Universal newborn hearing screening: systematic review to update the 2001 US Preventive Services Task Force Recommendation

Impact of national health insurance and socioeconomic disparities on newborn hearing screening performance in South Korea: A nationwide population-based evaluation

OBJECTIVES

This study aimed to assess the impact of national health insurance coverage on newborn hearing screening (NHS) outcomes by analyzing hearing questionnaires from the National Infant Health Check-up Program (NIHCP) in South Korea.

METHODS

This study evaluated the performance and referral rates of NHS using nationwide data from 814,875 infants enrolled in the 4-month NIHCP from January 2017 to December 2019. This period encompasses the periods before and after the National Health Insurance in South Korea began covering NHS expenses in October 2018. The study also investigated household income levels to determine their relationship with participation in the NIHCP and NHS outcomes.

RESULTS

The performance of NIHCP increased year-on-year, with NHS performance rates increasing from 88.5 % in 2017 to 91.5 % in 2019. Analysis by household income level revealed that the medical benefit recipients' group had the lowest NHS performance rate of 81.9 % in 2019, whereas that of the higher income level group exceeded 90 %. The NHS referral rate remained consistent at 0.9 % nationally during the study period.

CONCLUSION

The inclusion of NHS in national insurance coverage positively influenced its performance rates across South Korea. Nevertheless, the data indicate the need for more focused and customized support for low-income families to enhance early hearing detection and interventions in newborns and infants.

The Association between Prenatal Nicotine Exposure and Offspring's Hearing Impairment

OBJECTIVES

 The objective of this study is to evaluate whether there is an association between in-utero exposure to nicotine and subsequent hearing dysfunction.

MATERIALS AND METHODS

 Secondary analysis of a multicenter randomized trial to prevent congenital cytomegalovirus (CMV) infection among gravidas with primary CMV infection was conducted. Monthly intravenous immunoglobulin hyperimmune globulin therapy did not influence the rate of congenital CMV. Dyads with missing urine, fetal or neonatal demise, infants diagnosed with a major congenital anomaly, congenital CMV infection, or with evidence of middle ear dysfunction were excluded. The primary outcome was neonatal hearing impairment in one or more ears defined as abnormal distortion product otoacoustic emissions (DPOAEs; 1 to 8 kHz) that were measured within 42 days of birth. DPOAEs were interpreted using optimized frequency-specific level criteria. Cotinine was measured via enzyme-linked immunosorbent assay kits in maternal urine collected at enrollment and in the third trimester (mean gestational age 16.0 and 36.7 weeks, respectively). Blinded personnel ran samples in duplicates. Maternal urine cotinine >5 ng/mL at either time point was defined as in-utero exposure to nicotine. Multivariable logistic regression included variables associated with the primary outcome and with the exposure (p < 0.05) in univariate analysis.

RESULTS

 Of 399 enrolled patients in the original trial, 150 were included in this analysis, of whom 46 (31%) were exposed to nicotine. The primary outcome occurred in 18 (12%) newborns and was higher in nicotine-exposed infants compared with those nonexposed (15.2 vs. 10.6%, odds ratio [OR] 1.52, 95% confidence interval [CI] 0.55-4.20), but the difference was not significantly different (adjusted odds ratio [aOR] = 1.0, 95% CI 0.30-3.31). This association was similar when exposure was stratified as heavy (>100 ng/mL, aOR 0.72, 95% CI 0.15-3.51) or mild (5-100 ng/mL, aOR 1.28, 95% CI 0.33-4.95). There was no association between nicotine exposure and frequency-specific DPOAE amplitude.

CONCLUSION

 In a cohort of parturients with primary CMV infection, nicotine exposure was not associated with offspring hearing dysfunction assessed with DPOAEs.

KEY POINTS

· Nicotine exposure was quantified from maternal urine.. · Nicotine exposure was identified in 30% of the cohort.. · Exposure was not associated with offspring hearing dysfunction..

Disparities in Newborn Hearing Screening Outcomes in the United States From 2007 to 2017

OBJECTIVE

Establishing timely language intervention for children who are deaf or hard of hearing is crucial for their cognitive and language development. Newborn hearing screening (NBHS) programs are now commonplace, but disparities in receipt of support may exist. This study seeks to investigate if states with more diverse populations, less educated mothers, fewer resources, and no legislative mandate of screening have lower rates of milestone completion.

STUDY DESIGN

This is a cross-sectional study.

SETTING

Data describing screening, identification, and intervention rates from individual state NBHS programs were aggregated by the Centers for Disease Control and Prevention from 2007 to 2017.

METHODS

Regression models were fitted to assess associations between these outcomes and state demographic and policy variables. Forest plots from meta-analyses were used to obtain nationwide pooled estimates of the relative risk (RR) of maternal predictors from individual state data.

RESULTS

State averages of maternal education level, age, and race/ethnicity were found to be significantly associated with various outcomes. The presence of program funding and legislative state mandate were associated with multiple improved outcomes. Meta-analyses identified increased RRs for most outcomes based on maternal education less than high school, age 19 and below, and non-White race/ethnicity.

CONCLUSION

There is evidence of disparities in access to and timing of screening, identification testing, and intervention by various demographic and policy factors at the state level. More research is needed to further explore these relationships and determine how to address existing disparities in order to provide more equitable care.

Newborn cytomegalovirus screening: is this the new standard?

PURPOSE OF REVIEW

Congenital cytomegalovirus infection (cCMV) is a major cause of childhood hearing loss and neurodevelopmental delay. Early identification of cCMV allows for interventions that improve outcomes, particularly for cCMV-related hearing loss that develops in early childhood. Most cCMV is asymptomatic at birth and is rarely diagnosed without newborn screening. Therefore, various approaches to cCMV screening are increasingly being adopted.

RECENT FINDINGS

Both universal screening (testing all newborns) and targeted screening (testing triggered by failed hearing screening) for cCMV appear valuable, feasible and cost-effective, though universal screening is predicted to have greatest potential overall benefits. CMV PCR testing of newborn oral swabs is sensitive and practical and is therefore widely used in targeted screening programs. In contrast, PCR using dried-blood spots (DBS) is less sensitive but was adopted by current universal cCMV screening initiatives because DBS are already collected from all newborns in high-income countries, which circumvents large-scale oral swab collection.

SUMMARY

Targeted screening is widely recommended as standard of care, while universal screening is less common but is progressively considered as the optimal strategy for identification of children with cCMV. As with all screening programs, cCMV screening requires commitments to equitable and reliable testing, follow-up and services.

Loss to follow-up in a newborn hearing screening program in Saudi Arabia

OBJECTIVES

Newborn hearing screening (NHS) program was officially initiated in Saudi Arabia in 2016. Although the rate of follow-up default is considered one of the major challenges to the NHS program, no studies have investigated the NHS rate of follow-up default and its reasons in Saudi Arabia. This study aimed to investigate the rate of follow-up default in a hospital-based NHS program and the possible reasons for it.

METHODS

All newborns who were delivered at a tertiary hospital-based NHS program between June 2020 and February 2022 were retrospectively included. The number of live births, newborns who passed NHS, newborns who referred NHS, and newborns who did not complete the appropriate screening or diagnostic stages were reviewed. In a prospective study, parents of all newborns who defaulted the follow-up on screening or diagnosis were telephonically interviewed about the reasons for their follow-up default.

RESULTS

In total, 2312 newborns were screened. Screening coverage of 96% and referral rate of 0.6% were found, which align well with the international benchmark. The follow-up default was 18%, which was higher than the benchmark. Parents of all newborns who defaulted the follow-up (n = 424) were also included. The most frequent reasons for follow-up default were related to the parents' unawareness of the recommended follow-up screening (39.5%) and their perception that follow-up was not necessary (24.7%). Coronavirus disease 2019 was also reported by 15.8% of the parents as a reason for follow-up default.

CONCLUSION

Lack of knowledge regarding recommendations made for follow-up and the importance of NHS were the most common reasons for default. Reducing follow-up defaults is essential for successful NHS programs, which can be achieved by implementing a tracking system to remind and encourage parents. Further studies are needed to evaluate the national NHS and investigate the reasons for follow-up defaults from different demographic regions in Saudi Arabia.

Mismatch negativity as a marker of music perception in individual cochlear implant users: A spike density component analysis study

OBJECTIVE

Ninety percent of cochlear implant (CI) users are interested in improving their music perception. However, only few objective behavioral and neurophysiological tests have been developed for tracing the development of music discrimination skills in CI users. In this study, we aimed to obtain an accurate individual mismatch negativity (MMN) marker that could predict behavioral auditory discrimination thresholds.

METHODS

We measured the individual MMN response to four magnitudes of deviations in four different musical features (intensity, pitch, timbre, and rhythm) in a rare sample of experienced CI users and a control sample of normally hearing participants. We applied a recently developed spike density component analysis (SCA), which can suppress confounding alpha waves, and contrasted it with previously proposed methods.

RESULTS

Statistically detected individual MMN predicted attentive sound discrimination ability with high accuracy: for CI users 89.2% (278/312 cases) and for controls 90.5% (384/424 cases). As expected, MMN was detected for fewer CI users when the sound deviants were of smaller magnitude.

CONCLUSIONS

The findings support the use of MMN responses in individual CI users as a diagnostic tool for testing music perception.

SIGNIFICANCE

For CI users, the new SCA method provided more accurate and replicable diagnostic detections than preceding state-of-the-art.

Analysis of Newborn Hearing Screening Results in South Korea after National Health Insurance Coverage: A Nationwide Population-Based Study

Newborn hearing screening (NHS) has been covered by national health insurance since October 2018 in Korea. However, the results of the NHS are not reported due to the absence of a follow-up tracking system. This study analyzed the status and the predicted referral rates of NHS after the Korean national health insurance coverage by analyzing the National Health Insurance Service database in 2019 and 2020. The NHS coverage was 91.7% of total birth in 2019 and 92.1% in 2020. The predicted referral rate of NHS calculated by the duplicated NHS cases was 1.05% in 2019 and 0.99% in 2020. However, another predicted referral rate calculated by the number of diagnostic auditory brainstem responses (ABRs) performed was 1.44% in 2019 and 1.43% in 2020. The first NHS was performed within one day of birth for 96.5% of the babies and within three days of birth for 97%. However, diagnostic ABR was adequately performed within three months of birth for only 4.3%, while 82.3% performed the test after six months which delays appropriate intervention for hearing loss. National support such as national coordinators, follow-up tracking, and data management systems are needed for early hearing detection and intervention of newborns and infants in Korea.

Effectiveness of universal newborn hearing screening: A systematic review and meta-analysis

Background

Permanent bilateral hearing loss (PBHL) is a serious condition in newborns, with a prevalence of at least one per 1000 live births. However, there has been no recent systematic review and meta-analysis of the effectiveness of universal newborn hearing screening programs (UNHS).

Methods

We registered our study protocol on PROSPERO CRD42020175451. Primary outcomes were any identification of PBHL (ie, PBHL diagnosed at any time), age of identification of PBHL, and neurodevelopment. Two reviewers searched standard databases to March 2022 and extracted data. We used fixed and random effects meta-analysis to pool data and graded the certainty of evidence using standard methods.

Results

The search retrieved 2834 records. We identified five studies reporting on the effects of UNHS vs no UNHS in 1 023 610 newborns. The relative risk of being identified with PBHL before nine months in infants with UNHS compared to infants without UNHS was 3.28 (95% confidence interval (95% CI) = 1.84, 5.85, one study, 1 023 497 newborns, low certainty evidence). The mean difference in the age of identification of PBHL in infants with UNHS compared to infants without UNHS was 13.2 months earlier (95% CI = -26.3, -0.01, two studies, 197 newborns, very low certainty evidence). The relative risk of infants eventually being identified with PBHL in infants with UNHS compared to infants without UNHS was 1.01 (95% CI = 0.89, 1.14, three studies, 1 023 497 newborns, low certainty evidence). At the latest follow-up at 3-8 years, the standardised mean difference (SMD) in receptive language development between infants with UNHS compared to infants without UNHS was 0.60 z scores (95% CI = 0.07, 1.13, one study, 101 children, low certainty evidence) and the mean difference in developmental quotients was 7.72 (95% CI = -0.03, 15.47, three studies, 334 children, very low certainty evidence). The SMD in expressive language development was 0.39 z scores (95% CI = -0.20, 0.97, one study, 87 children, low certainty evidence) and the mean difference in developmental quotients was 10.10 scores (95% CI = 1.47, 18.73, 3 studies, 334 children, very low certainty evidence).

Conclusions

UNHS programs result in earlier identification of PBHL and may improve neurodevelopment. UNHS should be implemented across high-, middle-, and low-income countries.

Registration

PROSPERO (CRD42020175451).

Magnitude and Factors Associated with Refer Results of Newborn Hearing Screening at Academic Tertiary Level Hospital, Addis Ababa, Ethiopia

Background

Hearing impairment is a leading cause of disability worldwide. Early identification and early intervention of hearing loss can prevent further disability in the development of speech, language, cognition, and other developmental domains. This study aimed to determine the magnitude and factors associated with the refer results of newborn hearing screening at an academic tertiary hospital.

Methods

An institution-based time series cross-sectional study was conducted with a calculated sample size of 368 newborns selected by systemic random sampling from a total of 2087 newborns born in SPHMMC during the study period. Two stage screening protocol was conducted using Transient Evoked Otoacoustic Emission (TEOAE) on the first, followed by TEOAE and Auditory Brainstem Reflex (ABR) as a second stage for newborns with refer results. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 26.0. Bivariate and multivariate analyses between dependent and independent variables were performed using binary logistic regression with a significance level of P value <0.05.

Result

Of the total sample size of 368 newborns, 62% (228) passed the first TEOAE and 38% (140) yielded refer results. From 121 who came for follow-up screening (6–28 days), 49.5% (60) passed the second TEOAE and 50.5% (61) had refer results. AABR screening of 61 newborns yielded pass in 11.5% (7) and refer result in 88.5% (54) newborns. Noise (AOR= 4.746, 95% CI 2.505–8.992, P < 0.001), vernix caseosa (AOR= 19.745, 95% CI 9.057–43.043, P < 0.001), and very low birth weight (AOR= 4.338, 95% CI 1.338–14.067, P=0.015) were found to be significantly associated with the refer rate of the first TEOAE test. Noise (AOR 39.445, 95% CI 5.974–260.467, P < 0.001) and neonatal jaundice (AOR 21.633, 95% CI 1.540–303.994, P=0.023) were significantly associated with the follow-up screening refer result of TEOAE. Repeat TEOAE has decreased the refer rate from 38.0% (140/368) to 17.5% (61/349), 19 of which were lost to follow-up. AABR has decreased the overall refer rate from 17.5% to 15.5% (54/349).

Conclusion

This study shows a significant number of newborns (15.5%) who need diagnostic audiologic work-up and may need intervention. Vernix caseosa and noise are avoidable factors, but newborns with jaundice and very low birth weight should be sent to ENT for screening.

What do Speech-Language Pathologists want to know when assessing early vocal development in children who are deaf/hard-of-hearing?

PURPOSE

Delays in vocal development are an early predictor of ongoing language difficulty for children who are deaf/hard-of-hearing (CDHH). Despite the importance of monitoring early vocal development in clinical practice, there are few suitable tools. This study aimed to identify the clinical decisions that speech-language pathologists (SLPs) most want to make when assessing vocal development and their current barriers to doing so.

METHOD

58 SLPs who provide services to CDHH younger than 22 months completed a survey. The first section measured potential barriers to vocal development assessment. The second section asked SLPs to rate the importance of 15 clinical decisions they could make about vocal development.

RESULTS

SLPs believed assessing vocal development was important for other stakeholders, and reported they had the necessary skills and knowledge to assess vocal development. Barriers primarily related to a lack of commercially available tests. SLPs rated all 15 clinical decisions as somewhat or very important. Their top 5 decisions included a variety of assessment purposes that tests are not typically designed to support, including measuring change, differential diagnosis, and goal setting.

CONCLUSIONS

SLPs wish to make a number of clinical decisions when assessing vocal development in CDHH but lack access to appropriate tools to do so. Future work is needed to develop tools that are statistically equipped to fulfill these purposes. Understanding SLPs' assessment purposes will allow future tests to better map onto the clinical decisions that SLPs need to make to support CDHH and their families and facilitate implementation into clinical practice.

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.

Association of Age of Enrollment in Early Intervention with Emergent Literacy in Children Who Are Deaf or Hard of Hearing

OBJECTIVE

Literacy skill development in deaf or hard of hearing (DHH) children is essential for success in school and beyond. Our objective was to evaluate the association between age of early intervention (EI) enrollment for DHH children and emergent literacy in preschool.

METHODS

This was a population-based study that leveraged state public health and education data on all children identified with hearing loss. The sample included children born between 2008 and 2014 enrolled in EI for hearing loss who received preschool supports (years 2011-2014) through the Ohio Department of Education. The Get it! Got it! Go!, measuring emergent literacy domains of picture naming, rhyming, and alliteration, was administered during preschool in fall and spring. Exposure was enrollment into EI before age 6 months (early) versus at/after 6 months (later). Propensity score matching and mixed model analyses were used to examine associations between EI enrollment and outcomes over time. Model least square means with 95% confidence intervals (CIs) were reported.

RESULTS

One hundred two successful matches were made for 256 preschoolers. Children enrolled in EI early had significantly higher mean scores (mean [95% CI]) over time for emerging literacy domains of picture naming (2.42 [0.47-4.37]), rhyming (1.2 [0.35-2.06]), and alliteration (0.61 [0.15-1.07]) compared with later enrolled children. Children enrolled early had significantly higher emergent literacy scores at entry, although literacy development was similar between groups.

CONCLUSION

Children enrolled in EI before age 6 months had consistently higher scores in emergent literacy components over time compared with children enrolled at/after age 6 months.

An Economic Evaluation of Australia's Newborn Hearing Screening Program: A Within-Study Cost-Effectiveness Analysis

OBJECTIVES

Hearing loss is one of the most prevalent congenital disorders among children. Many countries have implemented universal newborn hearing screening (UNHS) for the early diagnosis and treatment of hearing loss. Despite widespread implementation, the value for money of UNHS is unclear due to lack of cost and outcomes data from rigorous study designs. The objective of this research is to conduct a within-study cost-effectiveness analysis of UNHS compared with targeted screening (targeting children with risk factors of hearing loss) from the Australian healthcare system perspective. This evaluation is the first economic evaluation to assess the cost-effectiveness of UNHS compared to targeted screening using real-world data from a natural experiment.

DESIGN

The evaluation assumed the Australian healthcare system perspective and considered a time horizon of 5 years. Utilities were estimated using responses to the Health Utilities Index Mark III. Screening costs were estimated based on the Victorian Infant Hearing Screening Program. Ongoing costs were estimated based on administrative data, while external data sources were used to estimate costs related to hearing services. Missing data were handled using the multiple imputation method. Outcome measures included quality-adjusted life years (QALYs) and four language and communication-related outcomes: Peabody Picture Vocabulary Test, Wechsler Nonverbal Scale of Ability, Progressive Achievement Test, and comprehensive, expressive, and total language scores based on the Preschool Language Scale.

RESULTS

On average, the UNHS cost an extra Australian dollar (A$)22,000 per diagnosed child and was associated with 0.45 more QALYs per diagnosed child compared with targeted screening to 5 years, resulting in an incremental cost-effectiveness ratio (ICER) of A$48,000 per QALY gained. The ICERs for language outcomes lay between A$3,900 (for expressive language score) and A$83,500 per one-point improvement in language score (for Wechsler Nonverbal Scale of Ability). UNHS had a 69% probability of being more cost-effective compared to targeted screening at a willingness to pay threshold of A$60,000 per QALY gained. ICERs were most sensitive to the screening costs.

CONCLUSIONS

The evaluation demonstrated the usefulness of a within-study economic evaluation to understand the value for money of the UNHS program in the Australian context. Findings from this evaluation suggested that screening costs were the key driver of cost-effectiveness results. Most outcomes were not significantly different between UNHS and targeted screening groups. The ICER may be overestimated due to the short follow-up period. Further research is warranted to include long-term resource use and outcome data, late diagnosis, transition and remission between severity levels, and timing of diagnosis and treatment.

Identifying the Factors that Affect Consistent Hearing Aid Use in Young Children With Early Identified Hearing Loss: A Scoping Review

OBJECTIVES

This study is a scoping review examining factors that affect consistent hearing aid use in young children with early identified hearing loss (HL).

DESIGN

Online databases were used to identify journal articles published between 2009 and 2019, yielding over 1800 citations. The citations were uploaded into an online software product called Covidence that enables scoping/systematic review management. After duplicates were removed, 857 articles were screened by abstract and title name, 93 of which were put through for full-text screening. Twenty-five articles met predetermined inclusion and exclusion criteria. Appraisal tools were utilized to establish the quality of the studies included. Numerical summaries were used to synthesize and describe the data set. Thematic analysis was utilized to identify global and subthemes within the data set.

RESULTS

Numerical summaries revealed that over half of the studies in the data set used a quantitative design. Thematic analysis of the data identified four global themes namely, "each child is an individual," "parents are key," "parents require support," and "professionals make a difference." Each global theme was further divided into subthemes, most of which centered around the parents of children with HL. Each subtheme was categorized as a malleable or a fixed factor that impacts on hearing aid use in young children with HL.

CONCLUSION

This scoping review identified malleable and fixed factors that impact on hearing aid use in young children with HL. These factors centered around the individual characteristics of children with HL, the key responsibility their parents have, and the important contribution that professionals can make. Irrespective of whether factors are malleable or fixed, parents and professionals working with children with HL can have a positive impact on hearing aid use. This is likely to have a flow on, positive impact on their overall communication and learning outcomes.

Benefits of Exome Sequencing in Children with Suspected Isolated Hearing Loss

Purpose: Hearing loss is characterized by an extensive genetic heterogeneity and remains a common disorder in children. Molecular diagnosis is of particular benefit in children, and permits the early identification of clinically-unrecognized hearing loss syndromes, which permits effective clinical management and follow-up, including genetic counselling. Methods: We performed whole-exome sequencing with the analysis of a panel of 189 genes associated with hearing loss in a prospective cohort of 61 children and 9 adults presenting mainly with isolated hearing loss. Results: The overall diagnostic rate using exome sequencing was 47.2% (52.5% in children; 22% in adults). In children with confirmed molecular results, 17/32 (53.2%) showed autosomal recessive inheritance patterns, 14/32 (43.75%) showed an autosomal dominant condition, and one case had X-linked hearing loss. In adults, the two patients showed an autosomal dominant inheritance pattern. Among the 32 children, 17 (53.1%) had nonsyndromic hearing loss and 15 (46.7%) had syndromic hearing loss. One adult was diagnosed with syndromic hearing loss and one with nonsyndromic hearing loss. The most common causative genes were STRC (5 cases), GJB2 (3 cases), COL11A1 (3 cases), and ACTG1 (3 cases). Conclusions: Exome sequencing has a high diagnostic yield in children with hearing loss and can reveal a syndromic hearing loss form before other organs/systems become involved, allowing the surveillance of unrecognized present and/or future complications associated with these syndromes.

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.

Diagnosing newborns with suspected mitochondrial disorders: an economic evaluation comparing early exome sequencing to current typical care

PURPOSE

To determine the value of early exome sequencing (eES) relative to the current typical care (TC) in the diagnosis of newborns with suspected severe mitochondrial disorders (MitD).

METHODS

We used a decision tree-Markov hybrid to model neonatal intensive care unit (NICU)-related outcomes and costs, lifetime costs and quality-adjusted life-years among patients with MitD. Probabilities, costs, and utilities were populated using published literature, expert opinion, and the Pediatric Health Information System database. Incremental cost-effectiveness ratios (ICER) and net monetary benefits (NMB) were calculated from lifetime costs and quality-adjusted life-years for singleton and trio eES, and TC. Robustness was assessed using univariate and probabilistic sensitivity analyses (PSA). Scenario analyses were also conducted.

RESULTS

Findings indicate trio eES is a cost-minimizing and cost-effective alternative to current TC. Diagnostic probabilities and NICU length-of-stay were the most sensitive model parameters. Base case analysis demonstrates trio eES has the highest incremental NMB, and PSA demonstrates trio eES had the highest likelihood of being cost-effective at a willingness-to-pay (WTP) of $200,000 relative to TC, singleton eES, and no ES.

CONCLUSION

Trio and singleton eES are cost-effective and cost-minimizing alternatives to current TC in diagnosing newborns suspected of having a severe MitD.

Identification of Potential Barriers to Timely Access to Pediatric Hearing Aids

Importance

Despite various barriers identified to early pediatric access to cochlear implantation, barriers to timely access to pediatric hearing aids are not well characterized.

Objective

To identify socioeconomic, demographic, and clinical factors that may be associated with pediatric access to hearing aids.

Design, Setting, and Participants

This retrospective cohort study included 90 patients aged 1 to 15 years who were referred for auditory brainstem response (ABR) testing and evaluation for hearing aids at a single tertiary care academic medical center from March 2004 to July 2018. Children who did not receive both ABR testing and hearing aids at the same center were excluded from analysis.

Main Outcomes and Measures

Associations of insurance type (private vs public), race/ethnicity (white vs other), primary language (English vs other), cause of hearing loss (complex vs not complex), zip code, hearing aid manufacturer, and severity of hearing loss (in decibels) with the duration of intervals from newborn hearing screening to ABR testing, from ABR testing to ordering of hearing aids, and from ABR testing to dispensing of hearing aids.

Results

Of the 90 patients, mean (SD) age was 5.6 (3.7) years, 56% were female, and 77 (86%) were non-Hispanic. Results of χ2 tests indicated significant assocations existed between public insurance and race/ethnicity and between public insurance and primary language other than English. Variables associated with the interval from newborn hearing screening to ABR testing included insurance type (mean difference, 7.4 months; 95% CI, 2.6-12.2 months) and race/ethnicity (mean difference, 6.9 months; 95% CI, 2.7-11.1 months). Increased delays between birth and a child's first ABR test were associated with public insurance (mean difference, 6.0 months; 95% CI, 1.8-10.2 months) and race/ethnicity other than white (mean difference, 6.0 months; 95% CI, 2.3-9.7 months). The mean time from birth to initial ABR testing was a mean of 6 months longer for patients from non-English-speaking families than for those from English-speaking families (mean [SD] interval, 14.9 [16.3] months vs 9.0 [8.5] months), although the difference was not statistically significant. Severity of hearing loss was associated with a decrease in the interval from ABR testing to ordering of hearing aids after accounting for other potential barriers (odds ratio, 0.6; 95% CI, 0.4-0.9). Zip code and complexity of the child's medical condition did not appear to be associated with timely access to pediatric hearing aids.

Conclusions and Relevance

This study's findings suggest that insurance type, race/ethnicity, and primary language may be barriers associated with pediatric access to hearing aids, with the greatest difference observed in time to initial ABR testing. Clinical severity of hearing loss appeared to be associated with a significant decrease in time from ABR testing to ordering of hearing aids. Greater efforts to assist parents with ABR testing and coordination of follow-up may help improve access for other at-risk children.

Cochlear Implantation in Infants: Why and How

In children with congenital deafness, cochlear implantation (CI) prior to 12 months of age offers the opportunity to foster more typical auditory development during late infancy and early childhood. Recent studies have found a positive association between early implantation and expressive and receptive language outcomes, with some children able to achieve normal language skills by the time of school entry. Universal newborn hearing screening improved early detection and diagnosis of congenital hearing loss, allowing for earlier intervention, including decision-making regarding cochlear implant (CI) candidacy. It can be more challenging to confirm CI candidacy in infants; therefore, a multidisciplinary approach, including objective audiometric testing, is recommended to not only confirm the diagnosis but also to counsel families regarding expectations and long-term management. Surgeons performing CI surgery in young children should consider both the anesthetic risks of surgery in infancy and the ways in which mastoid anatomy may differ between infants and older children or adults. Multiple studies have found CI surgery in infants can be performed safely and effectively. This article reviews current evidence regarding indications for implantation in children younger than 12 months of age and discusses perioperative considerations and surgical technique.

Kindergarten Readiness in Children Who Are Deaf or Hard of Hearing Who Received Early Intervention

BACKGROUND

Children who are deaf or hard of hearing (D/HH) have improved language outcomes when enrolled in early intervention (EI) before the age of 6 months. Little is understood about the long-term impact of EI on outcomes of kindergarten readiness (K-readiness). The study objective was to evaluate the impact of EI before the age of 6 months (early) versus after 6 months (later) on K-readiness in children who are D/HH.

METHODS

In this study, we leveraged data from the Ohio Early Hearing Detection and Intervention Data Linkage Project, which linked records of 1746 infants identified with permanent hearing loss born from 2008 to 2014 across 3 Ohio state agencies; 417 had kindergarten records. The Kindergarten Readiness Assessment was used to identify children as ready for kindergarten; 385 had Kindergarten Readiness Assessment scores available. Multiple logistic regression was used to investigate the relationship between K-readiness and early EI entry while controlling for confounders (eg, hearing loss severity and disability status).

RESULTS

Children who were D/HH and entered EI early (n = 222; 57.7% of the cohort) were more likely to demonstrate K-readiness compared with children who entered EI later (33.8% vs 20.9%; P = .005). Children who entered early had similar levels of K-readiness as all Ohio students (39.9%). After controlling for confounders, children who entered EI early were more likely to be ready for kindergarten compared with children who entered later (odds ratio: 2.02; 95% confidence interval 1.18-3.45).

CONCLUSIONS

These findings support the sustained effects of early EI services on early educational outcomes among children who are D/HH. EI entry before the age of 6 months may establish healthy trajectories of early childhood development, reducing the risk for later academic struggles.

Cross-modal plasticity and central deficiencies: the case of deafness and the use of cochlear implants

The primary objective of this chapter is to describe the consequences of central deficiencies on the neurodevelopment of children. We approach this topic from the standpoint of congenital deafness. Thus we first present the current state of knowledge on cortical reorganization following congenital deafness. The allocation of auditory cortices to other sensory systems can enhance sensory processing and therefore the cognitive functions related to them. Second, we explore the linguistic development of deaf children. Given that the English written system is speech-based, its acquisition is complex and atypical for deaf children, usually leading to poorer achievements. Next, we explore the impact of a neural prosthesis named the cochlear implant on the neurocognitive and linguistic development of deaf children. In some cases, it allows the individuals to, at least partially, regain access to the lost sense. We also comment on the specific needs of the deaf population when it comes to neuropsychological assessment. Finally, we touch on the specific context of deaf children born of deaf parents, and therefore naturally exposed to sign language as the only means of communication.

Mothers' perceptions of universal newborn hearing screening in transitional Albania

The universal newborn hearing screening (UNHS) component of the multi-center EUSCREEN project is being piloted in Albania since January 1^st 2018. The aim of this study was to explore mothers’ perceptions about various elements of UNHS in Albania. A cross-sectional study was carried out in the three sites of UNHS in Albania, namely in Tirana, Kukës and Pogradec during May-June 2019. During this period 512 consecutively approached mothers giving birth to included maternity hospitals were interviewed face-to-face about different aspects of UNHS. Basic socio-demographic and socioeconomic information was also collected. Mean age of participating mothers was 28.6 years ± 5.5 years. The overwhelming majority (93%) of mothers knew what their baby was being tested for, 33% were aware that hearing screening was offered in maternity hospital, 94% were very satisfied/satisfied with UNHS and about 62% were very stressed/stressed waiting for screening results, with significant sociodemographic and socioeconomic differences. The main information source about UNHS was screening staff in the maternity hospitals where mothers gave birth, reported in 67% of cases. All mothers (100%) agreed on the importance of early detection of newborn hearing problems, all mothers were willing to be informed early if their newborn baby had a hearing problem and all mothers were willing to contribute financially for testing the hearing of their newborn baby. These findings should guide information and education campaigns about UNHS in Albania. The public willingness to financially support neonatal hearing testing should be considered as an opportunity to achieve universal newborn hearing screening in the country.

Results of a Government-supported Newborn Hearing Screening Pilot Project in the 17 Cities and Provinces from 2014 to 2018 in Korea

BACKGROUND

The aim of this study was to present and analyze, for the first time, the results of a government-supported nationwide newborn hearing screening (NHS) pilot project in the 17 major cities and provinces of Korea.

METHODS

We analyzed a nationwide NHS database of 344,955 newborns in the pilot project from 2014 to 2018. The government supported the cost of one NHS and one diagnostic auditory brainstem response (ABR) test. Hearing loss (HL) was defined as ≥ 40 dB nHL on either side of the ABR threshold test.

RESULTS

Most NHS tests were performed in the maternity clinics (91.5%). In regions with lack of maternity clinics, the screening rate of local clinics was high (Jeju: 31.1% and Sejong: 12.9%). In most regions, automated ABR was mainly used for screening test (89.7%), but Gangwon (32.7%), Jeju (31.0%), and Jeonbuk (29.6%) performed more NHS tests using (automated) otoacoustic emissions than other regions. The mean referral rate was 1.5%, but the overall diagnostic ABR rate was low at 18.5%. The referral rates of Busan (0.6%) and Gyeongnam (0.9%) were lower than 1%, and Jeju's referral rate was 7.3%. Prevalence of HL including unilateral HL was 0.12%.

CONCLUSION

Depending on the cities and provinces, there were significant differences in the screening rates and referral rates by hospital type and NHS method. For successful early hearing detection and intervention (EHDI) and quality control, it will be necessary to support and manage EHDI according to regional NHS's characteristics and ensure that the whole country conducts EHDI as standard.

Development of in-house genetic screening for pediatric hearing loss

OBJECTIVES

To evaluate the efficiency of in-house genetic testing for mutations causing the most common types of inherited, nonsyndromic, sensorineural hearing loss (SNHL).

METHODS

Retrospective cohort study of 200 patients at a single, pediatric medical center with suspected or confirmed hearing loss who underwent either send out vs in-house genetic testing for mutations in GJB2/GJB6, SLC26A4, and MTRNR1. Primary outcome measure was the difference in mean turnaround time for send-out vs in-house genetic testing. Additional outcomes included associations between audiometric findings and genetic test results.

RESULTS

One hundred four send-out tests were performed between October 2010 and June 2014, and 100 in-house tests were performed between November 2014 and November 2016. The mean turnaround time for send-out testing was 53.7 days. The mean turnaround time for in-house testing was 18.9 days. This difference was statistically significant (P < .001). The largest component of turnaround time was the amount of time elapsed between receipt of specimen in the lab and final test result. These intervals were 47.0 and 18.3 days for send-out and in-house tests, respectively. Notably, the longest turnaround time for in-house testing (43 days) was less than the average turnaround time for send-out testing. In addition, we identified two simple audiometric parameters (ie, bilateral newborn hearing screen referral and audiometry showing symmetric SNHL) that may increase diagnostic yield of genetic testing.

CONCLUSIONS

The development of in-house genetic testing programs for inherited SNHL can significantly reduce testing turnaround times. Newborn hearing screening and audiometry results can help clinicians identify patients most likely to benefit from genetic testing.

LEVEL OF EVIDENCE

IV.

Prevalence and risk factors for hearing loss in high-risk neonates in Germany

AIM

Hearing loss in infants is often diagnosed late, despite universal screening programmes. Risk factors of hearing impairment in high-risk neonates, identified from population-based studies, can inform policy around targeted screening. Our aim was to determine the prevalence and the risk factors of hearing loss in a high-risk neonatal population.

METHODS

This was a retrospective cohort study of neonates hospitalised at the University Hospital Cologne, Germany from January 2009 to December 2014 and were part of the newborn hearing screening programme. Multivariable regression analyses using the lasso approach was performed.

RESULTS

Data were available for 4512 (43% female) neonates with a mean gestational age at birth of 35.5 weeks. The prevalence of hearing loss was 1.6%, and 42 (0.9%) neonates had permanent hearing loss. Craniofacial anomalies, hyperbilirubinaemia requiring exchange transfusion, oxygen supplementation after 36 weeks of gestation and hydrops fetalis showed associations with permanent hearing loss.

CONCLUSION

Our findings of risk factors for hearing loss were consistent with other studies. However, some commonly demonstrated risk factors such as perinatal infections, meningitis, sepsis and ototoxic drugs did not show significant associations in our cohort. Targeted screening based on risk factors may help early identification of hearing loss in neonates.

Nationwide population genetic screening improves outcomes of newborn screening for hearing loss in China

PURPOSE

The benefits of concurrent newborn hearing and genetic screening have not been statistically proven due to limited sample sizes and outcome data. To fill this gap, we analyzed outcomes of newborns with genetic screening results.

METHODS

Newborns in China were screened for 20 hearing-loss-related genetic variants from 2012 to 2017. Genetic results were categorized as positive, at-risk, inconclusive, or negative. Hearing screening results, risk factors, and up-to-date hearing status were followed up via phone interviews.

RESULTS

Following up 12,778 of 1.2 million genetically screened newborns revealed a higher rate of hearing loss by three months of age among referrals from the initial hearing screening (60% vs. 5.0%, P < 0.001) and a lower rate of lost-to-follow-up/documentation (5% vs. 22%, P < 0.001) in the positive group than in the inconclusive group. Importantly, genetic screening detected 13% more hearing-impaired infants than hearing screening alone and identified 2,638 (0.23% of total) newborns predisposed to preventable ototoxicity undetectable by hearing screening.

CONCLUSION

Incorporating genetic screening improves the effectiveness of newborn hearing screening programs by elucidating etiologies, discerning high-risk subgroups for vigilant management, identifying additional children who may benefit from early intervention, and informing at-risk newborns and their maternal relatives of increased susceptibility to ototoxicity.

Newborn and Infant Hearing Screening Facing Globally Growing Numbers of People Suffering from Disabling Hearing Loss

Recent prevalence estimates indicate that in 2015 almost half a billion people-about 6.8% of the world's population-had disabling hearing loss and that prevalence numbers will further increase. The World Health Organization (WHO) currently estimates that at least 34 million children under the age of 15 have disabling hearing loss. Based on a 2012 WHO report, approximately 7.5 million of these children were under the age of 5 years. This review article focuses on the importance of high-quality newborn and infant hearing screening (NIHS) programs as one strategy to ameliorate disabling hearing loss as a global health problem. Two WHO resolutions regarding the prevention of deafness and hearing loss have been adopted urging member states to implement screening programs for early identification of ear diseases and hearing loss in babies and young children. The effectiveness of these programs depends on factors such as governmental mandates and guidance; presence of a national committee with involvement of professionals, industries, and stakeholders; central oversight of hearing screening; clear definition of target parameters; presence of tracking systems with bi-directional data transfer from screening devices to screening centers; accessibility of pediatric audiological services and rehabilitation programs; using telemedicine where connectivity is available; and the opportunity for case discussions in professional excellence circles with boards of experts. There is a lack of such programs in middle- and low-income countries, but even in high-income countries there is potential for improvement. Facing the still growing burden of disabling hearing loss around the world, there is a need to invest in national, high-quality NIHS programs.

The Listening and Spoken Language Data Repository: Design and Project Overview

Purpose

The purpose of the Listening and Spoken Language Data Repository (LSL-DR) was to address a critical need for a systemwide outcome data-monitoring program for the development of listening and spoken language skills in highly specialized educational programs for children with hearing loss highlighted in Goal 3b of the 2007 Joint Committee on Infant Hearing position statement supplement.

Method

The LSL-DR is a multicenter, international data repository for recording and tracking the demographics and longitudinal outcomes achieved by children who have hearing loss who are enrolled in private, specialized programs focused on supporting listening and spoken language development. Since 2010, annual speech-language-hearing outcomes have been prospectively obtained by qualified clinicians and teachers across 48 programs in 4 countries.

Results

The LSL-DR has been successfully implemented, bringing together the data collection efforts of these programs to create a large and diverse data repository of 5,748 children with hearing loss.

Conclusion

Due to the size and diversity of the population, the range of assessments entered, and the demographic information collected, the LSL-DR will provide an unparalleled opportunity to examine the factors that influence the development of listening in spoken language in this population.

The Advances in Hearing Rehabilitation and Cochlear Implants in China

Hearing loss (HL) is a common sensory impairment in humans, with significant economic and social impacts. With nearly 20% of the world's population, China has focused on economic development and health awareness to improve the care for its hearing-impaired population. Recently, the Chinese government has initiated national programs such as the China Disabled Persons Federation to fund prevention, treatment, and rehabilitation of hearing impairment. Newborn hearing screening and auditory rehabilitation programs in China have expanded exponentially with government support. While facing many challenges and overcoming obstacles, cochlear implantation (CI) programs in China have also experienced considerable growth. This review discusses the implementation of CI programs for HL in China and presents current HL data including epidemiology, newborn hearing screening, and determination of genetic etiologies. Sharing the experience in Chinese auditory rehabilitation and CI programs will shine a light on the developmental pathway of healthcare infrastructure to meet emerging needs of the hearing-impaired population in other developing countries.

Utility and limitations of exome sequencing as a genetic diagnostic tool for children with hearing loss

PURPOSE

Hearing loss (HL) is the most common sensory disorder in children. Prompt molecular diagnosis may guide screening and management, especially in syndromic cases when HL is the single presenting feature. Exome sequencing (ES) is an appealing diagnostic tool for HL as the genetic causes are highly heterogeneous.

METHODS

ES was performed on a prospective cohort of 43 probands with HL. Sequence data were analyzed for primary and secondary findings. Capture and coverage analysis was performed for genes and variants associated with HL.

RESULTS

The diagnostic rate using ES was 37.2%, compared with 15.8% for the clinical HL panel. Secondary findings were discovered in three patients. For 247 genes associated with HL, 94.7% of the exons were targeted for capture and 81.7% of these exons were covered at 20× or greater. Further analysis of 454 randomly selected HL-associated variants showed that 89% were targeted for capture and 75% were covered at a read depth of at least 20×.

CONCLUSION

ES has an improved yield compared with clinical testing and may capture diagnoses not initially considered due to subtle clinical phenotypes. Technical challenges were identified, including inadequate capture and coverage of HL genes. Additional considerations of ES include secondary findings, cost, and turnaround time.

Language Outcomes in Deaf or Hard of Hearing Teenagers Who Are Spoken Language Users: Effects of Universal Newborn Hearing Screening and Early Confirmation

Objectives:

This study aimed to examine whether (a) exposure to universal newborn hearing screening (UNHS) and b) early confirmation of hearing loss were associated with benefits to expressive and receptive language outcomes in the teenage years for a cohort of spoken language users. It also aimed to determine whether either of these two variables was associated with benefits to relative language gain from middle childhood to adolescence within this cohort.

Design:

The participants were drawn from a prospective cohort study of a population sample of children with bilateral permanent childhood hearing loss, who varied in their exposure to UNHS and who had previously had their language skills assessed at 6–10 years. Sixty deaf or hard of hearing teenagers who were spoken language users and a comparison group of 38 teenagers with normal hearing completed standardized measures of their receptive and expressive language ability at 13–19 years.

Results:

Teenagers exposed to UNHS did not show significantly better expressive (adjusted mean difference, 0.40; 95% confidence interval [CI], −0.26 to 1.05; d = 0.32) or receptive (adjusted mean difference, 0.68; 95% CI, −0.56 to 1.93; d = 0.28) language skills than those who were not. Those who had their hearing loss confirmed by 9 months of age did not show significantly better expressive (adjusted mean difference, 0.43; 95% CI, −0.20 to 1.05; d = 0.35) or receptive (adjusted mean difference, 0.95; 95% CI, −0.22 to 2.11; d = 0.42) language skills than those who had it confirmed later. In all cases, effect sizes were of small size and in favor of those exposed to UNHS or confirmed by 9 months. Subgroup analysis indicated larger beneficial effects of early confirmation for those deaf or hard of hearing teenagers without cochlear implants (N = 48; 80% of the sample), and these benefits were significant in the case of receptive language outcomes (adjusted mean difference, 1.55; 95% CI, 0.38 to 2.71; d = 0.78). Exposure to UNHS did not account for significant unique variance in any of the three language scores at 13–19 years beyond that accounted for by existing language scores at 6–10 years. Early confirmation accounted for significant unique variance in the expressive language information score at 13–19 years after adjusting for the corresponding score at 6–10 years (R² change = 0.08, p = 0.03).

Conclusions:

This study found that while adolescent language scores were higher for deaf or hard of hearing teenagers exposed to UNHS and those who had their hearing loss confirmed by 9 months, these group differences were not significant within the whole sample. There was some evidence of a beneficial effect of early confirmation of hearing loss on relative expressive language gain from childhood to adolescence. Further examination of the effect of these variables on adolescent language outcomes in other cohorts would be valuable.

Contrast Sensitivity Abnormalities in Deaf Individuals

Purpose:

Hearing impaired children are heavily dependent on their sense of vision to develop efficient communication skills; any contrast sensitivity defect can negatively impact their lives because they are not able to use auditory stimuli to recognize probable dangers in the world around them. The purpose of this study was to determine the contrast sensitivity abnormalities in deaf individuals.

Methods:

In this cross-sectional study, contrast sensitivity of 15- to 20-year-old high-school boys with hearing disability from Tehran, Iran were evaluated. Sixty-four eyes were tested for contrast sensitivity and refractive error. All subjects had an intelligence quotient (IQ) >70. We investigated their contrast sensitivity with Vector vision CVS-1000 in 4 different spatial frequencies.

Results:

Profound hearing loss was noted in 50% of the subjects. The frequency of contrast sensitivity abnormalities in 4 different spatial frequencies varied between 51.6% and 65.6%. The largest abnormalities were recorded at 18 cycles per degree. Only 12.5% of deaf students had corrected distance visual acuity (CDVA) greater than zero (in LogMAR). The abnormalities in contrast sensitivity showed no correlation with the type or severity of hearing loss.

Conclusion:

Hearing impaired boys are at a greater risk for contrast sensitivity abnormalities than boys with normal hearing. The larger frequency of contrast sensitivity abnormalities in high spatial frequencies than in other frequencies may demonstrate greater defects in the central visual system compared with the periphery in individuals with hearing loss.

[Follow-up protocol for newborns of birthweight less than 1500 g or less than 32 weeks gestation]

The mortality of children with a birthweight of less than 1500g or with a gestational age of less than 32 weeks (<1500<32) has decreased significantly in the last 20 years or so. Given the higher risk of disability in these children, follow-up after hospital discharge is considered essential. In this document, the Follow-Up Group of the Spanish Society of Neonatology, in collaboration with the Spanish Society of Paediatric Primary Care, propose a follow-up protocol specific for the<1500<32, which has as its aim to standardise the activities and evaluations according to good practice criteria.

Evaluating Evidence on Intermediate Outcomes: Considerations for Groups Making Healthcare Recommendations

INTRODUCTION

Groups making recommendations need evidence about whether preventive services improve health outcomes (HOs). When such evidence is not available, groups may choose to evaluate evidence about effects on intermediate outcomes (IOs) and the link between IOs and HOs. This paper aims to describe considerations for assessing the evidence linking changes in IOs to changes in HOs.

METHODS

Working definitions of IOs, HOs, and other outcomes were developed. All current U.S. Preventive Services Task Force (USPSTF) recommendations through April 2016 were examined to identify how evidence of the IO-HO link was gathered and the criteria that appeared to be used to determine the adequacy of the evidence. Methods of other expert and recommendation-making groups were also examined.

RESULTS

Forty-four USPSTF recommendations involved a relevant IO-HO link. The approaches used most commonly to gather evidence about the link were selected review (19 of 44, 43%) and systematic review (12 of 44, 27%). Some key considerations when assessing the adequacy of evidence about the IO-HO link include adjustment for confounding, proximity of the IO to the HO in the causal pathway, and independence of IO-HO relationship from specific treatments.

CONCLUSIONS

Considerations were identified for recommendation-making groups to use when gathering and assessing the adequacy of evidence about the IO-HO link. Using a standard set of written principles could improve the transparency of assessments of the IO-HO link, especially if used together with judgment in a reasoned conjecture and refutation process. Ideally, the process would result in an estimate of the magnitude of change in HOs that is expected for specified changes in IOs.

Prevalence of Hearing Impairment Among High-Risk Newborns in Ibadan, Nigeria

The burden of severe hearing impairment is increasing with two-thirds of these hearing impaired people residing in developing countries. Newborn hearing screening helps to identify early, babies who need intervention in order to prevent future disability. Neither universal nor targeted hearing screening programme is available in Nigeria. Objectives: This study was carried out to assess the prevalence of hearing impairment among high-risk newborns in UCH and the associated risk factors. Materials and Methods: Two hundred one newborns in the neonatal unit of UCH with risk factors for hearing impairment had hearing screening done using automated auditory brainstem response (AABR) at 30, 45, and 70 dB at admission and discharge, and those that failed screening at discharge were rescreened at 6 weeks post-discharge. Results: Eighty-three (41.3%) and 32 (15.9%) high-risk newborns failed at admission and discharge screening respectively, and 19 (9.5%) still failed at follow up screening. The majority of hearing loss at follow up was bilateral (94.7%) and severe (52.6%). The risk factors associated with persistent hearing loss at follow up were acute bilirubin encephalopathy (RR = 11.2, CI: 1.4-90.6), IVH (RR = 8.8, CI: 1.1-71.8), meningitis (RR = 4.8, CI: 1.01-29), recurrent apnoea (RR = 2.7, CI: 1.01-7.3), severe perinatal asphyxia NNE III (RR = 7, CI: 2.4-20.2). Conclusion: Severe and bilateral hearing impairment is a common complication among high risk newborns in UCH persisting till 6 weeks post-neonatal care. Severe perinatal asphyxia with NNE III, ABE, IVH, meningitis and administration of amikacin for more than 5 days were significant risk factors. We recommend that SCBU graduates with these risk factors should have mandatory audiologic evaluation at discharge.

Societal costs of permanent childhood hearing loss at teen age: a cross-sectional cohort follow-up study of universal newborn hearing screening

OBJECTIVE

To investigate the effects in adolescence of bilateral permanent childhood hearing loss (PCHL) > 40 dB and of exposure to universal newborn hearing screening (UNHS) on societal costs accrued over the preceding 12 months.

DESIGN SETTING PARTICIPANTS

An observational cohort study of a sample of 110 adolescents aged 13-20 years, 73 with PCHL and 37 in a normally hearing comparison group (HCG) closely similar in respect of place and date of birth to those with PCHL, drawn from a 1992-1997 cohort of 157 000 births in Southern England, half of whom had been exposed to a UNHS programme.

INTERVENTION

Birth in periods with and without UNHS.

OUTCOME MEASURES

Resource use and costs in the preceding 12-month period, estimated from interview at a mean age of 16.9 years and review of medical records. Effects on costs were examined in regression models.

RESULTS

Mean total costs for participants with PCHL and the HCG were £15 914 and £5883, respectively (difference £10 031, 95% CI £6460 to £13 603), primarily driven by a difference in educational costs. Compared with the HCG, additional mean costs associated with PCHL of moderate, severe and profound severity were £5916, £6605 and £18 437, respectively. The presence of PCHL and an additional medical condition (AMC) increased costs by £15 385 (95% CI £8532 to £22 238). An increase of one unit in receptive language z-score was associated with £1616 (95% CI £842 to £2389) lower costs. Birth during periods of UNHS was not associated with significantly lower overall costs (difference £3594, 95% CI -£2918 to £10 106).

CONCLUSIONS

The societal cost of PCHL was greater with more severe losses and in the presence of AMC and was lower in children with superior language scores. There was no statistically significant reduction in costs associated with birth in periods with UNHS.

TRIAL REGISTRATION NUMBER

ISRCTN03307358, pre-results.

Mild-moderate congenital hearing loss: secular trends in outcomes across four systems of detection

BACKGROUND

Universal newborn hearing screening (UNHS) targets moderate or greater hearing loss. However, UNHS also frequently detects children with mild loss that results in many receiving early treatment. The benefits of this approach are not yet established. We aimed to (i) compare language and psychosocial outcomes between four hearing loss detection systems for children aged 5-8 years with congenital mild-moderate hearing loss; (ii) determine whether age of detection predicts outcomes; and (iii) compare outcomes between children identified via well-established UNHS and the general population.

METHODS

Linear regression adjusted for potential confounding factors was used throughout. Via a quasi-experimental design, language and psychosocial outcomes were compared across four population-based Australian systems of hearing loss detection: opportunistic detection, born 1991-1993, n = 50; universal risk factor referral, born 2003-2005, n = 34; newly established UNHS, born 2003-2005, n = 41; and well-established UNHS, born 2007-2010, n = 21. In pooled analyses, we examined whether age of detection predicted outcomes. Outcomes were similarly compared between the current well-established UNHS system and typically developing children in the Early Language in Victoria Study, born 2003, n = 1217.

RESULTS

Age at diagnosis and hearing aid fitting fell steadily across the four systems. For moderate losses, mean expressive language (P for trend .05) and receptive vocabulary (P for trend .06) improved across the four systems, but benefit was not obvious for mild losses. In pooled analyses, diagnosis before age six months predicted better language outcomes for moderate losses. Children with mild-moderate losses exposed to well-established UNHS continue to experience expressive language scores well below children in the general population (adjusted mean difference -8.9 points, 95% CI -14.7 to -3.1).

CONCLUSIONS

Treatment arising from UNHS appears to be clearly benefitting children with moderate hearing losses. However, rigorous trials are needed to quantify benefits, versus costs and potential harms, of early aiding of children with mild losses.

[Epidemiology of hearing loss in children of the first year of life]

The aim of this study was the investigation of the epidemiology of permanent hearing impairment in the children of first year of life in the Russian Federation after the implementation of the newborn universal hearing screening program. The prevalence of hearing loss in children in the first year of life was estimated at 2.5 per 1,000 based on the official statistical data and reports of hearing rehabilitation centres in 2016. A cohort of 405 children born in 2012 was examined at the age from 0 to 4 years of life. Among them 276 children were diagnosed with permanent congenital and prelingual hearing loss. 88% of the cases were bilateral, sensorineural hearing loss confirmed in 84% of the cases. The genetic cause of hearing loss was revealed in 58% of the patients assessed for the presence of GJB2 gene mutations. In preterm infants, the permanent hearing loss was detected in 70% of the cases. The comprehensive audiological assessment before 3 months of life was conducted only in 32% of the children; this finding is not consistent with the international newborn hearing screening recommendations. Only 70% of the cases of congenital and preverbal hearing loss were diagnosed during the first year of life.

What Contribution Did Economic Evidence Make to the Adoption of Universal Newborn Hearing Screening Policies in the United States?

Universal newborn hearing screening (UNHS), when accompanied by timely access to intervention services, can improve language outcomes for children born deaf or hard of hearing (D/HH) and result in economic benefits to society. Early Hearing Detection and Intervention (EHDI) programs promote UNHS and using information systems support access to follow-up diagnostic and early intervention services so that infants can be screened no later than 1 month of age, with those who do not pass their screen receiving diagnostic evaluation no later than 3 months of age, and those with diagnosed hearing loss receiving intervention services no later than 6 months of age. In this paper, we first document the rapid roll-out of UNHS/EHDI policies and programs at the national and state/territorial levels in the United States between 1997 and 2005. We then review cost analyses and economic arguments that were made in advancing those policies in the United States. Finally, we examine evidence on language and educational outcomes that pertain to the economic benefits of UNHS/EHDI. In conclusion, although formal cost-effectiveness analyses do not appear to have played a decisive role, informal economic assessments of costs and benefits appear to have contributed to the adoption of UNHS policies in the United States.

Hearing loss screening tool (COBRA score) for newborns in primary care setting

Purpose

To develop and evaluate a simple screening tool to assess hearing loss in newborns. A derived score was compared with the standard clinical practice tool.

Methods

This cohort study was designed to screen the hearing of newborns using transiently evoked otoacoustic emission and auditory brain stem response, and to determine the risk factors associated with hearing loss of newborns in 3 tertiary hospitals in Northern Thailand. Data were prospectively collected from November 1, 2010 to May 31, 2012. To develop the risk score, clinical-risk indicators were measured by Poisson risk regression. The regression coefficients were transformed into item scores dividing each regression-coefficient with the smallest coefficient in the model, rounding the number to its nearest integer, and adding up to a total score.

Results

Five clinical risk factors (Craniofacial anomaly, Ototoxicity, Birth weight, family history [Relative] of congenital sensorineural hearing loss, and Apgar score) were included in our COBRA score. The screening tool detected, by area under the receiver operating characteristic curve, more than 80% of existing hearing loss. The positive-likelihood ratio of hearing loss in patients with scores of 4, 6, and 8 were 25.21 (95% confidence interval [CI], 14.69–43.26), 58.52 (95% CI, 36.26–94.44), and 51.56 (95% CI, 33.74–78.82), respectively. This result was similar to the standard tool (The Joint Committee on Infant Hearing) of 26.72 (95% CI, 20.59–34.66).

Conclusion

A simple screening tool of five predictors provides good prediction indices for newborn hearing loss, which may motivate parents to bring children for further appropriate testing and investigations.