Overcoming challenges in newborn hearing screening

Evaluation of the Natus ALGO 3 Newborn Hearing Screener

OBJECTIVE

To compare the ALGO 3 Newborn Hearing Screener (Natus Medical Inc.) to the ALGO 2e Newborn Hearing Screener (Natus Medical Inc.).

DESIGN

A prospective evaluation.

SETTING

Three maternity hospitals.

PATIENTS/PARTICIPANTS

199 newborns enrolled; 194 completed the study.

INTERVENTIONS

Patients were tested using either the ALGO 3 screener or the ALGO 2e screener first, and then screened with the alternate device. Initial screens resulting in REFER outcomes were repeated using the same device. An ALGO 2e PASS result was accepted as adequate evidence of hearing. Two sequential ALGO 2e REFER results required further diagnostic testing to determine hearing status.

MAIN OUTCOME MEASURES

Average screening times and referral rates of both hearing screeners.

RESULTS

The ALGO 3 screener averaged 70.8 seconds (95% confidence interval = 34.5-107.1 seconds), or was 23% faster than the ALGO 2e screener (p = .0002). There were 48% fewer REFER results after initial screening with the ALGO 3 screener (5.7%) than with the ALGO 2e screener (10.9%) (p = .06). Faster screen times and fewer referrals were noted at each hospital.

CONCLUSION

The ALGO 3 screener can increase caregiver efficiency by accurately screening hearing in newborns faster and with fewer REFER results than the ALGO 2e screener.

Newborn hearing screening in Western Australia

AIM

To report the preliminary findings of a pilot program to screen newborn babies for congenital bilateral permanent hearing loss.

SETTING

The five largest maternity hospitals in Perth, Western Australia. Screening was gradually introduced over seven months from February to August 2000.

PARTICIPANTS

All babies born at these hospitals after the introduction of hearing screening until 30 June 2001.

METHODS

One or both of two automated screening devices were used: one measuring transient evoked otoacoustic emissions (TEOAE) and the other automated auditory brainstem responses (AABR). If a "pass" was not obtained in both ears, screening was repeated. All babies who did not obtain a pass in either ear at follow-up were referred for audiological assessment.

MAIN OUTCOME MEASURES

Prevalence of permanent bilateral hearing loss.

RESULTS

Of 13 214 eligible babies, 12 708 (96.2%) received screening. The main reason for missing screening was early hospital discharge (309; 2.3%). Of the screened babies, 99% had a pass response in both ears at either the initial or follow-up screen. Twenty-three babies were referred for audiological assessment, and nine were diagnosed with bilateral permanent hearing loss (0.68/1000; 95% CI, 0.31-1.28).

CONCLUSIONS

Despite our program meeting process quality indicators, our detection rate was low. Before extending the program to smaller hospitals, we need to validate our screening instruments and put in place a system to monitor false negative results.