (JCIH) recommendations for screening all infants, diagnosing hearing loss (HL) within 3 months, and instituting intervention within 6 months.

STUDY DESIGN: Retrospective database and chart review in an academic tertiary care hospital.

METHODS: A 5-year retrospective review of all newborns screened at our medical center between 1997 to 2001 was performed. Screening was performed by multiple in-hospital postnatal sequential ABR with follow-up outpatient ABR for failures. The protocol called for each newborn to receive at least two separate ABR in-hospital screenings before discharge if the newborn failed the initial screening. For those newborns with extended hospital courses, additional ABR screening were performed randomly in attempt to decrease referral rates at time of discharge. Overall screening population capture rate, referral rate, and false-positive rate were calculated. In addition, HL risk factors, age at diagnosis of HL, and age of onset of intervention were obtained. Cost per diagnosis of HL was calculated as well.

RESULTS: The total number screened was 17,602. Seventy-eight (0.44%) were diagnosed with HL, with 62 (79%) in the high-risk population. The frequency of HL was 1 per 811 low-risk neonates versus 1 in 75 meeting high-risk criteria. Overall population capture rate was greater than 99%, referral rate 4.1%, and false-positive rate 3.6%. Mean age at diagnosis was 3.9 months, with mean age at intervention 6.1 months. Cost per diagnosis was estimated at US 5,074 dollars.

CONCLUSIONS: Our current UNHS protocol using sequential ABR has been successful in screening virtually all neonates and providing timely intervention. This retrospective review has shown one HL diagnosis for every 811 babies screened without high-risk factors.

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