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Cover of Universal Newborn Hearing Screening: Systematic Review to Update the 2001 U.S. Preventive Services Task Force Recommendation

Universal Newborn Hearing Screening: Systematic Review to Update the 2001 U.S. Preventive Services Task Force Recommendation

Evidence Syntheses, No. 62

Investigators and Staff: , MD, MPH, , BS, and , MA.

Oregon Evidence-based Practice Center
Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 08-05117-EF-1

Structured Abstract

Objective:

This review is an update for the U.S. Preventive Services Task Force (USPSTF) on universal newborn hearing screening (UNHS) to detect moderate to severe permanent, bilateral congenital hearing loss. The review focuses on 3 key questions regarding the effectiveness of universal screening and early interventions in improving language and other outcomes in childhood, the effectiveness of universal screening in identifying infants with hearing loss and leading them to early interventions, and adverse effects of screening and early interventions.

Methodology:

Literature searches of MEDLINE and Cochrane databases (2000–November 2007) were conducted to systematically identify articles addressing the 3 key questions published since the prior recommendation in 2001. Additional articles were obtained from reference lists of related reviews, studies, editorials, reports, websites, and by consulting experts. Articles were subjected to inclusion and exclusion criteria, data from included studies were abstracted, and studies were rated for quality with pre-determined criteria. Results were summarized descriptively in tables. An outcomes table estimating the number needed to screen was determined using estimates from the most relevant studies.

Results:

A good-quality retrospective study of children with hearing loss indicates that those who had early versus late confirmation and those who had undergone UNHS versus none had better receptive language at age 8 years, but not better expressive language or speech. A good-quality nonrandomized trial of a large birth cohort indicates that infants identified with hearing loss through UNHS have earlier referral, diagnosis, and treatment than those not screened. These findings are corroborated by multiple descriptive studies of ages of referral, diagnosis, and treatment. Universal newborn hearing screening programs have low false-positive and referral rates and are generally well accepted and tolerated by parents of newborns. Studies indicate that usual parental reactions to an initial non-pass on a hearing screen include worry, questioning, and distress. These negative emotions resolve for most parents when a diagnostic test is provided with a normal result. Little information exists about the adverse effects of early interventions, although cochlear implants are associated with higher risks for bacterial meningitis in young children.

Conclusions:

Children with hearing loss who had UNHS have better language outcomes at school age than those not screened. Infants identified with hearing loss through universal screening have significantly earlier referral, diagnosis, and treatment than those identified in other ways.

Contents

Oregon Health & Science University, Mailcode BICC, 3181 SW Sam Jackson Park Rd, Portland, Oregon 97239-3098. www​.ohsu.edu/epc

540 Gaither Road, Rockville, MD 20850. www​.ahrq.gov

This report is based on research conducted by the Oregon Evidence-based Practice Center (EPC)1 under contract to the Agency for Healthcare Research and Quality (AHRQ),2 Rockville, MD (Contract No. 290-02-0024, Task Order Number 1).

Suggested citation:

Nelson HD, Bougatsos C, Nygren P. Universal Newborn Hearing Screening: Systematic Review to Update the 2001 U.S. Preventive Services Task Force Recommendation. Evidence Synthesis No. 62. AHRQ Publication No. 08-05117-EF-1. Rockville, Maryland: Agency for Healthcare Research and Quality, July 2008.

The investigators involved have declared no conflicts of interest with objectively conducting this research. The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.

This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in this report.

1

Oregon Health & Science University, Mailcode BICC, 3181 SW Sam Jackson Park Rd, Portland, Oregon 97239-3098. www​.ohsu.edu/epc

2

540 Gaither Road, Rockville, MD 20850. www​.ahrq.gov

Bookshelf ID: NBK33992PMID: 20722159
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