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Performance and characteristics of the Newborn Hearing Screening Program in Campania region (Italy) between 2013 and 2019. Eur Arch Otorhinolaryngol 2021; 279:1221-1231. [PMID: 33768315 PMCID: PMC8897375 DOI: 10.1007/s00405-021-06748-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/11/2021] [Indexed: 11/06/2022]
Abstract
Purpose Universal newborn hearing screening (UNHS) in the first month of life is crucial for facilitating both early hearing detection and intervention (EHDI) of significant permanent hearing impairment (PHI). In Campania region, UNHS has been introduced in 2003 by the Regional Council Resolution and started on January 2007. The aim of this paper is to update a previous article describing the performance of the program since its implementation in the period between 2013 and 2019. Methods A longitudinal retrospective study was carried at the Regional Reference Center III on 350,178 babies born in the analysis period. The paper reports the main results of overall coverage, referral rate, lost-to-follow-up rate,yield for PHI and shall determine various risk factor associations with hearing impairment Results In Campania region, 318,878 newborns were enrolled at I level, with a coverage rate of 91.06%, 301,818 (86.18%) Well Infant Nurseries (WIN) and 17,060 (5.35%) Neonatal Intensive Care Unit (NICU) babies. PHI was identified in 413 children, 288 (69.73%) bilaterally and 125 (30.26%) unilaterally. The overall cumulative incidence rate of PHI was 1.29 per 1000 live-born infants (95% CI 1.17–1.42) with a quite steady tendency during the whole study period. Conclusions This study confirms the feasibility and effectiveness of UNHS in Campania region also in a setting with major socioeconomic and health organization restrictions.The program meets quality benchmarks to evaluate the progress of UNHS. Nowadays, it is possible to achieve an early diagnosis of all types of HL avoiding the consequences of hearing deprivation.
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Sato T, Nakazawa M, Takahashi S, Mizuno T, Ishikawa K, Yamada T. Outcomes of regional-based newborn hearing screening for 35,461 newborns for 5 years in Akita, Japan. Int J Pediatr Otorhinolaryngol 2020; 131:109870. [PMID: 31951982 DOI: 10.1016/j.ijporl.2020.109870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 01/07/2020] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Newborn hearing screening (NHS) has been actively performed since 2001 in Akita, Japan. The NHS coverage rate has increased yearly, and performance has been consistently >90% since 2012. The purpose of this study was to summarize NHS outcomes in the Akita prefecture of Japan and to obtain new insights for from our summarized data for the future. METHODS A total of 35,461 newborns in hospitals and clinics where hearing screening was performed in Akita from 2012 to 2016 were included. The outcome data of NHS were collected for analysis. RESULTS The overall screening coverage rate for hearing loss was 94.7%. Of the screened infants, 0.53% received a referral on the 2-stage automated auditory brainstem response (ABR), and 80.4% of referred infants had a check-up at the hospital to receive a diagnostic hearing examination. Finally, the prevalence of bilateral congenital hearing loss was 0.14%, that of bilateral moderate to profound hearing loss was 0.12%, and that of unilateral congenital hearing loss was 0.10%. Furthermore, the average consultation period in infants with risk factors was significantly later than that in infants without risk factors (p = 0.0015). Follow-up for infants diagnosed with normal hearing after diagnostic hearing examination revealed that 4.7% suffered bilateral moderate to profound hearing loss later. This percentage is significantly higher than that of the general group (p < 0.001). CONCLUSION The prevalence of bilateral congenital hearing loss was 0.14% in Akita and 0.12% of infants were diagnosed with bilateral moderate to severe hearing loss. Medical personnel should be enlightened regarding the importance of performing hearing diagnostic examinations until 3 months of age. Even if infants were diagnosed with normal hearing after a diagnostic examination, we strongly suggest continuing follow-up until they are able to perform pure tone audiometry with accuracy.
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Affiliation(s)
- Teruyuki Sato
- Department of Otorhinolaryngology, Omagari Kousei Medical Center, Daisen, Japan.
| | - Misao Nakazawa
- Department of Otorhinolaryngology, Akita Prefectural Center for Rehabilitation and Psychiatric Medicine, Daisen, Japan; Department of Otorhinolaryngology, Nakadori General Hospital, Akita, Japan
| | - Shin Takahashi
- Department of Otorhinolaryngology, Head & Neck Surgery. Akita University Graduate School of Medicine, Akita, Japan; Takahashi ENT & Eye Clinic, Yokote, Japan
| | - Tomomi Mizuno
- Department of Otorhinolaryngology, Head & Neck Surgery. Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuo Ishikawa
- Department of Otorhinolaryngology, Japanese Red Cross Akita Hospital, Akita, Japan
| | - Takechiyo Yamada
- Department of Otorhinolaryngology, Head & Neck Surgery. Akita University Graduate School of Medicine, Akita, Japan
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Butcher E, Dezateux C, Cortina-Borja M, Knowles RL. Prevalence of permanent childhood hearing loss detected at the universal newborn hearing screen: Systematic review and meta-analysis. PLoS One 2019; 14:e0219600. [PMID: 31295316 PMCID: PMC6622528 DOI: 10.1371/journal.pone.0219600] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/27/2019] [Indexed: 11/19/2022] Open
Abstract
CONTEXT Permanent childhood hearing loss (PCHL) can affect speech, language, and wider outcomes. Adverse effects are mitigated through universal newborn hearing screening (UNHS) and early intervention. OBJECTIVE We undertook a systematic review and meta-analysis to estimate prevalence of UNHS-detected PCHL (bilateral loss ≥26 dB HL) and its variation by admission to neonatal intensive care unit (NICU). A secondary objective was to report UNHS programme performance (PROSPERO: CRD42016051267). DATA SOURCES Multiple electronic databases were interrogated in January 2017, with further reports identified from article citations and unpublished literature (November 2017). STUDY SELECTION UNHS reports from very highly-developed (VHD) countries with relevant prevalence and performance data; no language or date restrictions. DATA EXTRACTION Three reviewers independently extracted data and assessed quality. RESULTS We identified 41 eligible reports from 32 study populations (1799863 screened infants) in 6195 non-duplicate references. Pooled UNHS-detected PCHL prevalence was 1.1 per 1000 screened children (95% confidence interval [CI]: 0.9, 1.3; I2 = 89.2%). This was 6.9 times (95% CI: 3.8, 12.5) higher among those admitted to NICU. Smaller studies were significantly associated with higher prevalences (Egger's test: p = 0.02). Sensitivity and specificity ranged from 89-100% and 92-100% respectively, positive predictive values from 2-84%, with all negative predictive values 100%. LIMITATIONS Results are generalisable to VHD countries only. Estimates and inferences were limited by available data. CONCLUSIONS In VHD countries, 1 per 1000 screened newborns require referral to clinical services for PCHL. Prevalence is higher in those admitted to NICU. Improved reporting would support further examination of screen performance and child demographics.
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Affiliation(s)
- Emma Butcher
- Life Course Epidemiology and Biostatistics, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Carol Dezateux
- Life Course Epidemiology and Biostatistics, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Mario Cortina-Borja
- Clinical Epidemiology, Nutrition and Biostatistics, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Rachel L. Knowles
- Life Course Epidemiology and Biostatistics, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Public Health England, London, United Kingdom
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Leaflets and continual educational offerings led to increased coverage rate of newborn hearing screening in Akita. Auris Nasus Larynx 2018; 45:673-679. [DOI: 10.1016/j.anl.2017.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/14/2017] [Accepted: 11/16/2017] [Indexed: 11/20/2022]
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Molini E, Calzolaro L, Lapenna R, Ricci G. Universal newborn hearing screening in Umbria region, Italy. Int J Pediatr Otorhinolaryngol 2016; 82:92-7. [PMID: 26857323 DOI: 10.1016/j.ijporl.2016.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/04/2016] [Accepted: 01/06/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In Italy, universal newborn hearing screening (UNHS) was first introduced in some regions from 1997. Umbria Region has launched a UNHS program in all hospitals, which has been implemented throughout the region since July 2010. Before UNHS implementation in Umbria region, the average age of identification of congenital hearing loss was around 32 months of age with an average age of initial amplification treatment at least 2 months later. The coverage rate of newborn screening was only 34.4% in 2006. The aim of this study was to examine the results of this program and its evolution in the first 2.5 years since implementation in our region. METHODS Since July 2010, all 11 birth centers and hospitals in Umbria region have been involved in a UNHS program. The screening involves the automated otoacoustic emissions (AOAE) test and automatic auditory brain stem response (AABR) audiometry. The number of screening stages and tests used were different depending on whether the infants had audiological risk factors or not. RESULTS A total of 20,841 babies were born in the hospitals involved of whom 20,051 were well born babies (WB), while 790 babies (3.8%) presented identified audiological risk factors (BRF). The overall coverage rate in the study period was 93.8%. The prevalence of hearing loss was 2‰ for WB infants and 4.3% for BRF. Mean age at diagnosis was 5.31±3.95 and 11.28±7.73 months in the WB and BRF groups, respectively. CONCLUSIONS UNHS has allowed us to substantially increase the coverage rates and decrease the mean age at diagnosis and subsequent treatment. The identification of audiological risk factors is very important for adequate screening and follow-up. However the Joint Committee on Infant Hearing 2007 quality indicators and benchmarks for screening have not yet been fully achieved and there is still scope for some improvement. This could be achieved with a closer cooperation among institutions, parents, pediatricians, and ENT doctors.
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Affiliation(s)
- Egisto Molini
- Department of Surgical and Biomedical Sciences, Section of Otolaryngology-Head and Neck Surgery, University of Perugia, S.M. della Misericordia Hospital, Via G. Dottori 1, Perugia 06156, Italy
| | - Lucia Calzolaro
- Department of Surgical and Biomedical Sciences, Section of Otolaryngology-Head and Neck Surgery, University of Perugia, S.M. della Misericordia Hospital, Via G. Dottori 1, Perugia 06156, Italy
| | - Ruggero Lapenna
- Department of Surgical and Biomedical Sciences, Section of Otolaryngology-Head and Neck Surgery, University of Perugia, S.M. della Misericordia Hospital, Via G. Dottori 1, Perugia 06156, Italy.
| | - Giampietro Ricci
- Department of Surgical and Biomedical Sciences, Section of Otolaryngology-Head and Neck Surgery, University of Perugia, S.M. della Misericordia Hospital, Via G. Dottori 1, Perugia 06156, Italy
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Mincarone P, Leo CG, Sabina S, Costantini D, Cozzolino F, Wong JB, Latini G. Evaluating reporting and process quality of publications on UNHS: a systematic review of programmes. BMC Pediatr 2015. [PMID: 26198353 PMCID: PMC4511235 DOI: 10.1186/s12887-015-0404-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Congenital hearing loss is one of the most frequent birth defects, and Early Detection and Intervention has been found to improve language outcomes. The American Academy of Pediatrics (AAP) and the Joint Committee on Infant Hearing (JCIH) established quality of care process indicators and benchmarks for Universal Newborn Hearing Screening (UNHS). We have aggregated some of these indicators/benchmarks according to the three pillars of universality, timely detection and overreferral. When dealing with inter-comparison, relying on complete and standardised literature data becomes crucial. The purpose of this paper is to verify whether literature data on UNHS programmes have included sufficient information to allow inter-programme comparisons according to the indicators considered. Methods We performed a systematic search identifying UNHS studies and assessing the quality of programmes. Results The identified 12 studies demonstrated heterogeneity in criteria for referring to further examinations during the screening phase and in identifying high-risk neonates, protocols, tests, staff, and testing environments. Our systematic review also highlighted substantial variability in reported performance data. In order to optimise the reporting of screening protocols and process performance, we propose a checklist. Another result is the difficulty in guaranteeing full respect for the criteria of universality, timely detection and overreferral. Conclusions Standardisation in reporting UNHS experiences may also have a positive impact on inter-program comparisons, hence favouring the emergence of recognised best practices. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0404-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pierpaolo Mincarone
- Institute for Research on Population and Social Policies, National Research Council, Rome, 00185, Italy.
| | - Carlo Giacomo Leo
- Institute of Clinical Physiology, National Research Council, Lecce, 73100, Italy. .,Division of Clinical Decision Making, Department of Medicine, Tufts Medical Center, Boston, MA, 02111, USA.
| | - Saverio Sabina
- Institute of Clinical Physiology, National Research Council, Lecce, 73100, Italy.
| | - Daniele Costantini
- Newborn Hearing Screening Service, Azienda USL7 Siena, Siena, 53100, Italy.
| | | | - John B Wong
- Division of Clinical Decision Making, Department of Medicine, Tufts Medical Center, Boston, MA, 02111, USA. .,School of Medicine, Tufts University, Boston, MA, 02111, USA.
| | - Giuseppe Latini
- Institute of Clinical Physiology, National Research Council, Lecce, 73100, Italy. .,Division of Neonatology, "Perrino" Hospital, ASL Brindisi, Brindisi, 72100, Italy.
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Vos B, Lagasse R, Levêque A. Main outcomes of a newborn hearing screening program in Belgium over six years. Int J Pediatr Otorhinolaryngol 2014; 78:1496-502. [PMID: 25012194 DOI: 10.1016/j.ijporl.2014.06.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 06/10/2014] [Accepted: 06/14/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To present the outcomes of the newborn hearing screening program in Belgium (French-speaking area) since its implementation and to analyze its evolution between 2007 and 2012 in the neonatal population without reported risk factors for hearing loss. METHODS The study was descriptive and based on a retrospective analysis of six annual databases (2007-2012) from the newborn hearing screening program. The main outcomes were identified: prevalence of reported hearing impairment; coverage rates (first and second test, follow-up); proportions of conclusive screening tests; referral rate. Each outcome was presented for the six years and by year of birth. Chi-squares were used to study differences in the various outcomes according to time. RESULTS Over the six years, 264,508 newborns were considered as eligible for the screening. Hearing impairment was confirmed in 1.41‰ (n = 374) of them, with significant disparities from year to year, between 0.67‰ and 1.94‰. Analysis of the screening process showed that only 92.71% (n = 245,219) of the eligible newborns underwent a first hearing test. This coverage rate varied greatly over time: at the beginning, less than 90% of the newborns had a first test and it rose to almost 95%. After the two screening steps, 2.40% (n = 6340) of the newborns were referred to an ENT doctor; the referral rate slightly decreased during the first years of the program and then stabilized around 2.4%. Over the period, only 62.21% of the referred newborns had a follow-up; the follow-up rate was particularly low for the first year (44.91%) and then strongly increased (+19.52% in 2008) but never exceeded 70%. CONCLUSIONS Outcome measures for the newborn hearing screening program in Belgium are lower than the benchmarks released by the Joint Committee on Infant Hearing. Nevertheless, the evolution of the outcome measures since the implementation of the program has been positive, particularly during the first years. At some point, most of the outcome measures decreased or at least did not change any further. The motivation and commitment of the professionals have to be supported in a variety of ways to improve outcome measures and thus, the quality of the program.
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Affiliation(s)
- Bénédicte Vos
- Université libre de Bruxelles, School of Public Health, Research Center Health Policy and Systems - International Health, Route de Lennik 808, Brussels 1070, Belgium; Centre d'Epidémiologie Périnatale (CEpiP), Route de Lennik 808, Brussels 1070, Belgium.
| | - Raphaël Lagasse
- Université libre de Bruxelles, School of Public Health, Research Center Health Policy and Systems - International Health, Route de Lennik 808, Brussels 1070, Belgium.
| | - Alain Levêque
- Université libre de Bruxelles, School of Public Health, Research Center Health Policy and Systems - International Health, Route de Lennik 808, Brussels 1070, Belgium; Centre d'Epidémiologie Périnatale (CEpiP), Route de Lennik 808, Brussels 1070, Belgium; Université libre de Bruxelles, School of Public Health, Research Center Epidemiology, Biostatistic and Clinical Research, Route de Lennik 808, Brussels 1070, Belgium.
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Feasibility and effectiveness of a population-based newborn hearing screening in an economically deprived region of Italy. Int J Pediatr Otorhinolaryngol 2013; 77:329-33. [PMID: 23357779 DOI: 10.1016/j.ijporl.2012.09.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 09/13/2012] [Accepted: 09/14/2012] [Indexed: 11/21/2022]
Abstract
AIM To describe the effectiveness of a population-based newborn hearing screening program in an economically deprived region of southern Italy. METHODS A screening protocol was proposed for all newborns of the Campania region, starting on January, 2007. For infants identified with hearing loss, information on degree and type of hearing loss and presence of risk factors was collected. RESULTS The infants born in the 3-year study period were 182,188. Among them, 146,026 (80%) were tested with OAE. Sensorineural hearing loss ≥40dBnHL was established for 159 infants (1.1×1000). Among the NICU and WIN infants, the rate of hearing loss was respectively 9×1000 and 0.67×1000. Follow-up information was available for 111 children (70%), as 48 (30%) got care in other regions or health facilities. Most infants were fitted hearing aids by 1 month after diagnosis and 15 children (13.5%) received a cochlear implant at a mean age of 25 months (SD 10). CONCLUSIONS Even in a setting of population poverty, a universal newborn screening program can deliver satisfactory outcomes. The coverage and the tracking system of the program need to be improved, as well as the cooperation between public and private health services.
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van der Ploeg CPB, Uilenburg NN, Kauffman-de Boer MA, Oudesluys-Murphy AM, Verkerk PH. Newborn hearing screening in youth health care in the Netherlands: National results of implementation and follow-up. Int J Audiol 2012; 51:584-90. [DOI: 10.3109/14992027.2012.684402] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Schade G. Early detection of hearing loss. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2010; 7:Doc05. [PMID: 22073092 PMCID: PMC3199831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The universal newborn hearing screening (UNHS) is currently spreading in Germany, as well, even though there can be no talk of a comprehensive establishment. The introduction of UNHS in several federal states such as Hamburg, Hessen, and Schleswig-Holstein can be ascribed to the personal commitment of individual pediatric audiologists. Apart from the procurement of the screening equipment and the training of the staff responsible for the examination of the newborns, the tracking, i.e. the follow-up on children with conspicuous test results, is of utmost importance. This involves significant administration effort and work and is subject to data protection laws that can differ substantially between the various federal states. Among audiologists, there is consensus that within the first three months of a child's life, a hearing loss must be diagnosed and that between the age of 3 and 6 months, the supply of a hearing aid must have been initiated. For this purpose, screening steps 1 (usually a TEOAE measurement) and 2 (AABR testing) need to be conducted in the maternity hospital. The follow-up of step 1 then comprises the repetition of the TEOAE- and AABR measurement for conspicuous children by a specialized physician. The follow-up of step 2 comprises the confirmatory diagnostics in a pediatric audiological center. This always implies BERA diagnostics during spontaneous sleep or under sedation. The subsequent early supply of a hearing aid should generally be conducted by a (pediatric) acoustician specialized on children.
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Affiliation(s)
- Götz Schade
- Univ. HNO-Klinik Bonn, Deutschland,*To whom correspondence should be addressed: Götz Schade, Univ. HNO-Klinik Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Deutschland, Tel.: +49(0)228 28715563, E-mail:
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Mezzano P, Serra G, Calevo MG. Cost analysis of an Italian neonatal hearing screening programme. J Matern Fetal Neonatal Med 2009; 22:806-11. [DOI: 10.3109/14767050902994465] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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