Universal newborn hearing screening in the Champagne-Ardenne region: a 4-year follow-up after early diagnosis of hearing impairment

Effects of ambient air pollution, fresh fruit and vegetable intakes as well as maternal psychosocial stress on the outcome of newborn otoacoustic emission hearing screening

BACKGROUND

Newborn hearing screening results indicated that more than 40% of the detected infants had no recognized risk factors. To determine whether maternal exposure to ambient air pollutants and experience of stressful life event, as well as lack of fresh fruit and vegetable during pregnancy are associated with the abnormal hearing development among newborns.

METHODS

A total of 1193 newborns and their mothers were recruited in this study. Personal information and covariates were collected by face to face interview. Medical examination results of newborns and their mothers were extracted from medical record. We estimated personal air pollutant exposure level through inverse distance weighted method based on data from air quality monitoring stations and assessed the auditory development of newborns via distortion product otoacoustic emission (DPOAE). Unconditional logistic regression model was used to estimate the relationship between DPOAE screening result and the potential influential factors as well as the combined effect.

RESULTS

The results indicated that PM₁₀ exposure during the second trimester and stressful life event during the third trimester could increase the risk of not passing DPOAE test among newborns. However, frequent intakes of fruit and vegetable significantly reduced the risk. There was a synergetic interaction between PM₁₀ exposure and stressful life event on neonatal hearing development.

CONCLUSIONS

To alleviate abnormal auditory development among fetus, pregnant woman should decrease the exposures to ambient air pollutant and negative life event and at the same time, intake sufficient fresh fruit and vegetable.

Value of Newborn Hearing Screening on Early Intervention in the Saudi Population and Review of International Records

Background

Hearing impairment is found to be the most prevalent disabling condition worldwide. Early diagnosis is crucial to avoid speech and language delays and to ensure the best performance results after cochlear implant (CI) surgery. Universal newborn hearing screening is a way to recognize newborns with a hearing impairment with or without risk factors. In this article, we have studied the effect of the newborn hearing screening program on early presentation to a healthcare center and, hence, early intervention in patients with congenital hearing loss, and reviewed the international numbers.

Objectives

The objective of this study was to determine whether neonatal hearing screening in Saudi Arabia helped prelingually deaf children to present earlier or not.

Design

Retrospective cross-sectional review

Setting

King Abdullah Ear Specialist Center (KAESC), Riyadh, Saudi Arabia

Subjects and methods

We included all patients who presented to the CI committee for the first time at KAESC, between March 2016 and March 2018, and met the inclusion criteria. Data were retrieved through phone calls and patient files. The sample size was 242.

Main outcomes

The timing difference between those who were screened positive for hearing loss at birth versus patients who were screened negative or not screened at all.

Results

By far, patients who were screened positive for hearing loss presented earlier (p-value >0.001) to a healthcare center than those who were not screened at all or screened negative for hearing loss and they finished the journey to CI 17 months earlier than those who were not screened. On the other hand, those who were screened negative were not found to present later than those who were not screened.

Conclusion

Going with the international trend, screening was found to have a significant positive effect on age at presentation, diagnosis, hearing aid fitting, surgery, and, hence, performance after implantation. Testing false negative on screening did not show a significant further delay when compared to those who were not screened.

Newborn hearing screening: Prevalence and medical and paramedical treatment of bilateral hearing loss in a neonatal series in the Île-de-France region of France

OBJECTIVES

We report results for newborn hearing screening in a cohort of children born in the Île-de-France region of France, as part of a national screening program set up by the French national health insurance agency.

MATERIALS AND METHODS

A prospective study was performed on neonates undergoing hearing screening by automated auditory brainstem response at 35 dB in maternity departments between 2005 and 2011. In case of positive findings, a further check was performed; if this was also positive in one or both ears, the child was referred to the diagnostic center.

RESULTS

The study recruited 27,885 births; 96% of neonates were tested. Retest was positive in 0.84% of cases. Bilateral hearing loss was diagnosed in 0.63% of infants. Fifty-nine percent of these had ≥ 1 risk factor. Hearing normalized by end of follow-up in 25% of cases. Hearing loss was moderate in 59% of hearing-impaired children, severe in 12% and profound in 29%. Mean age at hearing aid fitting ranged from 4 months in profound hearing loss to 11.4 months in moderate hearing loss. In children receiving a cochlear implant, mean age at implantation was 14 months.

CONCLUSION

Newborn hearing screening is now public policy. It is effective in terms of exhaustiveness, age at diagnosis and early management. Caution is appropriate in the treatment of moderate hearing loss. In case of moderate hearing loss associated with otitis media serosa, transtympanic aerators should be suggested as of the age of 6 months to enable hearing threshold measurement. Hearing aid fitting can then be considered around 9 months of age if hearing has not improved.

The effect of the transducers on paediatric thresholds estimated with auditory steady-state responses

The objective of this study was to investigate the usefulness of auditory steady-state responses (ASSRs) for estimating hearing thresholds in young children, compared with behavioural thresholds. The second objective was to investigate ASSR thresholds obtained with insert earphones versus supra-aural headphones to determine which transducer produces ASSR thresholds most similar to behavioural thresholds measured with supra-aural headphones. This retrospective study included 29 participants (58 ears): 12 children (24 ears) in the insert group and 17 children (34 ears) in the supra-aural group. No general anaesthesia was used. For both groups, there was a strong correlation between behavioural and ASSR thresholds, with a stronger correlation for the insert group. When behavioural thresholds are difficult to obtain, ASSR may be a useful objective measure that can be combined with other audiometric procedures to estimate hearing thresholds and to determine appropriate auditory rehabilitation approaches.

Newborn hearing screening: analysis and outcomes after 100,000 births in Upper-Normandy French region

OBJECTIVES

Neonatal hearing impairment is a common disorder with a prevalence of 1 to 2‰ worldwide, with significant consequences on overall development when rehabilitated too late. New-born hearing screening has been implemented in the 1990s in most European countries and the USA. The Upper-Normandy region of France has been conducting a pilot program since 1999. The aim of this prospective study was to evaluate and critically analyse it.

METHODS

The Upper-Normandy universal new-born hearing screening program is performed in two steps. Between 1999 and 2004, first, we administered a Transient Evoked Oto Acoustic Emission (TEOAE) test was administered a few days after birth for healthy newborns without risk factors. For newborns admitted to a neonatal intensive care unit (NICU) or presenting risk factors, was administered an automated auditory brainstem response (AABR) test prior to discharge. Second, newborns who failed the initial hearing screening were retested as outpatients using TEOAE. Since 2004, infants who failed the initial screen were tested with AABR 3 to 4 weeks later as outpatients, providing an opportunity to compare the two protocols.

RESULTS

Overall screening coverage in the Upper-Normandy region is 99.8%. First step coverage is 99.58% in well-infant nurseries and 97.09% in the NICU. The test-retest procedure during the first step and the use of AABR for the second resulted in higher follow-up rates and lower false positive rates.

CONCLUSIONS

The Upper-Normandy region universal newborn hearing screening program facilitated diagnosis and rehabilitation of infants before age of 9 months, most notably when severe to profound hearing impairment was found.

Hearing screening by community physicians in under-2 year-olds

The efficacy of neonatal screening in lowering age at diagnosis and treatment in congenital hearing loss should not mask the limitations due to the fact that hearing loss often appears or is detected after birth. Early diagnosis of secondary or progressive postnatal hearing loss is nevertheless necessary and justifies systematic screening of hearing disorder in all children seen in consultation, for whatever reason. Screening bilateral hearing loss in under-2 year-olds in a community context is feasible, using simple means: parent interview, clinical observation, and acoumetry using the voice and sound-emitting toys. In case of abnormality detected or suspected on screening, children of whatever age should be referred to an ENT specialist for complete audiometric assessment. Behavioural audiometry is feasible in very young children, and indispensable to diagnosis. The parents will only be reassured after specialized hearing examinations have been performed.

Congenital cytomegalovirus is the second most frequent cause of bilateral hearing loss in young French children

OBJECTIVE

To estimate the prevalence of congenital cytomegalovirus (cCMV) among causes of bilateral hearing loss in young French children.

STUDY DESIGN

Children <3 years old with hearing loss were prospectively included at their first visit to a referral center. Cytomegalovirus polymerase chain reaction was performed on dried blood spots from Guthrie cards. Medical records were reviewed.

RESULTS

One hundred children with bilateral hearing loss were included at a median age of 15 months; the prevalence of cCMV was 8% (8/100) (95% CI, 2.7%-13.3%) in this population and 15.4% (8/52) in the subpopulation of children with profound bilateral hearing loss. Delayed neurodevelopment and brain abnormalities on computed tomography scan were found more often in children with cCMV than in children with hearing loss without cCMV (P = .027, P = .005). In 6 of 8 cCMV cases, cCMV infection had not been diagnosed before the study.

CONCLUSIONS

In a comprehensive study of the causes of bilateral hearing loss in young French children, cCMV is the second most frequent cause of hearing loss after connexin mutations. It underlines that a majority of French children with hearing loss and cCMV are not diagnosed early and therefore may not benefit from early intervention including the possibility of neonatal antiviral treatment. These results make the case for promoting systematic cytomegalovirus screening in neonates with confirmed hearing loss identified through neonatal hearing screening.

Universal newborn hearing screening, a revolutionary diagnosis of deafness: real benefits and limitations

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-to-follow-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.