Early identification of hearing loss and centralized newborn hearing screening facility-the Cochin experience

Newborn Hearing Screening with Two-Step Protocol and Risk Factor Identification: Our Experience at a Tertiary Care Centre in Eastern India

Objective

To estimate the prevalence of hearing loss and identify the high-risk factors among neonates with hearing loss.

Methods

Retrospective study done on 1054 infants in a tertiary care centre in Eastern India from 2020 to 2021 and approved by the Institutional Ethics Committee. A two-step protocol is used for screening. In the well-nursed group, OAE and BOA were performed. In the case of REFER results for automated ABR following OAE evaluation in well-nursed babies, a detailed audiological evaluation was scheduled to be carried out using diagnostic ABR within one month of age. In the high-risk group, hearing screening includes OAE, BOA, and AABR evaluations. AABR evaluation was performed as a part of the screening protocol irrespective of the results of OAE screening as PASS or REFER.

Results

In our study among 1053 neonates screened, 375 were in the risk category, and 679 were without risk factors. The overall prevalence of hearing loss in neonates was 22.78 per 1000 screened neonates and 56 per 1000 among high-risk neonates. In the high-risk group, we were able to identify 4 cases of Auditory spectrum neuropathy disorder with the use of AABR during 1st step of screening. In multivariate regression analysis, the risk factors for hearing loss identified were NICU stay (OR = 3.6, 95% CI = 1.1-12.03) and Craniofacial anomalies (OR = 55.37, 95% CI = 16.48- 186.01).

Conclusion

Early neonatal screening helps in the detection, intervention, and rehabilitation of hearing loss. The use of AABR in risk infant screening enhanced the chance of detection of auditory spectrum neuropathy disorder (ASND) cases.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03723-3.

Prevalence of Hearing Impairment in High-Risk Neonates at Kalaburagi Region of Northern Karnataka: A Hospital-Based Cross-Sectional Study

The study estimated the prevalence of hearing impairment in high-risk neonates and effect of high-risk factors on the hearing. A hospital-based cross sectional study was conducted on 327 neonates with high-risk factors. All the high-risk babies were screened using TEOAE and AABR followed by diagnostic ABR testing. Six (2%) of high-risk neonates were found to have bilateral severe sensorineural hearing loss. Risk factors associated with hearing impairment include multiple risk factors of Preterm delivery, hyperbilirubinemia, congenital anomalies, neonatal sepsis, viral or bacterial infection, positive family history of hearing loss and prolonged NICU stay. Further, the inclusion of AABR along with TEOAE has been shown to be a useful tool in reducing false-positive rates and identifying hearing loss.

Early hearing detection and intervention (EHDI) programmes for infants and young children in low-income and middle-income countries in Asia: a systematic review

BACKGROUND

Early hearing detection and intervention (EHDI) measures initiated in high-income countries (HICs) were attempted in low-income and middle-income countries (L&MICs). However, information regarding the models of EHDI, context-specific adaptations made to strategies and outcomes are not known.

AIMS

The aims of this systematic review were to identify the various models of EHDI used in Asian L&MICs in the published scientific literature and to describe their efficacy and validity.

METHODS

The studies were eligible if the programme was from Asian L&MICs, implemented for children below 6 years of age and published between 2010 and 2021. Google Scholar, PubMed, Web of Science, Scopus, EBSCOHost and EBSCO-CINAHL were used to find articles. Data were extracted from each selected article, and the risk of bias was assessed. The search results were summarised using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. For primary outcomes, narrative synthesis was used, and forest plots were generated for secondary outcomes.

RESULTS

In all, 82 studies were included, and these studies were divided into two categories: newborn and infant screening programmes and screening programmes for older children. Predominantly, a two-stage objective otoacoustic emission (Distortion Product/Transient Evoked) or automated auditory brainstem response screening, followed by a detailed auditory brainstem response to confirm the hearing loss, was used in newborn and infant screening programmes. Audiologists were the most frequent screening personnel. Screening of older children was mostly done by otolaryngologists, school instructors and nurses. They performed a single-stage pure tone audiometry screening followed by a detailed examination.

CONCLUSION

The screening tools and protocols used were similar to those used in HICs. However, no uniform protocols were followed within each country. Long-term viability of EHDI programmes was not known as there was limited information on impact outcomes such as cost-benefit.

PROSPERO REGISTRATION NUMBER

CRD42021240341.

Experience, Challenges and Outcome of Implementing Universal New Born Hearing Screening in a Medical College Hospital Set Up

In India, newborn hearing screening programs have been implemented as a part of research studies since early 1970s. Amongst the previously reported programs most are from the southern region and very few are from the west and the northern region of the country. There is a lack of evidence of such program in other region of the country. 1. To study the outcome, experience, and challenges faced during the implementation of the universal newborn hearing screening program in a medical college set up of Raipur, Chhattisgarh. 2. To determine the prevalence of hearing impairment with a two tier screening protocol with Otoacoustic emission and Auditory Brainstem Response. The Prospective Non randomised study was carried out between December 2017 and December 2019. A total of 1200 neonates delivered at the medical college, Raipur were screened using the two tier screening protocol. In our study, the prevalence of hearing loss was 2 per 1000 live births for bilateral hearing loss and 1 per 1000 live births for unilateral hearing loss. Implementing universal newborn screening in a vast country like India is a challenging task because of a high birth rate, diverse socio-economic and cultural background with limited resources. Though several hospitals and clinics have implemented the UNHS program, yet there is a dearth of literature regarding the program outcome, success, challenges, and lessons learnt. Therefore best practices of such evolved programs should be in public domain.

Outcome of Universal Neonatal Hearing Screening Programme at a Tertiary Care Centre: A Prospective Study

Hearing is an important sense organ for human beings essential for speech, language and overall development. Universal neonatal hearing screening programmes are mandatory in many developed countries. In India out of 1000 neonates approximately 5-6 infants are diagnosed with hearing impairment but still universal neonatal hearing screening programme is in its infancy. To screen all neonates delivered at our centre in three years, with secondary objective of determining the significance of risk factors with neonatal hearing loss and to provide appropriate intervention following the detection of a permanent hearing impairment. It is a non-randomised prospective cohort study conducted at a tertiary care centre to screen all neonates born between Jan 2017 and Dec 2019 with 2 stage protocol using distortion product otoacoustic emission and auditory brainstem response. The study population was also divided into two groups, ''at risk'' and ''no risk'' groups to determine the significance of risk factors on neonatal hearing loss. Total 2676 neonates were screened, OAE referral rate was 1.53%. There was a 94.12% follow up. The incidence of hearing impairment was found to be 7 per 1000(In the "no risk" group, 2.9 per 1000 and in the "at risk" group, 41.38 per 1000). Statistically, a significant difference was found in the incidence of hearing impairment between the two groups (p < 0.05, chi-square Test). Hospital based universal hearing screening of new born before discharge is feasible at a tertiary care centre. A high incidence of 0.7% congenital hearing impairment warrants universal newborn hearing screening programme. Considering the limitations and infrastructure in India, we should at least employ screening for all high risk neonates.

A Study of JCIH (Joint Commission on Infant Hearing) Risk Factors for Hearing Loss in Babies of NICU and Well Baby Nursery at a Tertiary Care Center

Babies in Neonatal Intensive Care Units (NICU) have an additional risk for hearing loss due to various risk factors like, prematurity, low birth weight, mechanical ventilation, hyperbillirubinemia, ototoxic drugs, low APGAR score etc. as compared to the babies from well baby nursery (WBN) who, poses risk factors mostly family history, syndromic deafness. So the present study was aimed know the risk factors responsible for hearing loss in NICU and WBN babies and to assess the incidence of deafness. A total of 800 babies from NICU (n = 402) and WBN (n = 398) underwent hearing screening from a tertiary care center. Hearing screening was done using two staged screening protocol as per JCIH guidelines with Distortion product Evoked Otoacoustic Emissions (DPOAE) and Automated Auditory Brainstem Responses (A-ABR). According to DPOAE test, 311 from NICU and 383 from WBN passed the test and during second screening, 80 out of 91 from NICU and 11 out of 13 from WBN passed the DPOAE test. Further BERA was done at the 3rd month of corrected age where 6 out of 11 showed positive responses from NICU and 3 babies from WBN had profound hearing loss. Data analysis revealed that family history of deafness, anemia and hypertension in ANC, TORCH in mother, low Apgar score and hyperbillirubinemia in newborns were a major risk factor for hearing impairment. We conclude that the diagnoses of auditory disorders at early stage due to various risk factors are important since appropriate therapeutic intervention and rehabilitation would help in better development of children.

Outcomes of Training Nurses Engaged in a Public Sector Newborn Hearing Screening Program in South India

This study evaluated the outcomes of training nurses engaged in a public sector newborn hearing screening (NHS) program in one urban district in South India. Twenty nurses performing NHS in Corporation Maternity Hospitals (CMH) participated in the training and evaluation. Baseline knowledge and skill of nurses regarding NHS and overall program outcomes were obtained eight months post the initial training. Knowledge was evaluated using questionnaire, skill was evaluated using Objective Structured Clinical Examination (OSCE) and agreement between screening results obtained by audiologist and nurse. Records used for documentation of screening were analysed to evaluate program outcomes. A two-day retraining was designed to address the gaps identified. Evaluations were conducted immediately post and three months post retraining following the same procedure as baseline evaluations. Gaps were identified in knowledge and skill as well as in the program outcomes. Immediate post retraining evaluation results showed overall improvement in nurses' knowledge and skill. Three months post retraining, all the nurses achieved benchmark criteria of 75% in knowledge and skill. Program outcomes, such as coverage (95.3%), refer rate (3.2%) and follow up rate (86.1%) improved post retraining. The findings of this study suggests that knowledge and skill of nurses improved with periodic training. Periodic evaluation and monitoring enhanced the overall outcomes of the program.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-021-02920-2.

UNHS: A Decade Long Feasibility and Sustenance Study from a Tertiary Care Hospital in India

Objective The aim of this study is to estimate the incidence of hearing loss in neonates at a tertiary referral center, to assess the associated risk factors in those identified with hearing loss and to explore the challenges of starting and continuing a universal neonatal hearing screening programme in a tertiary care hospital over a decade. Materials and Methods It is a cohort prospective observational study conducted from January 2008 to January 2018. Five thousand five hundred and forty neonates underwent screening for hearing loss, of which 2688 were well babies and 2854 babies had one or more risk factors causing hearing loss. Otoacoustic emissions (OAE) is employed as the first level of screening within one month of birth. Brainstem evoked response audiometry (BERA) is done at 3 months of gestational age for all the well babies who were referred on OAE testing and all the high risk babies irrespective of the result of the OAE screening. The High risk criteria are based on the set criteria by the Joint Committee on Infant Hearing (2007) and American Academy of Pediatrics (1994). Results In our study the incidence of hearing impairment is 5.41 per 1000 neonates screened. In well babies and at risk babies it is 1.49 and 9.11 per 1000 respectively.The common neonatal risk factors associated with hearing loss in our study are babies admitted to neonatal intensive care units (NICU), intrauterine growth retardation (IUGR), birth weight less than 1500 g, respiratory distress syndrome (RDS) and hyperbilirubinemia. Conclusion The incidence of hearing loss in our study is comparable to that reported in literature (Bachmann KR, ArvedsonJC (1998) Early identification and intervention for children who are hearing impaired. Pediatr Rev. 1998 May; Vol. 19. No.5. pp. 155-165. http://www.ncbi.nlm.nih.gov/pubmed/9584525 Accessed from May 1998, Nagapoornima P, Ramesh A, Srilakshmi, Rao S, Patricia PL, Gore M, et al. Universal hearing screening. Indian J Pediatr. 2007 Jun 18; 74(6):545-9., Augustine AM, Jana AK, Kuruvilla KA, Danda S, Lepcha A, Ebenezer J, et al. (2014) Neonatal hearing screening-experience from a tertiary care hospital in southern India. Indian Pediatr. Vol. 51. No.3. pp 179-183. http://www.ncbi.nlm.nih.gov/pubmed/24277966 Accessed from Mar 2014). Hearing loss is more common in those babies with risk factors as reported in literature (Nagapoornima P, Ramesh A, Srilakshmi, Rao S, Patricia PL, Gore M, et al. Universal hearing screening. Indian J Pediatr. 2007 Jun 18; 74(6):545-9. http://www.ncbi.nlm.nih.gov/pubmed/21654001 Paul AK (2011) Early identification of hearing loss and centralized newborn hearing screening facility-the Cochin experience. Indian Pediatr. Vol. 48. No. 5. pp 355-359. Accessed from May 2011). Implementation of neonatal hearing screening program at a tertiary care hospital using a two tier system with OAE and BERA is a feasible but challenging service.

Auditory Brainstem Evoked Response Patterns in the Neonatal Intensive Care Unit

OBJECTIVE

Delayed maturation of auditory brainstem pathway in neonates admitted to the neonatal intensive care unit (NICU) may lead to misdiagnosis of children with normal peripheral hearing and inappropriate use of amplification devices. The aim of this study is to determine the pattern of auditory brain stem response in neonates admitted to the NICU for proper hearing assessment in this high-risk population.

STUDY DESIGN

This prospective study was conducted on 1,469 infants who were admitted to the NICU, of which 1,423 had one or more risk factors for permanent congenital hearing loss and were screened with automated auditory brain stem response (AABR). A total of 60 infants were referred for diagnostic ABR analysis after failure on AABR screening. The control group comprised 60 well-baby nursery neonates with no risk factors for PCHL.

RESULTS

Mean values of absolute latencies of waves III and V; interpeak latencies I-III, III-V, and I-V; amplitude of waves I, and V; and I/V amplitude ratio at 90 dBnHL measured for the right and left ears at 1 and 3 months of age show significant difference in NICU neonates compared with controls (p < 0.05). All the diagnostic ABR measurements significantly improved at the age of 3 months (p < 0.001) except wave I absolute latency of both groups (p > 0.05). Significant correlations were found between ABR readings at the age of 1 and 3 months and the gestational age of the NICU neonates (p < 0.05).

CONCLUSION

Diagnostic ABR findings in NICU neonates suggested delayed maturation of the auditory brainstem pathway with a great impact of gestational age on this maturation. Auditory maturational changes were observed at 3 months of age of patient and control groups.

Perspectives of newborn hearing screening in resource constrained settings

Newborn hearing screening is an effective strategy for early identification of hearing loss in the newborn which result in early intervention and best outcome. However implementing universal screening strategy is a challenge in many resource constrained settings. There are various limitations towards successful implementation of hearing screening program in the developing countries. The cost effectiveness of the screening program also needs to be considered in a resource constrained settings. We attempt to provide a viewpoint that can be potentially helpful for the successful implementation of hearing screening in a resource constrained settings of the developing countries.

Newborn Hearing Screening: Time to Act!

The present study was carried out with the aim of assessing the outcomes of otoacoustic hearing screening in newborns coupled with the three stage protocol. It was a hospital based observational study which was conducted over a time period of twelve months at a tertiary care institute to screen 2000 live neonates for congenital hearing impairment using OAE, followed up by tympanometry and BERA, if required. 2000 neonates were screened for hearing impairment. 406 were in high risk group and the rest in non-high risk group. Seven neonates had absent V wave on BERA. Five of them were high risk babies and the rest two were non-high risk ones. In order to ensure that early detection and effective intervention are possible for all neonates with hearing impairment, UNHS should be performed. Three stage UNHS protocol using OAE and BERA showed that the implementation of UNHS for congenital childhood hearing loss for all neonates would be beneficial.

Prevalence of Severe and Profound Sensorineural Hearing Loss in School Children in West Bengal, India

There is pressing need for reliable information about prevalence of sensorineural hearing loss in children in India. Without this basic information it is difficult to plan services on a rational basis. In this stratified cross sectional study, we aimed to determine the prevalence of severe and profound sensorineural hearing loss in school children in West Bengal, India. We hypothesized that all children with severe or profound hearing loss in elementary schools (age 6-14 years) would be among those identified as 'children with special need' because of their marked problems with hearing, speech or communication. First stratum of our study included all 6-14 years old mainstream elementary school 'children with special need', with known or suspected hearing problem. Second stratum covered all 6-14 years old hearing impaired children attending special schools. Comprehensive audiological assessment of 10,763 'children with special need' in mainstream elementary schools identified 3984 children showing severe or profound SNHL (≥71 dB). A further 1022 children were identified with similar loss in special schools, giving a total of 5006 children with severe or profound sensorineural loss among a school population of 8,654,057, with estimated prevalence of 0.58 (CI 0.57-0.59) per 1000 children. This is the first large scale study of the epidemiology of severe and profound sensorineural hearing loss in school children in India. Although further studies are needed from other parts of India, in the interim, findings of this study can form the basis for planning resource allocation, service provision, investigation into etiology and prevention of sensorineural deafness in children in India.

Challenges and Solutions in Implementing Hearing Screening Program in India

Hearing is the key to learning spoken language, performing academically, and engaging socially for children. Degree of hearing loss quantifies the hearing ability from mild to profound, based on the audiometric findings for an individual across certain frequencies or pitches. Early identification and appropriate intervention is the prime need. A probable strategy is to ensure that every newborn is screened for possible hearing loss at the birth in the hospital. In India, hearing screening facility is mostly available to newborns brought into tertiary hospitals. Some of the key issues in the implementation of the program identified are lack of human resources, inadequate infrastructure, equipment-related shortcomings, and low priority for hearing impairment (HI) prevention. The Government of India initiated efforts toward prevention and control of HI, i.e., National Program for Prevention and Control of deafness and Rashtriya Bal Swasthya Karyakram which are significant milestones in the implementation of systematic nationwide hearing screening programs.

A Clinical Study of Effect of Hyperpyrexia on Otoacoustic Emissions in Children

Various degrees of sensory neural hearing loss can be seen in the progression of some hereditary periodic fever syndromes. Otoacoustic emission testing can help to establish the inner ear involvement at an early period of a periodic fever with a risk of hearing loss (Abdul Kadir et al. in J Int Adv Otol 9(2.79):08-11, 2014). Sensorineural hearing loss is the common most complication of bacterial meningitis in childhood (Richardson in Pediatrics 102(6):1364-1368, 1998). When present from birth, or acquired in the pre-school years, hearing loss of any degree, even mild hearing loss, interferes with speech and language development. In addition to obvious communication deficits, the consequences of hearing loss in children and adults include psychosocial problems, such as frustration, irritability, anxiety, the tendency to withdraw from social interactions, and even depression (Dhar and Hall in Otoacoustic emissions: principles, procedures, and protocols, Plural Publishing, San Diego, 2011). OAE are acoustic signals emitted from cochlea to the middle ear and into the external ear where they are recorded. Evoked OAE are undetectable when deafness is above 30-35 dB Sound pressure level (Biswas in Clinical audio-vestibulometry for otologists and neurologists, Bhalani Publishing House, Mumbai, 1995). OAEs permit early detection of inner ear abnormalities associated with a wide variety of diseases and disorders, including Alport syndrome etc. With early detection, the serious consequences of hearing loss can sometimes be prevented. With proper identification and diagnosis of hearing impairment, timely and effective management for the same can be taken. Data for this study was collected from children (5-14 years) attending the Department of Otorhinolaryngology and Paediatrics Out-patient departments in P.E.S.I.M.S.R, Kuppam. Among the study population 43 (57.3%) were male and 32 (42.7%) were females showing the slight male preponderance. study was done on children with temperature > 1000 F, children with temperature were screened with OAE, and OAE was recorded in same children once fever has subsided and results were compared. This is a new study where we compared same group of children with fever and once fever has subsided. In most other studies, study group was compared to the healthy control group. In our study, children with fever having abnormal FDP values at f1were 9, they reverted back to base line once fever has subsided. This shows that there is no much damage to inner ear at lower frequencies. Almost 47 abnormal FDP values at f2 reverted back to normal. At higher frequencies (f3 and f4), there is no much change in abnormal FDPs with fever and after fever has subsided, this shows that there is more damage to inner ear at higher frequencies. This study demonstrated that hyperpyrexia causes hearing loss in children with fever probably due to cochlear involvement. We conclude that OAE can be used as a screening tool in detecting hearing loss among children because the technique is simple, reproducible, not expensive, not time consuming also effectively narrows down the children with high chances of hearing loss thereby effectively improves the chances of early diagnosis and hence children can be rehabilitated early, making a marked change in their future.

Neonatal Screening for Prevalence of Hearing Impairment in Rural Areas

Hearing is one of the most important sense organs for man. Hearing loss is often associated with delayed speech and language development in young children. Early identification and intervention improves the chance a child gets to lesser delays in development and improving the overall quality of life. To find out the prevalence of hearing loss in neonates in the rural taluka of Maval, Pune, Maharashtra, India. Prospective Non Randomized Clinical Study. The study was carried out between April 2012 and April 2015. A total of 8192 babies were screened across various centers around the Maval area. The babies who had some high risk factors were 1683 in number and babies who had no high risk factors i.e. well babies were 6509. In our study, the overall prevalence of hearing loss in neonates in Maval taluka of Maharashtra was found to be 3.54 per 1000 live births, in normal born neonates (well babies) was 1.689 per 1000 births, in high risk babies was 10.69 per 1000 high risk births. The prevalence of low birth weight neonates, hyperbilirubinemia neonates and neonates with craniofacial abnormalities developing hearing impairment was found to be 5.9, 3.56 and 1.18 per 1000 high risk births respectively. India is the second most populated country in the world with nearly a fifth of the world's population. There is a need for the universal neonatal screening for deafness for earlier detection of deafness and rehabilitation. Level of Evidence: Level IV.

State of deaf children in West Bengal, India: What can be done to improve outcome

OBJECTIVE

Prelingual deafness in children demands urgent action as best outcome is dependent on earliest possible diagnosis and intervention. Objective of this study was to determine age of suspicion, diagnosis, intervention, and outcome in a representative group of deaf children in West Bengal, India, and suggest ways of improving these parameters.

METHODS

In this cross-sectional study, ages of suspicion, diagnosis, intervention and outcome of 303 randomly selected deaf children were elicited from a cohort of 1316 children with deafness identified in an earlier study.

RESULTS

Median ages of suspicion, diagnosis and amplification were 18, 72 and 84 months respectively. Age of suspicion was significantly related to parental education (p < 0.05); age of diagnosis to parental education and socio-economic status (p < 0.001) and children's geographic location (p < 0.01). Following diagnosis, 86% of children received hearing aids but only 6% used their aids consistently; 86% were non-verbal, 12% could communicate with a mixture of speech and gesture and only 2% with speech alone.

CONCLUSION

Current situation of deaf children in West Bengal, and evidence indicates, in much of India, is insupportable. However, widely diverse socio-economic conditions and scarcity of public health infrastructure preclude one solution of the problem for the whole country. In absence of the ideal universal newborn hearing screening, rigorously monitored and costed pilot programs of different models of early detection and intervention using newborn hearing screening, targeted screening and trial of calibrated noisemakers by primary care workers should be tried to see which works best where, so that successful programs can be scaled up over time.

Consensus Statement of the Indian Academy of Pediatrics on Newborn Hearing Screening

JUSTIFICATION

Hearing impairment is one of the most critical sensory impairments with significant social and psychological consequences. Evidence-based, standardized national guidelines are needed for professionals to screen for hearing impairment during the neonatal period.

PROCESS

The meeting on formulation of national consensus guidelines on developmental disorders was organized by Indian Academy of Pediatrics in Mumbai, on 18th and 19th December, 2015. The invited experts included Pediatricians, Developmental Pediatricians, Pediatric Neurologists and Clinical Psychologists. The participants framed guidelines after extensive discussions.

OBJECTIVE

To provide guidelines on newborn hearing screening in India.

RECOMMENDATIONS

The first screening should be conducted before the neonate's discharge from the hospital - if it 'fails', then it should be repeated after four weeks, or at first immunization visit. If it 'fails' again, then Auditory Brainstem Response (ABR) audiometry should be conducted. All babies admitted to intensive care unit should be screened via ABR. All babies with abnormal ABR should undergo detailed evaluation, hearing aid fitting and auditory rehabilitation, before six months of age. The goal is to screen newborn babies before one month of age, diagnose hearing loss before three months of age and start intervention before six months of age.

Outcomes of Newborn Hearing Screening Program: A Hospital Based Study

Hearing loss is hidden disability and second most common congenital pathology. Prevention, early identification and early intervention of hearing loss can prevent further disability in development of speech, language, cognition and other developmental domains. The prevalence of congenital hearing loss has been estimated to be 1.2-5.7 per thousand in neonates. In these contexts, the aim of study was to determine outcomes of neonates hearing screening program in Hospital. It is a clinical cross-sectional study which was conducted in tertiary care centre from 8th July, 2015 to 31th May, 2016. Total no of 2254 cases were screened. Details case history including high risk register, Pediatric Audiometry, Otoacoustic Emission tests were performed followed brainstem evoked response audiometry. The Prevalence of hearing loss among high risk babies confirmation by BERA was 8.8% per 1000 babies and 16 cases were recommended for Cochlear Implant. The screening protocol with objective test i.e. Distortion Product Otoacoustic Emission and confirmation by Brainstem Evoked Response Audiometry is very useful tool in early identification of congenital hearing loss in neonates. Hence, the results of this study will be used to initiate universal newborn hearing screening in other hospitals. Moreover, this study highlights the relevance of neonatal hearing screening in other states of India and country where this screening is not performed routinely in all hospitals and creating awareness to identify neonatal risk factors associated with hearing loss and understand the importance of early identification and early intervention and among health care professionals.

Follow-up in newborn hearing screening - A systematic review

INTRODUCTION

The quality and efficiency of newborn hearing screening programs (NHS) rely heavily on appropriate follow-up. The Joint Committee on Infant Hearing recommends a follow-up rate of more than 95% of infants who fail the initial hearing screening. However, a 70% benchmark is considered to be more feasible. This high loss to follow-up (LTF) rate acts as a threat to the overall success of NHS programs. The objective of the study was to identify and examine the reported rates of LTF, attributed reasons for LTF and strategies undertaken to reduce LTF.

METHODS

Using a systematic search, articles published between 2005 to December 2015 were identified from PubMed/Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Educational Resources Information Center (ERIC), Scopus, Ovid, ProQuest, and Cochrane Library. To be included in the review, the study should be exploring the loss to follow-up or drop-out rate in newborn hearing screening programs and be published in an indexed peer-reviewed journal in the English language. The main outcome measures were overall rate of LTF, factors leading to LTF and measures adopted to overcome LTF.

RESULTS

53 articles were short-listed for data extraction. Out of these, 27 were single-centre studies, 19 were multi-centre, 3 compared multiple databases, and 4 used survey-based methods. Overall LTF rates of 20% in single-centre and 21% in multiple-centre studies were observed. Educational disparity and lack of adequate knowledge among parents were associated with LTF. The most commonly used strategy to overcome LTF suggested by studies was the use of an adequate data management system.

CONCLUSION

This review is a novel attempt to explore the LTF among NHS studies, reasons for LTF and strategies to reduce LTF. This review can act as a basis for planning and execution of effective NHS programs.

Current and future perspective of newborn screening: an Indian scenario

BACKGROUND

Newborn screening comprises a paramount public health program seeking timely detection, diagnosis, and intervention for genetic disorders that may otherwise produce serious clinical consequences. Today newborn screening is part of the health care system of developed countries, whereas in India, newborn screening is still in the toddler stage.

METHOD

We searched PubMed with the keywords newborn screening for metabolic disorders, newborn screening in India, and congenital disorder in neonates, and selected publications that seem appropriate.

RESULTS

In India, in spite of the high birth rate and high frequency of metabolic disorders, newborn screening programs are not part of the health care system. At Union Territory, Chandigarh in 2007, newborn screening was initiated and is currently ongoing for three disorders, that is, congenital hypothyroidism, congenital adrenal hyperplasia, and glucose-6-phosphate dehydrogenase (G6PD) deficiency. Prevalence of these disorders is found to be 1:1400 for congenital hypothyroidism, 1:6334 for congenital adrenal hyperplasia, and 1:80 for G6PD deficiency.

CONCLUSION

Mandatory newborn screening for congenital hypothyroidism should be implemented in India, and other disorders can be added in the screening panel on the basis of region-wise prevalence. The objective of this review is to provide insight toward present scenario of newborn screening in India along with recommendations to combat the hurdles in the pathway of mandatory newborn screening.

Neonatal Hearing Screening Programme (NHSP): At A Rural Based Tertiary Care Centre

Deafness is the most common curable childhood handicap. It is a well recognised fact that unidentified hearing impairment can adversely affect optimal speech and language development and therefore academic, social and emotional development. Universal neonatal hearing screening programmes are implemented in many developed countries. However it is still in its early stage in India. The incidence of hearing impairment in India is 1-6 per thousand newborns screened (Paediatrics 19:155-165, 1998; Indian J Paediatr 74(6):545-549, 2007; Status of Disability in India, pp 172-185 2000). To determine the incidence of permanent hearing loss of moderate to evere variety in neonates taking care in a tertiary care rural based hospital in Gujarat. It was a non randomised observational study done for duration of 3 years. All neonates born in Shri Krishna Hospital underwent screening using two stage protocols with DPOAE test and final confirmation done with BERA. Total 2534 neonates were screened out of them 52 failed and 2482 (97.94 %) neonates passed in the 1st DPOAE test with 2.05 % refer rate. Total 7 (2 per 1000) neonates were detected with hearing impairment. 10 % neonates had one or other high risk factor. Out of high risk neonates, 1.8 % were diagnosed with hearing impairment in high risk group. Overall the follow-up rate was 72.7 %. Hospital based universal hearing screening of new born before discharge is feasible at a rural based tertiary care centre. Non specialist staff is invaluable in achieving a satisfactory referral rate with two stage hearing screening protocol. However, more efficacious tracking and follow up system is needed to improve the follow up rate for diagnosis.

Challenges of Implementing Universal Newborn Hearing Screening at a Tertiary Care Centre from India

OBJECTIVES

To report experience of implementing universal newborn hearing screening (UNHS) in a tertiary care neonatal unit, identify risk factors associated with failed two-step automated acoustic brainstem response (AABR) screen and evaluate cost of AABR.

METHODS

This was a prospective study of UNHS outcomes of all live births with two step AABR using BERAphone MB11®. Outcome measures were screening coverage, refer, pass and lost to follow up rates and cost of AABR using micro-costing method. To identify risk factors for failed screening, authors performed multivariate logistic regression with failed two-step AABR screen as dependent variable and baseline risk factors significant on univariate analysis as predictors.

RESULTS

Screening coverage was moderate (84 %), with 2265 of total 2700 eligible infants screened with initial AABR (mean gestation 37.2 ± 2.3 wk; birth weight 2694 ± 588 g; 305 received nursery care). A total of 273 of 2265 infants were "refer" on first screen. Second screen was done on 233, of which 58 were "refer". Of these, 35 underwent conventional ABR, of which 5 were diagnosed to have hearing impairment. Only 2 could get hearing aid. Overall, a total of 2197 (81.4 %) infants passed, 496 (18.4 %; excluding 2 deaths) were lost to follow up at various stages, and 5 (0.2 %) were diagnosed with hearing impairment, all of whom were high risk. Average cost of AABR was INR 276 per test. No factor emerged as significant on multivariate analysis.

CONCLUSIONS

UNHS is feasible to implement, but significant lost to follow up and non-linkage with appropriate rehabilitation services limit its utility. Cost effectiveness of UNHS compared to high risk based screening needs to be determined.

Newborn screening: need of the hour in India

After a review of the current health scene in India, the authors suggest that the Government of India should consider seriously, the introduction of new born screening. As a first step, a central advisory committee should be constituted to recommend what is required to be done to strengthen the infrastructure and the manpower to carry out new born screening, and the disorders to be screened. In the urban hospitals newborn screening (NBS) for three disorders can be easily introduced (congenital hypothyroidism, congenital adrenal hyperplasia and G-6-PD deficiency), while in the rural areas this should begin with congenital hypothyroidism, especially in the sub Himalayan areas. Concurrently, logistic issues regarding diets and special therapies for inborn errors of metabolism should be sorted out, laboratories to confirm the diagnosis should be set up, and a cadre of metabolic physicians should be build up to treat those identified to have inborn errors of metabolism. Once these are established on a firm footing, tandem mass spectrometry should be introduced as it allows the identification of a number of disorders in an affordable manner. The recent improvements and current trends in health care in India have created the necessary infrastructure for adopting NBS for the benefit of infants in India.

Neonatal hearing screening--experience from a tertiary care hospital in southern India

OBJECTIVE

To implement a neonatal hearing screening program using automated auditory brainstem response audiometry in a tertiary care set-up and assess the prevalence of neonatal hearing loss.

DESIGN

Descriptive study.

SETTING

Tertiary care hospital in Southern India.

PARTICIPANTS

9448 babies born in the hospital over a period of 11 months.

INTERVENTION

The neonates were subjected to a two stage sequential screening using the BERAphone. Neonates suspected of hearing loss underwent confirmatory testing using auditory steady state response audiometry. In addition, serological testing for TORCH infections, and connexin 26 gene was done.

MAIN OUTCOME MEASURES

Feasibility of the screening program, prevalence of neonatal hearing loss and risk factors found in association with neonatal hearing loss.

RESULTS

164 babies were identified as suspected for hearing loss, but of which, only 58 visited the audiovestibular clinic. Among 45 babies who had confirmatory testing, 39 were confirmed to have hearing loss and were rehabilitated appropriately. 30 babies had one or more risk factors; 6 had evidence of TORCH infection and 1 had connexin 26 gene mutation.

CONCLUSION

Neonatal hearing screening using BERAphone is a feasible service. The estimated prevalence of confirmed hearing loss was comparable to that in literature. Overcoming the large numbers of loss to follow-up proves to be a challenge in the implementation of such a program.

Efficacy of Distortion Product Oto-Acoustic Emission (OAE)/Auditory Brainstem Evoked Response (ABR) Protocols in Universal Neonatal Hearing Screening and Detecting Hearing Loss in Children <2 Years of Age

Deafness is commonest curable childhood handicap. Most remedies and programmes don't address this issue at childhood level leading to detrimental impact on development of newborns. Aims and objectives are (A) screen all newborns for deafness and detect prevalence of deafness in children less than 2 years of age. and (B) assess efficacy of multi-staged OAE/ABR protocol for hearing screening.

METHODOLOGY

Non-randomized, prospective study from August 2008 to August 2011. All infants underwent a series of oto-acoustic emission (OAE) and final confirmatory auditory brainstem evoked response (ABR) audiometry. Finally, out of 1,101 children, 1,069 children passed the test while 12 children had impaired hearing after final testing, confirmed by ABR. Positive predictive value of OAE after multiple test increased to 100 %. OAE-ABR test series is effective in screening neonates and multiple tests reduce economic burden. High risk screening will miss nearly 50 % deaf children, thus universal screening is indispensable in picking early deafness.

Neonatal hearing screening and intervention in resource-limited settings: an overview

From a developmental perspective, optimal speech and language outcome is indisputably the primary motivation for neonatal hearing screening of infants with congenital or early-onset hearing loss (PCHL). This paper additionally outlines more broadly the potential value of early hearing detection and intervention in resource-poor countries against the backdrop of limitations of primary prevention of PCHL based on a review of literature from low-income and middle-income countries with per capita incomes of approximately US$6000 or less. It establishes the scientific and developmental foundation for priority consideration for neonatal hearing screening and intervention in any global initiatives for effective early childhood development programmes in resource-limited countries. It also highlights approaches to addressing the various challenges to implementing effective early hearing detection and intervention programmes, and concludes with a discussion on the pivotal role of paediatricians in facilitating timely referral for requisite tests and (re)habilitative services especially for infants with established risk factors.