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This publication is provided for historical reference only and the information may be out of date.

Cover of Newborn Hearing Screening

Newborn Hearing Screening

Systematic Evidence Reviews, No. 5

, MD, MS, , MS, , MD, , MD, , MD, MPH, and , MD, MPH.

Oregon Health Sciences University Evidence-based Practice Center, Portland, Oregon
Rockville (MD): Agency for Healthcare Research and Quality (US); .
Report No.: 02-S001

Structured Abstract

Context:

Each year approximately 5000 infants are born in the United States with moderate to profound, bilateral sensorineural hearing loss (SNHL). Universal newborn hearing screening (UNHS) has been proposed as a means to speed diagnosis and treatment, and thereby improve language outcomes in these children.

Objective:

To identify strengths, weaknesses, and gaps in the evidence supporting UNHS and to compare the additional benefits and harms of UNHS with those of selective screening of high-risk newborns.

Data Sources:

A keyword search of MEDLINE, CINAHL, and PsycINFO databases for relevant papers published from 1994 to August 2001, using terms for hearing disorders, infant or newborn, screening, and relevant treatments. We contacted experts and reviewed reference lists to identify additional articles, including those published before 1994.

Study Selection:

We included controlled and observational studies of (1) the accuracy, yield, or harms of screening using otoacoustic emissions (OAEs), auditory brainstem response (ABR), or both in the general newborn population or (2) the effects of screening or of early identification and treatment on language outcomes. Nineteen articles, including 1 controlled trial, met these inclusion criteria.

Data Extraction:

Data on population, test performance, outcomes, and methodological quality were extracted using prespecified criteria developed by the US Preventive Services Task Force. We queried authors when information needed to assess study quality was missing.

Data Synthesis:

Good quality studies show from 2041 to 2794 low-risk, and 86 to 208 high-risk, newborns were screened to find 1 case of moderate to profound SNHL. The best estimate of positive predictive value is 6.7%. Six percent to 15% of infants who fail the screening tests are subsequently diagnosed with bilateral SNHL. In a trial of UNHS versus clinical screening at 8 months of age, UNHS increased the proportion of infants with moderate to severe hearing loss diagnosed by 10 months of age (57% vs 14%), but did not reduce the rate of diagnosis after 18 months of age. No good-quality controlled study has compared UNHS to selective screening of high-risk newborns. In fair- to poor-quality cohort studies, intervention before 6 months of age was associated with improved language and communication skills by 2 to 5 years of age. These studies had unclear criteria for selecting subjects, and none compared an inception cohort of low-risk newborns identified by screening to those identified in usual care, making it impossible to exclude selection bias as an explanation for the results. In a mathematical model based on the literature review, we estimated that extending screening to low-risk infants would detect 1 additional case before 10 months for every 1441 low-risk infants screened, and result in treatment before 10 months of 1 additional case for every 2401 low-risk infants screened. With UNHS, 254 newborns would be referred for audiological evaluation because of false-positive second-stage screening test results, versus 48 for selective screening.

Conclusions:

Modern screening tests for hearing impairment can improve identification of newborns with SNHL, but the efficacy of UNHS to improve long-term language outcomes remains uncertain.

2101 East Jefferson Street, Rockville, MD 20852. www​.ahrq.gov

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-97-0018 Task Order No. 2, Technical Support of the U.S. Preventive Services Task Force. Prepared by: Oregon Health Sciences University Evidence-based Practice Center, Portland, Oregon.

Suggested citation:

Helfand M, Thompson DC, Davis R, et al. Newborn Hearing Screening. Systematic Evidence Review Number 5 (Contract 290-97-0018 to the Oregon Health & Science University Evidence-based Practice Center, Portland, Oregon). AHRQ Publication No. 02-S001. Rockville, MD: Agency for Healthcare Research and Quality. October 2001.

On December 6, 1999, under Public Law 106-129, the Agency for Health Care Policy Research (AHCPR) was reauthorized and renamed the Agency for Healthcare Research and Quality (AHRQ). The law authorizes AHRQ to continue its research on the cost, quality, and outcomes of health care, and expands its role to improve patient safety and address medical errors.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or 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.

1

2101 East Jefferson Street, Rockville, MD 20852. www​.ahrq.gov

Bookshelf ID: NBK42616PMID: 20722147
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