Progress Towards Universal Neonatal Hearing Screening: A World Review

Status of Newborn Hearing Screening Program in the State of Tamil Nadu, India

Newborn hearing screening in India is gaining momentum and more programs are getting established every year. We need to know their performance levels, strengths and weaknesses to provide suggestions for building effective future programs. The study aimed to report the status of Newborn Hearing Screening (NHS) program in the state of Tamil Nadu, India. A questionnaire on "Newborn Hearing Screening Survey" was developed and sent to 80 sites with NHS facility all over Tamil Nadu, India. The information collected was subjected to descriptive statistical analyses. On a 95% return rate, private sector contribution towards NHS program are the highest and most of the private hospitals have outsourced the NHS program. In most of the sites, audiologists are incharge of the NHS program and carried out the NHS testing. The majority of sites (67.1%) follow selective screening such as high risk factors, doctor's referral and admission at NICU. The preferred testing was TEOAE in the screening program. NHS protocol was found to be variable at each site and for each patient. The time between second screening and diagnostic testing went up to 3-6 months. However, there is a lack of organized system for documenting the program outcome. The result of this study calls the need for wider implementation of UNHS and to introduce a centralised state or local reporting system for documenting and tracking the infants with hearing impairment.

Limitations and drawbacks of the hospital-based universal neonatal hearing screening program: First report from the Arabian Peninsula and insights

OBJECTIVES

To assess the efficacy of the current universal neonatal hearing screening program in a tertiary medical institution in Oman, identify its limitations and drawbacks, and explore their causative factors.

METHODS

A retrospective review was carried out to analyse the hearing screening of 12,743 live babies born between January 2016 and December 2018. Screen coverage, drop outs, follow up rate, and age at completion of screening, diagnosis, and intervention were analysed. The results were compared with the Joint Committee on Infant Hearing (JCIH) performance quality indices. Prospective questionnaire-based telephonic interviews were then conducted with the parents or caregivers of neonates with hearing loss. Finally, the causes of loss to follow up or delays in hearing screenings, diagnosis, and/or early intervention were studied.

RESULTS

The true prevalence of hearing loss was 4.0 in 1000. The coverage of first-stage screening was 90% whereas the compliance with the second stage was 88.04%. 22.8% of the patients eventually obtained final diagnostic confirmation. The overall compliance with amplification was 30.2%. The completion ages of primary screening and final confirmation were 7.98 and 17.3 weeks respectively. The importance of hearing screening is well received by parents, but problems related to communication, delays in the appointment system, and inefficient follow up tracking were identified as the main limitations and drawbacks of the program.

CONCLUSION

The coverage of the neonatal hearing screening program had not yet reached the required goal of 95%. The performance indicators also fell below the international benchmark. There is a need to address the identified causative factors. Effective communication and well-maintained tracking systems need to be implemented.

Why parents refuse newborn hearing screening and default on follow-up rescreening--a South African perspective

OBJECTIVES

This study describes screen refusal and follow-up default characteristics together with caregiver reasons for screen refusal and follow-up default in two South African universal newborn hearing screening programs.

METHODS

A retrospective record review of universal newborn hearing screening conducted at two hospitals (Hospital A n = 954 infants; Hospital B n = 2135) over a 31-33 month period. Otoacoustic emission screening was conducted with rescreen recommended within six weeks for a uni- or bilateral refer. Program efficacy was described according to coverage, referral and follow-up rates. A prospective telephonic interview with caregivers who declined the initial screen (n = 25) and who defaulted on follow-up (n = 25) constituted the next study component. Caregivers were randomly selected from the screening programs for a survey related to reasons for newborn hearing screening refusal and follow-up default.

RESULTS

Screening coverage (89.3% Hospital A; 57.4% Hospital B), initial referral rates (11.6% Hospital A; 21.2% Hospital B) and follow-up return rates (56.1% Hospital A; 35.8% Hospital B) differed significantly between hospitals and were below benchmarks. The most frequent reasons for screen refusal were related to costs (72%), caregiver knowledge of newborn hearing screening (64%) and health care professional knowledge and team collaboration (16%). Almost all caregivers (96%) indicated that if costs had been included in the birthing package or covered by medical insurance they would have agreed to newborn hearing screening. Reasons for follow-up default were most commonly related to caregiver knowledge of newborn hearing screening (32%) and costs (28%). One in four caregivers (24%) defaulted on follow-up because they forgot to bring their infant for a rescreen. Only half of caregivers (48%) who defaulted on follow-up reported being aware of initial screen results while 60% reported being aware of the recommended follow-up rescreen.

CONCLUSION

Caregivers most commonly refused screening due to associated costs and mostly defaulted on follow-up due to an apparent lack of knowledge regarding initial screen outcome and recommendations made for follow-up. Including NHS as a mandated birthing service is essential if coverage is to be increased, while reducing follow-up defaults requires proactive reminders and improved communication with caregivers.