Effectiveness of population-based newborn hearing screening in England: ages of interventions and profile of cases

Role of Newborn Hearing Screening Done Over One Year in a Tertiary Care Hospital: A Cross-Sectional Study

BACKGROUND

Newborn hearing screening (NHS) is universally acknowledged as a critical early intervention to prevent adverse developmental outcomes caused by undetected hearing loss. Despite its proven benefits, the implementation of NHS varies, especially in tertiary care hospitals that manage high-risk neonates. This study investigates the effectiveness and implementation of NHS protocols in these settings.

METHODOLOGY

This cross-sectional study was conducted in the Department of Neonatology at Saveetha Medical College, Chennai. All newborns delivered between January 2023 and December 2023 were included. Screening involved initial otoacoustic emissions (OAEs) tests, automated auditory brainstem response (AABR) followed by brainstem evoked response audiometry (BERA) for those who failed. Data on demographic characteristics, screening results, and follow-up compliance were collected and analyzed.

RESULTS

A total of 1,398 neonates were screened. Initial screening resulted in 416 (29.7%) referrals. Follow-up screenings showed high compliance rates, with significant detections of hearing impairments through BERA. The screening was completed for 1,341 babies. Fifty-five babies were lost to follow-up. Of these, 2 babies (0.1%) with a high risk for hearing loss were diagnosed with bilateral severe hearing loss. The study also noted demographic factors such as kinship and obstetric history that might influence hearing loss risks.

CONCLUSIONS

NHS plays a vital role in the early detection and management of hearing impairments, which is crucial for preventing negative impacts on a child's development. This study advocates for the systematic implementation of NHS protocols in all tertiary care hospitals, especially those serving high-risk neonates, to ensure optimal developmental outcomes.

Performance of Statistical Indicators in the Objective Detection of Speech-Evoked Envelope Following Responses

OBJECTIVES

To assess the sensitivity of statistical indicators used for the objective detection of speech-evoked envelope following responses (EFRs) in infants and adults.

DESIGN

Twenty-three adults and 21 infants with normal hearing participated in this study. A modified/susa∫i/speech token was presented at 65 dB SPL monoaurally. Presentation level in infants was corrected using in-ear measurements. EFRs were recorded between high forehead and ipsilateral mastoid. Statistical post-processing was completed using F -test, Magnitude-Square Coherence, Rayleigh test, Rayleigh-Moore test, and Hotelling's T 2 test. Logistic regression models assessed the sensitivity of each statistical indicator in both infants and adults as a function of testing duration.

RESULTS

The Rayleigh-Moore and Rayleigh tests were the most sensitive statistical indicators for speech-evoked EFR detection in infants. Comparatively, Magnitude-Square Coherence and Hotelling's T 2 also provide clinical benefit for infants in all conditions after ~30 minutes of testing, whereas the F -test failed to detect responses to EFRs elicited by vowels with accuracy greater than chance. In contrast, the F-test was the most sensitive for vowel-elicited response detection for adults in short tests (<10 minute) and performed comparatively with the Rayleigh-Moore and Rayleigh test during longer test durations. Decreased sensitivity was observed in infants relative to adults across all testing durations and statistical indicators, but the effects were largest in low frequency stimuli and seemed to be mostly, but not wholly, caused by differences in response amplitude.

CONCLUSIONS

The choice of statistical indicator significantly impacts the sensitivity of speech-evoked EFR detection. In both groups and for all stimuli, the Rayleigh test and Rayleigh-Moore tests have high sensitivity. Differences in EFR detection are present between infants and adults regardless of statistical indicator; however, these effects are largest for low-frequency EFR stimuli and for amplitude-based statistical indicators.

Prevalence of Hearing Loss in Dutch Newborns; Results of the Nationwide Well-Baby Newborn Hearing Screening Program

Background: Few studies report prevalence rates of hearing loss in newborns for nationwide populations. The Dutch well-baby newborn hearing screening covers almost all eligible children and has high participation rates for follow-up screening rounds and diagnosis. This allows calculating reliable prevalence rates of permanent neonatal hearing loss specified by severity. Methods: Results from the well-baby newborn hearing screening program and diagnostic follow-up of referred children from 2015 to 2019 were included in calculating prevalence rates. Hearing loss was classified according to the degree of severity. Results: A total of 99.7% of 833,318 children eligible for screening were included. A total of 0.3% were referred for audiological diagnostics. Permanent bilateral hearing loss of ≥40 dB was diagnosed in 23.7% of them and unilateral hearing loss in 14.4%. A prevalence rate of 1.23 per 1000 children was found, 0.46 for unilateral hearing loss and 0.76 for bilateral hearing loss. Moderate hearing loss is most common in children with bilateral hearing loss (0.47), followed by profound (0.21) and severe (0.06) hearing loss. In children with unilateral hearing loss, prevalence rates are the highest for profound hearing loss (0.21), followed by moderate (0.16) and severe (0.09) hearing loss. A total of 87.5% of the children were diagnosed within the age of 3 months. Conclusions: Because of the high quality of the Dutch well-baby hearing screening program, reported results approximate true prevalence rates of permanent hearing loss by severity.

The Accuracy of Envelope Following Responses in Predicting Speech Audibility

OBJECTIVES

The present study aimed to (1) evaluate the accuracy of envelope following responses (EFRs) in predicting speech audibility as a function of the statistical indicator used for objective response detection, stimulus phoneme, frequency, and level, and (2) quantify the minimum sensation level (SL; stimulus level above behavioral threshold) needed for detecting EFRs.

DESIGN

In 21 participants with normal hearing, EFRs were elicited by 8 band-limited phonemes in the male-spoken token /susa∫i/ (2.05 sec) presented between 20 and 65 dB SPL in 15 dB increments. Vowels in /susa∫i/ were modified to elicit two EFRs simultaneously by selectively lowering the fundamental frequency (f0) in the first formant (F1) region. The modified vowels elicited one EFR from the low-frequency F1 and another from the mid-frequency second and higher formants (F2+). Fricatives were amplitude-modulated at the average f0. EFRs were extracted from single-channel EEG recorded between the vertex (Cz) and the nape of the neck when /susa∫i/ was presented monaurally for 450 sweeps. The performance of the three statistical indicators, F-test, Hotelling's T, and phase coherence, was compared against behaviorally determined audibility (estimated SL, SL ≥0 dB = audible) using area under the receiver operating characteristics (AUROC) curve, sensitivity (the proportion of audible speech with a detectable EFR [true positive rate]), and specificity (the proportion of inaudible speech with an undetectable EFR [true negative rate]). The influence of stimulus phoneme, frequency, and level on the accuracy of EFRs in predicting speech audibility was assessed by comparing sensitivity, specificity, positive predictive value (PPV; the proportion of detected EFRs elicited by audible stimuli) and negative predictive value (NPV; the proportion of undetected EFRs elicited by inaudible stimuli). The minimum SL needed for detection was evaluated using a linear mixed-effects model with the predictor variables stimulus and EFR detection p value.

RESULTS

of the 3 statistical indicators were similar; however, at the type I error rate of 5%, the sensitivities of Hotelling's T (68.4%) and phase coherence (68.8%) were significantly higher than the F-test (59.5%). In contrast, the specificity of the F-test (97.3%) was significantly higher than the Hotelling's T (88.4%). When analyzed using Hotelling's T as a function of stimulus, fricatives offered higher sensitivity (88.6 to 90.6%) and NPV (57.9 to 76.0%) compared with most vowel stimuli (51.9 to 71.4% and 11.6 to 51.3%, respectively). When analyzed as a function of frequency band (F1, F2+, and fricatives aggregated as low-, mid- and high-frequencies, respectively), high-frequency stimuli offered the highest sensitivity (96.9%) and NPV (88.9%). When analyzed as a function of test level, sensitivity improved with increases in stimulus level (99.4% at 65 dB SPL). The minimum SL for EFR detection ranged between 13.4 and 21.7 dB for F1 stimuli, 7.8 to 12.2 dB for F2+ stimuli, and 2.3 to 3.9 dB for fricative stimuli.

CONCLUSIONS

EFR-based inference of speech audibility requires consideration of the statistical indicator used, phoneme, stimulus frequency, and stimulus level.

Outcomes of Universal Newborn Screening Programs: Systematic Review

BACKGROUND

This systematic review examined the outcomes (age of identification and intervention, developmental outcomes, cost-effectiveness, and adverse effects on parents) of universal newborn hearing screening (UNHS) for children with permanent congenital hearing loss (PCHL).

MATERIALS AND METHODS

Multiple electronic databases were interrogated in March and April 2020 with further reports identified from article citations and unpublished literature. UNHS reports in English with comparisons of outcomes of infants who were not screened, and infants identified through other hearing screening programs.

RESULTS

30 eligible reports from 14 populations with 7,325,138 infants screened through UNHS from 1616 non-duplicate references were included. UNHS results in a lower age of identification, amplification, and the initiation of early intervention services and better language/literacy development. Better speech perception/production were shown in younger, but not in older, children with early identification after UNHS. No significant findings were found for behavior problems and quality of life. UNHS was found to be cost-effective in terms of savings to society. In addition, no significant parental harm was noted as a result of UNHS.

CONCLUSIONS

In highly developed countries, significantly better outcomes were found for children identified early through UNHS programs. Early language development predicts later literacy and language development.

Generation of inner ear sensory neurons using blastocyst complementation in a Neurog1+/--deficient mouse

This research is the first to produce induced pluripotent stem cell-derived inner ear sensory neurons in the Neurog1^+/− heterozygote mouse using blastocyst complementation. Additionally, this approach corrected non-sensory deficits associated with Neurog1 heterozygosity, indicating that complementation is specific to endogenous Neurog1 function. This work validates the use of blastocyst complementation as a tool to create novel insight into the function of developmental genes and highlights blastocyst complementation as a potential platform for generating chimeric inner ear cell types that can be transplanted into damaged inner ears to improve hearing.

Quality measures of a multicentre universal newborn hearing screening program in Malaysia

OBJECTIVE

To evaluate and discuss the outcomes of the universal newborn hearing screening program conducted at four public hospitals in Malaysia.

METHOD

A retrospective analysis of the universal newborn hearing screening database from each hospital was performed. The database consisted of 28,432 and 30,340 screening results of babies born in 2015 and 2016, respectively. Quality indicators (coverage rate, referral rate, return for follow-up rate, and ages at screening and diagnosis) were calculated.

RESULTS

Overall coverage rate across the four hospitals was 75% in 2015 and 87.4% in 2016. Over the two years, the referral rates for the first screening ranged from 2.7% to 33.93% with only one hospital achieving the recommended benchmark of <4% in both years. The return for follow-up rates for each participating hospital was generally below the recommended benchmark of ≥95%. The mean age at screening was 3.9 ± 1.2 days and 3.3 ± 0.4 days, respectively. The mean age at diagnosis for 70 infants diagnosed with permanent hearing loss was 4.7 ± 0.7 months in 2015 and 3.6 ± 0.9 months in 2016.

CONCLUSIONS

Quality measures for the universal newborn hearing screening program in four public hospitals in Malaysia were lower than the required standards. Nevertheless, some quality indicators showed statistically significant improvements over the two years. Next steps involve identifying and implementing the best practice strategies to improve the outcome measures and thus the quality of the program.

Prevalence of permanent childhood hearing loss detected at the universal newborn hearing screen: Systematic review and meta-analysis

CONTEXT

Permanent childhood hearing loss (PCHL) can affect speech, language, and wider outcomes. Adverse effects are mitigated through universal newborn hearing screening (UNHS) and early intervention.

OBJECTIVE

We undertook a systematic review and meta-analysis to estimate prevalence of UNHS-detected PCHL (bilateral loss ≥26 dB HL) and its variation by admission to neonatal intensive care unit (NICU). A secondary objective was to report UNHS programme performance (PROSPERO: CRD42016051267).

DATA SOURCES

Multiple electronic databases were interrogated in January 2017, with further reports identified from article citations and unpublished literature (November 2017).

STUDY SELECTION

UNHS reports from very highly-developed (VHD) countries with relevant prevalence and performance data; no language or date restrictions.

DATA EXTRACTION

Three reviewers independently extracted data and assessed quality.

RESULTS

We identified 41 eligible reports from 32 study populations (1799863 screened infants) in 6195 non-duplicate references. Pooled UNHS-detected PCHL prevalence was 1.1 per 1000 screened children (95% confidence interval [CI]: 0.9, 1.3; I2 = 89.2%). This was 6.9 times (95% CI: 3.8, 12.5) higher among those admitted to NICU. Smaller studies were significantly associated with higher prevalences (Egger's test: p = 0.02). Sensitivity and specificity ranged from 89-100% and 92-100% respectively, positive predictive values from 2-84%, with all negative predictive values 100%.

LIMITATIONS

Results are generalisable to VHD countries only. Estimates and inferences were limited by available data.

CONCLUSIONS

In VHD countries, 1 per 1000 screened newborns require referral to clinical services for PCHL. Prevalence is higher in those admitted to NICU. Improved reporting would support further examination of screen performance and child demographics.

Parental Conceptualizations of Autism and Deafness in British Deaf Children

The co-occurrence of childhood deafness and autism raises complex challenges for diagnosis and family support. In this article, we explore with hearing and Deaf parents their observations of the interaction between deafness and autism and identify how the intersections of deafness and autism are conceptualized in everyday life. Eight parents participated (two of whom were Deaf BSL users) in semi-structured interviews in either BSL or spoken English. Data analysis was underpinned by a phenomenological approach in the hermeneutic tradition. Findings are discussed in terms of parents' perceptions of the relevance of deafness to their understanding of autism for their particular child, the effects of autism on sign and spoken language development and the relationship between deafness and autism in terms of their own and others' attributions of their children's characteristics. The significance of the findings for parental contributions' to diagnostic assessment and the tailoring of family support are considered.

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

BACKGROUND

The 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.

RESULTS

The 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.

CONCLUSIONS

The 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.

The Physiologic and Psychophysical Consequences of Severe-to-Profound Hearing Loss

Substantial loss of cochlear function is required to elevate pure-tone thresholds to the severe hearing loss range; yet, individuals with severe or profound hearing loss continue to rely on hearing for communication. Despite the impairment, sufficient information is encoded at the periphery to make acoustic hearing a viable option. However, the probability of significant cochlear and/or neural damage associated with the loss has consequences for sound perception and speech recognition. These consequences include degraded frequency selectivity, which can be assessed with tests including psychoacoustic tuning curves and broadband rippled stimuli. Because speech recognition depends on the ability to resolve frequency detail, a listener with severe hearing loss is likely to have impaired communication in both quiet and noisy environments. However, the extent of the impairment varies widely among individuals. A better understanding of the fundamental abilities of listeners with severe and profound hearing loss and the consequences of those abilities for communication can support directed treatment options in this population.

Diagnostic value of conventional MRI combined with DTI for neonatal hyperbilirubinemia

BACKGROUND

Neonatal hyperbilirubinemia (NHB) is a common clinical disease and can cause bilirubin encephalopathy in severe cases. It is now widely accepted that increased signal intensity in the globus pallidus on MR T1WI is an important sign of neonatal bilirubin encephalopathy. And brain diffusion tensor imaging (DTI) has not been used extensively to study hyperbilirubinemia (HB). So we compared newborns with different hyperbilirubinemia of different severities and healthy newborns in order to determine the relationships among MRI signal intensities, serum bilirubin levels, and the molecular changes in brain water diffusion in hyperbilirubinemia.

METHODS

Seventy-three newborns with hyperbilirubinemia were grouped into three groups: the mild increase group (M, 27 cases), the moderate increase group (O, 28 cases), and the severe group (S, 18 cases). The groups were based on serum bilirubin levels. We performed cranial MRI in these newborns, as well as 29 healthy full-term infants (group N). We compared and analyzed the mean signal values for the globus pallidus and the relationship between the bilirubin level and the score on the neonatal behavioral neurological assessment. Fifteen, 10, and 10 patients in groups M, O + S, and N were successfully examined using diffusion tensor imaging (DTI). We assessed the relationships among the signal from the globus pallidus, fractional anisotropy (FA), and average diffusion coefficient (DCav) of the posterior limb of the internal capsule (PLIC).

RESULTS

There were significant differences in the mean signal value of bilateral globus pallidus between group O/S and group N [p = 0.029 and 0.000 (left), 0.038 and 0.000 (right)]. There were no significant differences in bilateral FA or DCav values between the patient groups and group N. The bilateral PLIC-FA and DCav values were significantly different between the patient groups and group N (P = 0.014 and 0.047, respectively).

CONCLUSIONS

Increased signal intensity in the globus pallidus on T1-weighted imaging can be used as an objective index to evaluate neonatal bilirubin encephalopathy. Globus pallidus and PLIC injuries are likely to occur when the total serum bilirubin level is ≥20 mg/dl.

Acceptance of internet-based hearing healthcare among adults who fail a hearing screening

OBJECTIVE

This study measured help-seeking readiness and acceptance of existing internet-based hearing healthcare (IHHC) websites among a group of older adults who failed a hearing screening (Phase 1). It also explored the effects of brief training on participants' acceptance of IHHC (Phase 2).

STUDY SAMPLE

Twenty-seven adults (age 55+) who failed a hearing screening participated.

DESIGN

During Phase 1 participants were administered the University of Rhode Island Change Assessment (URICA) and patient technology acceptance model (PTAM) Questionnaire. During Phase 2 participants were randomly assigned to a training or control group. Training group participants attended an instructional class on existing IHHC websites. The control group received no training. The PTAM questionnaire was re-administered to both groups 4-6 weeks following the initial assessment.

RESULTS

The majority of participants were either considering or preparing to do something about their hearing loss, and were generally accepting of IHHC websites (Phase 1). The participants who underwent brief IHHC training reported increases in hearing healthcare knowledge and slight improvements in computer self-efficacy (Phase 2).

CONCLUSIONS

Older adults who fail hearing screenings may be good candidates for IHHC. The incorporation of a simple user-interface and short-term training may optimize the usability of future IHHC programs for this population.

Role of Cortical Auditory Evoked Potentials in Reducing the Age at Hearing Aid Fitting in Children With Hearing Loss Identified by Newborn Hearing Screening

Recording of free-field cortical auditory evoked potential (CAEP) responses to speech tokens was introduced into the audiology management for infants with a permanent childhood hearing impairment (PCHI) during 2011-2015 at a U.K. service. Children with bilateral PCHI were studied from two sequential cohorts. Thirty-four children had followed an audiology pathway prior to CAEP introduction, and 44 children followed a pathway after the introduction of CAEP and were tested with unaided and aided CAEP responses. Data analysis explored the age of diagnosis, hearing aid fitting, and referral for cochlear implant (CI) assessment for each of these groups. CAEP offered a novel educative process for the parents and audiologists supporting decision-making for hearing aid fitting and CI referral. Delays in hearing aid fitting and CI referral were categorized as being due to the audiologist's recommendation or parental choice. Results showed that the median age of hearing aid fitting prior to CAEP introduction was 9.2 months. After the inclusion of CAEP recording in the infant pathways, it was 3.9 months. This reduction was attributable to earlier fitting of hearing aids for children with mild and moderate hearing losses, for which the median age fell from 19 to 5 months. Children with profound hearing loss were referred for CI assessment at a significantly earlier age following the introduction of CAEP. Although there has also been a national trend for earlier hearing aid fitting in children, the current study demonstrates that the inclusion of CAEP recording in the pathway facilitated earlier hearing aid fitting for milder impairments.

Childhood hearing surveillance activity in Italy: preliminary recommendations

Following the positive outcomes of the newborn hearing screening programmes already underway in several Italian regions, it is now necessary to address the identification of childhood hearing impairments that missed the neonatal screening programme or have delayed onset. Within the framework of the Ministry of Health project CCM 2013 "Preventing Communication Disorders: a Regional Program for early Identification, Intervention and Care of Hearing Impaired Children", a group of professionals identified three main recommendations that can be useful to improve hearing surveillance activity within the regional and state Italian Health System. The family paediatrician is recognised as having a key role in ongoing monitoring of hearing capacity and development of the growing child.

Analysis of neonatal hearing screening program performed on an outpatient basis: Analysis of an outpatient hearing screening program

OBJECTIVE

The aims of the present study were to analyze the coverage of an outpatient hearing screening program in a public hospital for healthy newborns, to describe the social and demographic profile of the mothers and to identify the prevalence of infants with severe or profound hearing losses.

METHODS

The method was descriptive and retrospective. In 2002 and 2003, the newborn hearing screening program was initiated in the maternity ward. Due to many logistic problems, in 2004, we implemented screening on an outpatient basis. Thus, upon discharge from the hospital, the mothers received a printed schedule referring the baby to an outpatient clinic. A two-stage screening protocol was implemented. The screening results were presented from 2004 to 2013.

RESULTS

The program was initiated on an outpatient basis in 2004. From 2004 to 2013, 14,882 infants were screened but the complete data for 14,205 cases were obtained. The adherence of the families was 32% in 2004 and increased to 85% in 2013. The mean age of the screened newborns was 48.66 days in 2005 and 24.53 days in 2013. The number of newborns who failed the test and were referred for diagnosis decreased from 12.3% in 2004 to 3% in 2013. The majority of the mothers were young, 69.77% of them aged up to 29 years old and 74.86% had completed basic education. Seventy infants showed hearing loss, totaling 0.49% or approximately 5 cases in 1000, with eight individuals diagnosed with severe or profound sensorineural hearing loss, totaling 0.06% or approximately six cases in 10,000.

CONCLUSIONS

The newborn hearing screening program offered by a public hospital in Brazil, over the years, has increased the coverage from 32% to 85%, and so, can be performed on an outpatient basis as an alternative to overcome the operating limitations that might occur in hospital hearing screening. The mothers of the newborns were young and had complete basic education; the prevalence was similar to international studies as hearing loss is concerned.

Cortical development and neuroplasticity in Auditory Neuropathy Spectrum Disorder

Cortical development is dependent to a large extent on stimulus-driven input. Auditory Neuropathy Spectrum Disorder (ANSD) is a recently described form of hearing impairment where neural dys-synchrony is the predominant characteristic. Children with ANSD provide a unique platform to examine the effects of asynchronous and degraded afferent stimulation on cortical auditory neuroplasticity and behavioral processing of sound. In this review, we describe patterns of auditory cortical maturation in children with ANSD. The disruption of cortical maturation that leads to these various patterns includes high levels of intra-individual cortical variability and deficits in cortical phase synchronization of oscillatory neural responses. These neurodevelopmental changes, which are constrained by sensitive periods for central auditory maturation, are correlated with behavioral outcomes for children with ANSD. Overall, we hypothesize that patterns of cortical development in children with ANSD appear to be markers of the severity of the underlying neural dys-synchrony, providing prognostic indicators of success of clinical intervention with amplification and/or electrical stimulation. This article is part of a Special Issue entitled <Auditory Synaptology>.

Evaluation of universal newborn hearing screening in South African primary care

BACKGROUND

Universal Newborn Hearing Screening (UNHC) is the gold standard toward early hearing detection and intervention, hence the importance of its deliberation within the South African context.

AIM

To determine the feasibility of screening in low-risk neonates, using Otoacoustic Emissions (OAEs), within the Midwife Obstetric Unit (MOU) three-day assessment clinic at a Community Health Centre (CHC), at various test times following birth.

METHOD

Within a quantitative, prospective design, 272 neonates were included. Case history interviews, otoscopic examinations and Distortion Product OAEs (DPOAEs) screening were conducted at two sessions (within six hours and approximately three days after birth). Data were analysed via descriptive statistics.

RESULTS

Based on current staffing profile and practice, efficient and comprehensive screening is not successful within hours of birth, but is more so at the MOU three-day assessment clinic. Significantly higher numbers of infants were screened at session 2, with significantly less false-positive results. At session 1, only 38.1% of the neonates were screened, as opposed to more than 100% at session 2. Session 1 yielded an 82.1% rate of false positive findings, a rate that not only has important implications for the emotional well-being of the parents; but also for resource-stricken environments where expenditure has to be accounted for carefully.

CONCLUSION

Current findings highlight the importance of studying methodologies to ensure effective reach for hearing screening within the South African context. These findings argue for UNHS initiatives to include the MOU three-day assessment to ensure that a higher number of neonates are reached and confounding variables such as vernix have been eliminated.

Parents' perspectives on the dilemmas with intervention for infants with auditory neuropathy spectrum disorder: A qualitative study

OBJECTIVE

This paper explores parental experiences of choices surrounding auditory management and language and communication development for infants and children with auditory neuropathy spectrum disorder (ANSD) in the light of the heterogeneity of condition, a poor evidence base for best outcomes in relation to management options, and the scarcity of data rooted in parent and family experience.

DESIGN

Qualitative narrative study.

STUDY SAMPLE

Twenty-five parents of 21 children (aged four months to six years) identified with ANSD through the newborn hearing screening programme.

RESULTS

Families identify barriers to early management due to conflicting expert opinions and ANSD-specific challenges with diagnosis and prognosis in infants, and share their accounts on their own evaluations of intervention benefit in their children.

CONCLUSIONS

The results are of relevance to the clinicians and other professionals involved in early intervention, management, and support of infants with ANSD.

Performance and characteristics of the Newborn Hearing Screening Programme in England: The first seven years

Objective: To assess the performance of the universal newborn hearing screen in England. Design: Retrospective analysis of population screening records. Study sample: A total of 4 645 823 children born 1 April 2004 to 31 March 2013. Results: 97.5% of the eligible population complete screening by 4/5 weeks of age and 98.9% complete screening by three months of age. The refer rate for the 12/13 birth cohort is 2.6%. The percentage of screen positive (i.e. referred) babies commencing follow up by four weeks of age and six months of age is 82.5% and 95.8% respectively. The yield of bilateral PCHL from the screen is around 1/1000. For bilateral PCHL in the 12/13 birth cohort the median age is nine days at screen completion, 30 days at entry into follow up, 49 days at confirmation, 50 days at referral to early intervention, and 82 days at hearing-aid fitting. Conclusion: The performance of the newborn hearing screening programme has improved continuously. The yield of bilateral PCHL from the screen is about 1/1000 as expected. The age of identification and management is well within the first six months of life, although there remains scope for further improvement with respect to timely entry into follow up.

Hearing screening in a tertiary care hospital in India

INTRODUCTION

To study the incidence of hearing loss among children and to determine and confirm the distribution of common risk factors in children with hearing loss presenting at a tertiary care hospital in India.

MATERIALS AND METHODS

Babies underwent hearing screening using Transient Evoked Otoacoustic Emission (TEOAE) and Automated Auditory Brainstem Response (AABR) from November 2009 to September 2011. It was a cross-sectional study carried out at our institute involving 500 babies (≤2 y). To identify the high risk babies, Joint Committee on Infant Hearing (2007) High risk registry was used.

RESULTS

In our study 110 (22%) babies belonged to high risk category and 11(2.2%) of total screened babies had significant hearing loss. Total number of babies who passed the initial screening with TEOAE was 284 (56.8%). On diagnostic AABR screening of TEOAE REFERRED babies, the babies with no risk factor showed normal AABR tracings whereas from among those with one or multiple risk factors (110 babies), 11(10%) showed different levels of hearing impairment. Hearing loss was highly associated with Neonatal Intensive Care Unit (NICU) admission i.e. 8/11(72.7%), followed by Low Birth Weight (LBW) and hypoxia (6/11 i.e. 54.5% each).

CONCLUSION

Hearing loss is more common in those babies with risk factors (majority being NICU admission, LBW and hypoxia). OAE and ABR screening of infants at risk for significant hearing loss is a clinically efficient and cost effective approach for early detection of significant hearing loss.

An auditory health program for neonates in ICU and/or intermediate care settings

Auditory screening and early identification and management of patients with hearing loss improve the development prospects of infants.

OBJECTIVE

To analyze the outcomes produced by an Auditory Health Program in neonates managed in an intensive care unit.

METHOD

This prospective cross-sectional study enrolled neonates referred to the neonatal care unit at hospital CAISM/Unicamp with stays lasting for 48 hours and more within a period of 13 months. Automated monitoring of brainstem auditory evoked potentials was used in the auditory screening of neonates at the time of discharge. Children with poor BAEPs were sent to undergo audiological, otorhinolaryngological, and genetic tests.

RESULTS

Auditory screening was performed for 84.7% of the live births; 39.7% were screened at 30 days or more of age. Diagnostic tests revealed that 63.8% of the children had normal hearing. Incidence of hearing loss was 4%; sensorineural hearing loss was observed in 1,4% of the subjects; 0.24% had auditory neuropathy spectrum disorder; and 2.2% had conductive hearing loss.

CONCLUSION

Neonatal auditory screening was not offered universally, and nor was it carried out, in many cases, within the child's first month of life. Screening must be performed before neonates are discharged and in more than one stage. A high incidence of hearing loss was observed.

Lexical variation and change in british sign language

This paper presents results from a corpus-based study investigating lexical variation in BSL. An earlier study investigating variation in BSL numeral signs found that younger signers were using a decreasing variety of regionally distinct variants, suggesting that levelling may be taking place. Here, we report findings from a larger investigation looking at regional lexical variants for colours, countries, numbers and UK placenames elicited as part of the BSL Corpus Project. Age, school location and language background were significant predictors of lexical variation, with younger signers using a more levelled variety. This change appears to be happening faster in particular sub-groups of the deaf community (e.g., signers from hearing families). Also, we find that for the names of some UK cities, signers from outside the region use a different sign than those who live in the region.

Autism spectrum disorders in 24 children who are deaf or hard of hearing

OBJECTIVES

Approximately 4% of children who are deaf or hard of hearing have co-occurring autism spectrum disorder (ASD). Making an additional diagnosis of ASD in this population can be challenging, given the complexities of determining whether speech/language and social delays can be accounted for by their hearing loss, or whether these delays might be indicative of a comorbid ASD diagnosis. This exploratory study described a population of 24 children with the dual diagnosis of ASD and hearing loss.

METHODS

Children completed a comprehensive ASD evaluation using standardized autism diagnostic instruments (Autism Diagnostic Observation Schedule, language and psychological testing). Children with permanent hearing loss who had a developmental evaluation between 2001 and 2011 and were diagnosed with an ASD based on the results of that evaluation were included. Information on communication modality, language and cognitive abilities was collected.

RESULTS

The median age of diagnosis was 14 months (range 1-71) for hearing loss and 66.5 months (range 33-106) for ASD. Only 25% (n=6) children were diagnosed with ASD ≤ 48 months of age and 46% by ≤ 6 years. Twelve (50%) children were diagnosed with ASD, 11 were diagnosed with pervasive developmental disorder not otherwise specified and 1 child had Asperger's. Most (67%) had profound degree of hearing loss. Fourteen (58%) children had received a cochlear implant, while 3 children had no amplification for hearing loss. Nine (38%) of the 24 children used speech as their mode of communication (oral communicators).

CONCLUSIONS

Communication delays in children who are deaf or hard of hearing are a serious matter and should not be assumed to be a direct consequence of the hearing loss. Children who received cochlear implants completed a multidisciplinary evaluation including a developmental pediatrician, which may have provided closer monitoring of speech and language progression and subsequently an earlier ASD diagnosis. Because children who are deaf or hard of hearing with ASD are challenging to evaluate, they may receive a diagnosis of ASD at older ages.

Inter-trial coherence as a marker of cortical phase synchrony in children with sensorineural hearing loss and auditory neuropathy spectrum disorder fitted with hearing aids and cochlear implants

OBJECTIVE

Although brainstem dys-synchrony is a hallmark of children with auditory neuropathy spectrum disorder (ANSD), little is known about how the lack of neural synchrony manifests at more central levels. We used time-frequency single-trial EEG analyses (i.e., inter-trial coherence; ITC), to examine cortical phase synchrony in children with normal hearing (NH), sensorineural hearing loss (SNHL) and ANSD.

METHODS

Single trial time-frequency analyses were performed on cortical auditory evoked responses from 41 NH children, 91 children with ANSD and 50 children with SNHL. The latter two groups included children who received intervention via hearing aids and cochlear implants. ITC measures were compared between groups as a function of hearing loss, intervention type, and cortical maturational status.

RESULTS

In children with SNHL, ITC decreased as severity of hearing loss increased. Children with ANSD revealed lower levels of ITC relative to children with NH or SNHL, regardless of intervention. Children with ANSD who received cochlear implants showed significant improvements in ITC with increasing experience with their implants.

CONCLUSIONS

Cortical phase coherence is significantly reduced as a result of both severe-to-profound SNHL and ANSD.

SIGNIFICANCE

ITC provides a window into the brain oscillations underlying the averaged cortical auditory evoked response. Our results provide a first description of deficits in cortical phase synchrony in children with SNHL and ANSD.

Central auditory maturation and behavioral outcome in children with auditory neuropathy spectrum disorder who use cochlear implants

OBJECTIVE

We examined cortical auditory development and behavioral outcomes in children with ANSD fitted with cochlear implants (CI).

DESIGN

Cortical maturation, measured by P1 cortical auditory evoked potential (CAEP) latency, was regressed against scores on the infant toddler meaningful auditory integration scale (IT-MAIS). Implantation age was also considered in relation to CAEP findings.

STUDY SAMPLE

Cross-sectional and longitudinal samples of 24 and 11 children, respectively, with ANSD fitted with CIs.

RESULTS

P1 CAEP responses were present in all children after implantation, though previous findings suggest that only 50-75% of ANSD children with hearing aids show CAEP responses. P1 CAEP latency was significantly correlated with participants' IT-MAIS scores. Furthermore, more children implanted before age two years showed normal P1 latencies, while those implanted later mainly showed delayed latencies. Longitudinal analysis revealed that most children showed normal or improved cortical maturation after implantation.

CONCLUSION

Cochlear implantation resulted in measureable cortical auditory development for all children with ANSD. Children fitted with CIs under age two years were more likely to show age-appropriate CAEP responses within six months after implantation, suggesting a possible sensitive period for cortical auditory development in ANSD. That CAEP responses were correlated with behavioral outcome highlights their clinical decision-making utility.

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.

Feasibility and effectiveness of a population-based newborn hearing screening in an economically deprived region of Italy

AIM

To describe the effectiveness of a population-based newborn hearing screening program in an economically deprived region of southern Italy.

METHODS

A screening protocol was proposed for all newborns of the Campania region, starting on January, 2007. For infants identified with hearing loss, information on degree and type of hearing loss and presence of risk factors was collected.

RESULTS

The infants born in the 3-year study period were 182,188. Among them, 146,026 (80%) were tested with OAE. Sensorineural hearing loss ≥40dBnHL was established for 159 infants (1.1×1000). Among the NICU and WIN infants, the rate of hearing loss was respectively 9×1000 and 0.67×1000. Follow-up information was available for 111 children (70%), as 48 (30%) got care in other regions or health facilities. Most infants were fitted hearing aids by 1 month after diagnosis and 15 children (13.5%) received a cochlear implant at a mean age of 25 months (SD 10).

CONCLUSIONS

Even in a setting of population poverty, a universal newborn screening program can deliver satisfactory outcomes. The coverage and the tracking system of the program need to be improved, as well as the cooperation between public and private health services.

Cost-effectiveness analysis of a national neonatal hearing screening program in China: conditions for the scale-up

BACKGROUND

In 2009, the Chinese Ministry of Health recommended scale-up of routine neonatal hearing screening - previously performed primarily only in select urban hospitals - throughout the entire country.

METHODS

A decision analytical model for a simulated population of all live births in china was developed to compare the costs and health effects of five mutually exclusive interventions: 1) universal screening using Otoacoustic Emission (OAE) and Automated Auditory Brainstem Response (AABR); 2) universal OAE; 3) targeted OAE and AABR; 4) targeted OAE; and 5) no screening. Disability-Adjusted Life Years (DALYs) were calculated for health effects.

RESULTS AND DISCUSSION

Based on the cost-effectiveness and potential health outcomes, the optimal path for scale-up would be to start with targeted OAE and then expand to universal OAE and universal OAE plus AABR. Accessibility of screening, diagnosis, and intervention services significantly affect decision of the options.

CONCLUSION

In conclusion, to achieve cost-effectiveness and best health outcomes of the NHS program, the accessibility of screening, diagnosis, and intervention services should be expanded to reach a larger population. The results are thus expected to be of particular benefit in terms of the 'rolling out' of the national plan.

Restoration of auditory evoked responses by human ES-cell-derived otic progenitors

Deafness is a condition with a high prevalence worldwide, produced primarily by the loss of the sensory hair cells and their associated spiral ganglion neurons (SGNs). Of all the forms of deafness, auditory neuropathy is of particular concern. This condition, defined primarily by damage to the SGNs with relative preservation of the hair cells, is responsible for a substantial proportion of patients with hearing impairment. Although the loss of hair cells can be circumvented partially by a cochlear implant, no routine treatment is available for sensory neuron loss, as poor innervation limits the prospective performance of an implant. Using stem cells to recover the damaged sensory circuitry is a potential therapeutic strategy. Here we present a protocol to induce differentiation from human embryonic stem cells (hESCs) using signals involved in the initial specification of the otic placode. We obtained two types of otic progenitors able to differentiate in vitro into hair-cell-like cells and auditory neurons that display expected electrophysiological properties. Moreover, when transplanted into an auditory neuropathy model, otic neuroprogenitors engraft, differentiate and significantly improve auditory-evoked response thresholds. These results should stimulate further research into the development of a cell-based therapy for deafness.

Plasticity in the developing auditory cortex: evidence from children with sensorineural hearing loss and auditory neuropathy spectrum disorder

The developing auditory cortex is highly plastic. As such, the cortex is both primed to mature normally and at risk for reorganizing abnormally, depending upon numerous factors that determine central maturation. From a clinical perspective, at least two major components of development can be manipulated: (1) input to the cortex and (2) the timing of cortical input. Children with sensorineural hearing loss (SNHL) and auditory neuropathy spectrum disorder (ANSD) have provided a model of early deprivation of sensory input to the cortex and demonstrated the resulting plasticity and development that can occur upon introduction of stimulation. In this article, we review several fundamental principles of cortical development and plasticity and discuss the clinical applications in children with SNHL and ANSD who receive intervention with hearing aids and/or cochlear implants.

The cultural and linguistic diversity of 3-year-old children with hearing loss

Understanding the cultural and linguistic diversity of young children with hearing loss informs the provision of assessment, habilitation, and education services to both children and their families. Data describing communication mode, oral language use, and demographic characteristics were collected for 406 children with hearing loss and their caregivers when children were 3 years old. The data were from the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study, a prospective, population-based study of children with hearing loss in Australia. The majority of the 406 children used spoken English at home; however, 28 other languages also were spoken. Compared with their caregivers, the children in this study used fewer spoken languages and had higher rates of oral monolingualism. Few children used a spoken language other than English in their early education environment. One quarter of the children used sign to communicate at home and/or in their early education environment. No associations between caregiver hearing status and children's communication mode were identified. This exploratory investigation of the communication modes and languages used by young children with hearing loss and their caregivers provides an initial examination of the cultural and linguistic diversity and heritage language attrition of this population. The findings of this study have implications for the development of resources and the provision of early education services to the families of children with hearing loss, especially where the caregivers use a language that is not the lingua franca of their country of residence.

The impact of early identification of permanent childhood hearing impairment on speech and language outcomes

It is well established that permanent childhood hearing impairment (PCHI) has a detrimental impact on speech and language development. The past two decades have seen the gradual introduction of universal newborn hearing screening (UNHS) programmes coupled with early intervention programmes. We review studies that have capitalised on the advent of newborn hearing screening to assess the impact of early identification of PCHI on language outcomes in deaf children. The research supports the conclusion that, in children with PCHI, newborn hearing screening and early identification lead to beneficial effects on language development, with the most consistent evidence provided for links between early identification of PCHI and positive language outcomes. Future research needs to encompass a wider range of outcomes and to assess the impact of UNHS in adolescents and young adults.

Age of identification of hearing impairment in Mumbai--a trend analysis

Implementation of Universal Newborn Hearing Screening (UNHS) has led to lowering the age of identification of congenital hearing loss in children. In the absence of UNHS in Mumbai (India), it is pertinent to establish a data base on the age of identification of permanent hearing loss in children to facilitate affirmative action.

OBJECTIVE

To study the trend in age of identification (AOI) of hearing impairment in children studying in special schools.

METHODS

This retrospective study was a survey conducted on a convenient sample. The authentic data about date of birth and age of identification (AOI) of 510 children were collected through parental interview, and scrutiny of documents like birth certificates, first audiological report maintained in special schools/institutes/hospitals.

RESULTS

Time series analysis of the data concluded that from 1989 to 2008, AOI has reduced by 9.59 months. AOI has not reached one year even by 2008 and is much below the target of three months of age as per the recommendation of Joint Committee on Infant Hearing (2007).

CONCLUSION

In absence of Universal Newborn Hearing Screening (UNHS) in Mumbai (India) the present efforts do not seem to be enough in lowering the age of identification of hearing loss and policy decision is warranted.

PEATE automático em recém nascidos de risco: estudo da sensibilidade e especificidade

OBJETIVO: verificar a sensibilidade e especificidade do teste de potencial evocado auditivo de tronco encefálico em equipamento automático (PEATEa), comparando-o ao teste de potencial evocado auditivo de tronco encefálico em equipamento diagnóstico (PEATE) em um programa de triagem auditiva neonatal em neonatos de risco. MÉTODO: foram avaliados 186 neonatos, 83 nascidos a termo e 103 pré-termo, sendo 88 do sexo masculino e 98 feminino. A triagem constou de emissões otoacústicas evocadas por estímulos transientes (EOAT), PEATEa e ao PEATE na mesma semana. RESULTADOS: dos 186 neonatos avaliados, 156 (83,9%) apresentaram audição normal. A perda condutiva foi encontrada em 9 neonatos (4,8%),sendo 7 bilaterais e 2 unilaterais. A perda auditiva coclear foi observada em 5 neonatos (2,7%) sendo um unilateral. Alteração central foi obtida em 11 neonatos (5,9%) e um neonato foi diagnosticado como espectro da neuropatia auditiva -ENA(0,5%).Em 4 casos houve atraso maturacional na avaliação inicial com normalização das respostas no mês seguinte Comparando-se os resultados do PEATEa com o PEATE, observou-se alta sensibilidade ( superior a 99%) para identificação de perda coclear,condutiva, central, atraso maturacional e ENA .A especificidade do PEATEa foi de 100% para ENA, mediana para perda coclear (75% na OD e 60% na OE), e para alterações centrais (54,5%OD e 63,6% OE). Para identificação de perdas condutivas (inferior a 43%). CONCLUSÃO: o PEATEa foi eficaz na identificação das neuropatias auditivas com elevada especificidade e sensibilidade. Contudo, falsos negativos foram observados para perdas cocleares, condutivas, para alterações centrais e atraso maturacional.

Outcome of a universal newborn hearing-screening programme based on multiple transient-evoked otoacoustic emissions and clinical brainstem response audiometry

CONCLUSION

This universal newborn hearing-screening (UNHS) programme revealed high efficacy. The proportion of congenital sensorineural hearing loss was higher in left ears and in males than in right ears and females, which was in line with the systematic ear asymmetries and sex differences in transient-evoked otoacoustic emission (TEOAE) pass percentage.

OBJECTIVES

To study the long-term outcome of a UNHS programme based on multiple TEOAEs and clinical click-evoked auditory brainstem response (ABR).

METHOD

The study included all the newborns that were screened during a 6-year period (n = 31 092). TEOAE pass/fail was analysed in detail. In an assessment performed 10 years after the start of the 6-year UNHS, prevalence, degree and type of congenital hearing loss were studied.

RESULTS

The proportion of screened newborns was high, i.e. 98%. Multiple TEOAE recordings minimized the need for clinical ABR. Fifty-seven (0.18%) subjects showed bilateral hearing loss (exceeding ≈ 30 dB HL); median ABR threshold = 60 dB nHL (at 2.5 months of age). Bilateral and unilateral sensorineural hearing loss was found in 0.17% (n = 52; 56% males) and 0.06% (n = 18; 61% left ears, 56% males) of the screened newborns, respectively. Higher TEOAE pass percentages (p < 0.01) were demonstrated in right ears and in females than in left ears and males.

Congenitally deaf children's care trajectories in the context of universal neonatal hearing screening: a qualitative study of the parental experiences

The objective of this study is to examine the early care trajectories of congenitally deaf children from a parental perspective, starting with universal neonatal hearing screenings. The analysis using a three-dimensional care trajectory concept is aimed at developing a basic typology of postscreening care trajectories. Children with severe/profound hearing loss, registered in the Flanders' (Belgium) universal neonatal hearing screening program, born between 1999 and 2001. Thematic content analysis of qualitative data collected retrospectively from participant's parents. Two basic types of care trajectories emerged; based on differences in care-use in the phase of further diagnosis and related parental experiences. Subtypes resulted from events related to cochlear implantation. Five trajectory phases were identified: screening, further diagnosis, care and technology, cochlear implantation, and reduction of care and were characterized by specific parental experiences such as confusion, disbelief, disappointment, and uncertainty. Those experiences relate to care professionals' acts and communication and the child's functional evolution. Early care interventions could benefit from coordinated transition between phases, parent support throughout the care trajectory, and a broad approach to deafness in professionals' communication.

Making targeted screening for infant hearing loss an effective option in less developed countries

Developing countries account for a disproportionate burden of infant hearing loss globally but the prospects of the more ideal universal newborn hearing screening (UNHS) have been debated. The Joint Committee on Infant Hearing (JCIH) of USA has consistently proposed targeted newborn hearing screening (TNHS) for such countries. This study therefore set out to examine the appropriateness of JCIH risk factors as a basis for TNHS in Sub-Saharan Africa and Southeast Asia. From a review of relevant literature published in PubMed in the last 10 years, evidence on the effectiveness of TNHS based on JCIH or other risk factors is sparse or limited. Consistent with the prevailing epidemiological profile of these countries additional putative risk factors not listed or more prevalent than those listed by JCIH such as maternal hypertensive disorders in pregnancy, lack of skilled attendant at delivery, non-elective cesarean delivery and infant undernutrition have been demonstrated besides consanguinity. While TNHS has intuitive appeal in resource-poor settings, it is likely to be fraught with diverse operational constraints that could significantly curtail its effectiveness in these two regions. Well-conducted pilot UNHS studies to determine context-specific risk factors, screening efficiency and the potential trade-offs are warranted in each country prior to embarking on TNHS where UNHS is not immediately practicable.

An initial overestimation of sensorineural hearing loss in NICU infants after failure on neonatal hearing screening

OBJECTIVE

Infants admitted to neonatal intensive care units have a higher incidence of significant congenital hearing loss. We classified audiologic diagnoses and follow-up in infants who had been admitted to our neonatal intensive care unit.

METHODS

We included all infants admitted to the neonatal intensive care unit at Sophia Children's Hospital between 2004 and 2009 who had been referred for auditory brainstem response measurement after failing neonatal hearing screening with automated auditory brainstem response. We retrospectively analyzed the results of auditory brainstem response measurement.

RESULTS

Between 2004 and 2009 3316 infants admitted to our neonatal intensive care unit had neonatal hearing screening. 103 infants failed neonatal hearing screening: 46 girls and 57 boys. After first auditory brainstem response measurement we found 18% had normal hearing or a minimal hearing loss. The remainder had a type of hearing loss, distributed as follows: 15% conductive, 32% symmetric sensorineural, 14% asymmetric sensorineural, and 21% absent auditory brainstem responses. Repeated auditory brainstem response measurement showed a shift in hearing outcome. The main difference was an improvement from symmetric sensorineural hearing loss to normal hearing. However, in a small percentage of children, the hearing deteriorated.

CONCLUSIONS

As many as 58% of infants in this high-risk population who failed the neonatal hearing screening were diagnosed with sensorineural hearing loss or absent auditory brainstem responses. An initial overestimation of sensorineural hearing loss of about 10% was seen at first auditory brainstem response measurement. This may be partially explained by a conductive component that has resolved. Finally, in a small percentage of children the hearing deteriorated.

Adesão a um Programa de Triagem Auditiva Neonatal

A Triagem Auditiva Neonatal tem se efetivado mundialmente como meio para detecção precoce da surdez. Na Unicamp, desde 2002, os recém-nascidos na maternidade do Centro de Atenção Integral à Saúde da Mulher são agendados para a triagem auditiva no Centro de Estudos e Pesquisas em Reabilitação "Prof. Dr. Gabriel Porto". No entanto, nem todos vêm para a triagem e alguns abandonam o processo de avaliação antes do diagnóstico. O objetivo desta pesquisa foi caracterizar as taxas de adesão de lactentes ao Programa de Triagem Auditiva Neonatal. Tratou-se de pesquisa que utilizou dados contidos nos prontuários dos lactentes que efetuaram a triagem no período de fevereiro a novembro de 2007. Permaneceram no alojamento conjunto do CAISM 2107 lactentes e vieram para a triagem 1310. Dentre aqueles que não passaram na triagem (92 lactentes), realizaram o exame de PEATE-A 73 lactentes. A adesão na primeira etapa da triagem foi de 62,17%, e na segunda, 79,34%. As taxas de adesão são inferiores às preconizadas pelo Joint Comittee on Infant Hearing e encontradas em alguns países desenvolvidos. No entanto, aproximam-se de outras experiências brasileiras de programas de triagem auditiva neonatal. O acompanhamento sistemático às famílias dos lactentes que não passaram na primeira avaliação e a conscientização destas sobre a detecção precoce da perda auditiva e suas consequências podem ter contribuído para o aumento da taxa de adesão na segunda etapa da triagem.

Interdisciplinary approach to design, performance, and quality management in a multicenter newborn hearing screening project. Discussion of the results of newborn hearing screening in Hamburg (part II)

Previously presented results of the newborn hearing screening in Hamburg and the perspectives are subsequently discussed. Minimum standards referring a participation of 95% of the neonates and a fail rate of less than 4% hearing-impaired children at the primary screening are fulfilled in Hamburg. Systematic screening of newborn hearing by an interdisciplinary approach provides early identification and intervention for children with permanent unilateral and bilateral hearing loss. But a newborn hearing screening on a voluntary basis alone cannot be maintained in the long run. Further, an anonymous data collection is not sufficient in regard to an uninterrupted tracking of conspicuous and unscreened neonates. A lost-to-follow-up rate of 31.3% at primary screening in Hamburg is much too high and emphasizes the need for a public health approach to a population-based newborn hearing screening with an elaborate and name-based tracking system. The legislation and implementation of a nationwide newborn hearing screening program in Germany and the association of German newborn hearing screening centers are highlighting long efforts of hearing professionals. But the implementation of a newborn hearing screening only makes sense if there exists an efficient tracking system. Sad to say, we are still a long way from the implementation of such a tracking system.

Incidence and clinical value of prolonged I-V interval in NICU infants after failing neonatal hearing screening

Infants admitted to neonatal intensive care units (NICUs) have a higher incidence of perinatal complications and delayed maturational processes. Parameters of the auditory brainstem response (ABR) were analyzed to study the prevalence of delayed auditory maturation or neural pathology. The prevalence of prolonged I–V interval as a measure of delayed maturation and the correlation with ABR thresholds were investigated. All infants admitted to the NICU Sophia Children’s Hospital between 2004 and 2009 who had been referred for ABR measurement after failing neonatal hearing screening with automated auditory brainstem response (AABR) were included. The ABR parameters were retrospectively analyzed. Between 2004 and 2009, 103 infants were included: 46 girls and 57 boys. In 58.3% (60 infants) of our population, the I–V interval was recordable in at least one ear at first diagnostic ABR measurement. In 4.9%, the I–V interval was severely prolonged. The median ABR threshold of infants with a normal or mildly prolonged I–V interval was 50 dB. The median ABR threshold of infants with a severely prolonged I–V interval was 30 dB. In conclusion, in case both peak I and V were measurable, we found only a limited (4.9%) incidence of severely prolonged I–V interval (≥0.8 ms) in this high-risk NICU population. A mild delay in maturation is a more probable explanation than major audiologic or neural pathology, as ABR thresholds were near normal in these infants.

Interdisciplinary approach to design, performance, and quality management in a multicenter newborn hearing screening project: introduction, methods, and results of the newborn hearing screening in Hamburg (Part I)

From the actual point of view, the "sensitive period" for the effects of hearing impairment on speech and language development is within the first year of life. Early exposure to acoustic or electric stimulation can compensate for the acoustic deficit. A regional-based, specifically designed concept of a universal newborn hearing screening (UNHS) was started in Hamburg in the year 2002. For the first time in Germany, a comprehensive protocol including screening measurement, follow-up procedures, tracking, and early intervention was implemented. An interdisciplinary approach from the very beginning could be realized. Sixty-three thousand, four hundred fifty-nine out of 65,466 births were registered during the period August 2002 to July 2006, 93% were primarily screened. 3.3% failed the test and 31.3% were lost to follow-up. A total of 118 children were diagnosed with hearing loss in the follow-up. The median age at time of diagnosis was 3.5 months. Seventy-four children received hearing aids. Out of these 74 children, 6 were subsequently supplied with cochlear implants. The high lost-to-follow-up rate is the biggest challenge for the tracking. Our results will be discussed in part II.