Outcomes of Universal Newborn Screening Programs: Systematic Review

Parental Evaluation of a Responsive Parenting Program for Infants with Hearing Loss

BACKGROUND

Parental satisfaction is an important factor in the evaluation of early intervention programs but is rarely investigated. The Muenster Parental Program (MPP) is a short, evidence-based early intervention program that focuses on parental responsiveness. It is a family-centered intervention for parents of infants aged 3-18 months who have recently been diagnosed with hearing loss and fitted with hearing devices, including prior to or following cochlear implant surgery.

OBJECTIVE

We aim to receive feedback from parents regarding the process and outcomes of their participation in the MPP.

METHOD

Following their participation, all participants of the MPP were asked to complete an evaluation questionnaire. This article reports feedback from the first 52 participants (44 mothers, 7 fathers, and 1 godmother). Their infants (N = 45) had moderate to complete hearing loss, they were aged 2-20 months, and 40% of them had an additional disease, disorder, and/or developmental delay.

RESULTS

Parents reported high levels of satisfaction with the content, didactics, setting, and individual benefits of the intervention, and a high recommendation rate (92%). The aspects most appreciated were meeting other affected parents and the concrete individual support of parent-child communication, including video feedback. Almost all parents (96%) reported a change in their communication style with their child. This confirms the results of a previous controlled intervention study on the enhancement of parental responsiveness via the MPP.

CONCLUSIONS

This evaluation of the MPP from a parental point of view has revealed equally high satisfaction with the content, setting, and didactics amongst all parents regardless of any potentially influential parent or child variables. The MPP is well suited to a wide range of close caregivers' needs despite the known diversity of children with hearing loss and their parents or families.

Development and Beta Validation of an mHealth-Based Hearing Screener (SRESHT) for Young Children in Resource-Limited Countries: Pilot Validation Study

BACKGROUND

The prevalence of hearing loss in infants in India varies between 4 and 5 per 1000. Objective-based otoacoustic emissions and auditory brainstem response have been used in high-income countries for establishing early hearing screening and intervention programs. Nevertheless, the use of objective screening tests in low- and middle-income countries (LMICs) such as India is not feasible. Mobile health (mHealth) solutions have been demonstrated to be a viable option for hearing screening in LMICs.

OBJECTIVE

This study aims to develop and beta-validate an affordable hearing screener for children younger than 6 years of age to identify moderately severe or higher degrees of hearing loss.

METHODS

In phase 1, a mHealth-based hearing screener (SRESHT) was developed using a single board computer with wireless commercial headphones and speakers as transducers, which were calibrated according to the standard procedure. Three subjective hearing screening modules were conceptualized and developed for different age groups: (1) behavioral observation audiometry-screening for infants aged from 0 to 1 year; (2) speech spectrum awareness task-screening for children 1 to 3 years old; and (3) speech recognition task-screening for children 3 to 6 years old. Different auditory stimuli for the screening modules were generated and suitability was assessed: (1) noisemakers, animal sounds, and environmental sounds for infants (birth to 1 year old); (2) animal sounds and nonsense syllables for children (1 to 3 years old); and (3) eighteen picturable spondee words for children (3 to 6 years old). In phase 2, the SRESHT screener was beta-validated in children aged below 6 years to establish the agreement between SRESHT modules and the gold-standard procedure in identifying moderately severe and higher degrees of hearing loss.

RESULTS

Off-the-shelf commercial speakers and headphones were selected and calibrated. On comparison of stimuli for behavioral observation audiometry on 15 children, Noisemaker stimuli were found suitable based on the average minimum response levels. On comparison of different stimuli for speech spectrum awareness task on 15 children, animal sounds were found to be suitable. On familiarity check of 18 spondee words for speech recognition task among 20 children, 12 spondee words had the eligibility cutoff (85%) and a presentation level of 5 dB SL (re-pure tone threshold) was sufficient to achieve 80% psychometric function. In phase 2, a total of 55 children aged 0 to 6 years (31 normal hearing and 24 hearing impairment) underwent SRESHT screening for beta validation. Cohen κ indicated that the overall SRESHT screener had a very good agreement (κ=0.82) with gold-standard audiometric screening for identifying moderately severe and higher degrees of hearing loss.

CONCLUSIONS

The development and beta validation of the SRESHT screener using the selected auditory stimuli showed that the stimuli were suitable for screening children.

Parental/Caregiver Satisfaction and Anxiety with Newborn Hearing Screening Program in Dakshina Karnataka, India - A Questionnaire Based Study

Aims

The present study aimed to assess parental/caregiver satisfaction with a Neonatal Hearing screening program and determine the levels of parental/caregiver stress and anxiety at the time of hearing screening/ rescreening.

Materials & Methods

A cross-sectional study design was adapted to collect data for the current study. The study was conducted in two phases, where phase one included the development of the questionnaire and its validation, and phase two included data collection and statistical analysis.

Results

The questionnaires on parental anxiety and satisfaction with the NHS were administered to 119 participants. These included 65 parents (53.8% mothers and 0.8% fathers) and 54 caregivers (45.3%). 85% of the participants were satisfied by the overall NHS program. More than 80% of participants were satisfied with the information and instructions provided and found it adequate and clear. 60% of participants disagreed that they were tensed. Participants expressed that they would have wanted a chance to ask for more details about the test procedures (85.7%) and results (81.5%).

Conclusion

The present study provides valuable information related to maternal/caregiver anxiety and satisfaction related to NHS. There is a need for developing better evidence-based materials and training resources in multiple languages for better dissemination of information and enable timely follow-up.

The Effectiveness and Cost Analysis of a Pilot Newborn Hearing Screening Program at a Hospital in a Low- to Middle-Income Country

Background

When a universal newborn hearing screening program is not feasible, particularly in the early stages of its establishment when it requires a great deal of effort and resources, a smaller scale in screening, such as a specific geographical subset or targeted group, is suggested rather than doing nothing. This study aims to pilot a newborn hearing screening program at a hospital in a low- to middle-income country and determine its effectiveness and costs in the context of a lack of qualified audiologists.

Methods

All high-risk births at Hatyai Hospital were recruited for newborn hearing screening between January and December 2021. Newborns who failed 2 stages of transient evoked otoacoustic emissions screening were referred for diagnostic assessment and subsequent interventions. The program's effectiveness was assessed based on the standards of the American Academy of Pediatrics. All costs related to screening, diagnostic, and intervention stages were also evaluated.

Results

Out of 883 newborns, 792 newborns were screened, resulting in a 95.1% screening coverage. The referral rate regarding the diagnostic stage was 3.9%. Also, 28.3% and 12.9% lost-to-follow-up rates were observed in the secondscreening and diagnostic assessment stages, respectively. Ten children were confirmed as having permanent hearing loss, with a prevalence of 1.3%. The total cost was US$13 611, and the cost (for the screening stage) per case screened was US$4.

Conclusion

The program was considered effective with 2 out of 3 benchmarks achieved.

Early Hearing Detection and Intervention programmes for neonates, infants and children in non-Asian low-income and middle-income countries: a systematic review

INTRODUCTION

Early Hearing Detection and Intervention (EHDI) programmes were established to reduce the impact of hearing loss on children. High-income countries (HICs) have resources and knowledge to execute these programmes. However, financial and other resource constraints limit the availability of these programmes to low-income and middle-income countries (LMICs). Yet, LMICs have explored strategies to implement EHDI programmes in their context; the outcomes are still largely unknown.The aim of this study is to identify the various models of the EHDI program implemented in non-Asian LMICs.

AIM

METHOD: Studies published between 2010 and 2023 reporting EHDI programmes in non-Asian LMICs for children were considered. The primary databases searched were PubMed, Scopus, Web of Science, EBSCOHost, EBSCO-CINAHL and ProQuest dissertations. The search results are summarised using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses chart. Quality appraisal and risk-of-bias assessment were assessed. Using the retrieved data, a narrative synthesis of the identified methods and forest plots for the prevalence estimate was created.

RESULTS

Fifty-six studies from 16 LMICs were included. They were grouped into 29 hearing screening programmes for neonates and infants and 26 programmes for older children. Predominantly hospital-based screening was employed for neonates and infants and school-based screening for older children. Two-stage otoacoustic emissions screening was employed for neonates and infants, while single-stage pure tone audiometry with otoscopy screening was used for older children. Predominantly, audiologists performed screening and diagnostics for neonates/infants while community health workers performed screening for the older children. Screening aspects were reported predominantly and not diagnostic evaluation/intervention outcomes. Overall, the economics of EHDI was reported only anecdotally in a few studies.

CONCLUSION

The screening strategies were not uniform among non-Asian LMICs. The protocols used were similar to HICs, yet few developed protocols adapting the Joint Committee of Infant Hearing. However, long-term outcomes such as rate of identification, suitable intervention and their outcomes are not known. EHDI programmes with successful outcomes of early intervention must be studied and reported with economic evaluations.

Coalition for Global Hearing Health Hearing Care Pathways Working Group: Guidelines for Clinical Guidance for Readiness and Development of Evidence-Based Early Hearing Detection and Intervention Programs

Editor's Note: The following article discusses the timely topic Clinical Guidance in the areas of Evidence-Based Early Hearing Detection and Intervention Programs. This article aims to discuss areas of services needed, guidance to countries/organizations attempting to initiate early hearing detection and intervention systems. Expert consensus and systematic/scoping reviews were combined to produce recommendations for evidence-based clinical practice. In Ear and Hearing, our long-term goal for the Point of View article is to stimulate the field's interest in and to enhance the appreciation of the author's area of expertise. Hearing is an important sense for children to develop cognitive, speech, language, and psychosocial skills. The goal of universal newborn hearing screening is to enable the detection of hearing loss in infants so that timely health and educational/therapeutic intervention can be provided as early as possible to improve outcomes. While many countries have implemented universal newborn hearing screening programs, many others are yet to start. As hearing screening is only the first step to identify children with hearing loss, many follow-up services are needed to help them thrive. However, not all of these services are universally available, even in high-income countries. The purposes of this article are (1) to discuss the areas of services needed in an integrated care system to support children with hearing loss and their families; (2) to provide guidance to countries/organizations attempting to initiate early hearing detection and intervention systems with the goal of meeting measurable benchmarks to assure quality; and (3) to help established programs expand and improve their services to support children with hearing loss to develop their full potential. Multiple databases were interrogated including PubMed, Medline (OVIDSP), Cochrane library, Google Scholar, Web of Science and One Search, ERIC, PsychInfo. Expert consensus and systematic/scoping reviews were combined to produce recommendations for evidence-based clinical practice. Eight essential areas were identified to be central to the integrated care: (1) hearing screening, (2) audiologic diagnosis and management, (3) amplification, (4) medical evaluation and management, (5) early intervention services, (6) family-to-family support, (7) D/deaf/hard of hearing leadership, and (8) data management. Checklists are provided to support the assessment of a country/organization's readiness and development in each area as well as to suggest alternative strategies for situations with limited resources. A three-tiered system (i.e., Basic, Intermediate, and Advanced) is proposed to help countries/organizations at all resource levels assess their readiness to provide the needed services and to improve their integrated care system. Future directions and policy implications are also discussed.

Mapping neonatal hearing screening services in Cape Town metro: A situational analysis

BACKGROUND

 Childhood hearing loss is a global health concern. Despite the proven benefits of neonatal hearing screening (NHS), it is not yet mandated in South Africa. The lack of awareness of hearing loss and absence of NHS leads to delayed diagnosis and adverse developmental outcomes for affected children.

AIM

 The study aimed to assess the availability of NHS services across primary healthcare (PHC) facilities in the City of Cape Town (CCT).

SETTING

 Surveys were conducted with 26 PHC facilities in the CCT metropolitan areas that offer mother and child healthcare services.

METHODS

 Surveys gathered data through online and telephone methods. The surveys aimed to assess the availability and nature of NHS services, care pathways and training of healthcare professionals regarding NHS.

RESULTS

 None of the facilities used objective screening methods to screen hearing or have standardised care pathways for at-risk babies. Instead, they relied on parental concerns, with the use of the Road to Health book. None of the respondents reported having received hearing screening training, and the majority of participants (62%) lacked confidence in their knowledge of ear and hearing care.

CONCLUSION

 The absence of NHS services highlights the need for standardised protocols and increased awareness among healthcare workers and caregivers. Implementing NHS services could facilitate earlier diagnosis and intervention of hearing loss for infants in the Western Cape.Contribution: This study's findings could guide efforts to improving access to NHS access at PHC level in Cape Town, ultimately providing early hearing screening services to infants.

Modelling the cost-effectiveness of a newborn hearing screening programme; usability and pitfalls

OBJECTIVE

The EUSCREEN project concerns the study of European vision and hearing screening programmes. Part of the project was the development of a cost-effectiveness model to analyse such programmes. We describe the development and usability of an online tool to enable stakeholders to design, analyse or modify a newborn hearing screening (NHS) programme.

DESIGN

Data from literature, from existing NHS programmes, and observations by users were used to develop and refine the tool. Required inputs include prevalence of the hearing impairment, test sequence and its timing, attendance, sensitivity, and specificity of each screening step. Outputs include the number of cases detected and the costs of screening and diagnostics.

STUDY SAMPLE

Eleven NHS programmes with reliable data.

RESULTS

Three analyses are presented, exploring the effect of low attendance, number of screening steps, testing in the maternity ward, or screening at a later age, on the benefits and costs of the programme. Knowledge of the epidemiology of a staged screening programme is crucial when using the tool.

CONCLUSIONS

This study presents a tool intended to aid stakeholders to design a new or analyse an existing hearing screening programme in terms of benefits and costs.

Factors that influence health service access in deaf and hard-of-hearing children: a narrative review

OBJECTIVES

Early diagnosis and intervention of deaf and hard-of-hearing (DHH) children leads to improved language and psychosocial outcomes. However, many child, parent and provider related factors can influence access to early intervention services, including hearing devices. This narrative review aims to explore factors that influence health service access in DHH children.

DESIGN

A systematic search was conducted to identify articles that explored factors that influenced health service access in DHH children in countries with Universal Newborn Hearing Screening, published between 2010 and 2022.

STUDY SAMPLES

Fifty-nine articles met the inclusion criteria for data extraction. This included 4 systematic reviews, 2 reviews, 39 quantitative and 5 mixed methods studies and 9 qualitative studies.

RESULTS

The identified factors were grouped into the following themes: (a) demographic factors, (b) family related factors, (c) child related factors, (d) factors specific to hearing devices, (e) service delivery, f) telehealth and (g) COVID-19.

CONCLUSION

This review provided a comprehensive summary of multiple factors that affect access to health services in DHH children. Psychosocial support, consistent clinical advice, allocation of resources to rural communities and use of telehealth are possible ways to address barriers and improve health service access.

Family-Centered Early Intervention Deaf/Hard of Hearing (FCEI-DHH): Call to Action

This Call to Action is the eighth and final article in this special issue on Family-Centered Early Intervention (FCEI) for children who are deaf or hard of hearing (DHH) and their families, or FCEI-DHH. Collectively, these articles highlight evidence-informed actions to enhance family well-being and to optimize developmental outcomes among children who are DHH. This Call to Action outlines actionable steps to advance FCEI-DHH supports provided to children who are DHH and their families. It also urges specific actions to strengthen FCEI-DHH programs/services and systems across the globe, whether newly emerging or long-established. Internationally, supports for children who are DHH are often siloed, provided within various independent sectors such as health/medicine, education, early childhood, and social and disability services. With this Call to Action, we urge invested parties from across relevant sectors to join together to implement and improve FCEI-DHH programs/services and systems, build the capacity of early intervention (EI) Providers and other professionals, extend research regarding FCEI-DHH, and fund EI supports, systems, and research, all with the aim of advancing outcomes for families and their children who are DHH.

Newborn Hearing Screening in Québec, Canada

PURPOSE

This study discusses the history and current state of the newborn hearing screening program in Québec and aims to assess general challenges associated with establishing universal newborn hearing screening (UNHS) programs.

METHOD

We reviewed the statistics of the occurrence and long-term effects of congenital hearing loss and the immediate and long-term benefits of UNHS and its limitations. The resources for this study included financial reports related to establishing UNHS in different health care systems; Canadian provincial, territorial, and federal regulations and publications; local and nationwide media; and interviews health care staff and program managers.

RESULTS

Because of its benefits and its cost-effectiveness, UNHS programs have been implemented in many health care systems around the world. Despite Canada's success in offering a wide array of health care services to its citizens, certain provinces trail behind others in developing UNHS programs. Although there have been recent improvements in the screening rate of the province of Québec, nearly half of all Québec newborns continue to not be screened for hearing loss. The reasons for the current low screening rate include delays in implementation, information-technology complications, operating costs, and lack of public awareness.

CONCLUSIONS

For UNHS to be implemented in a timely fashion, those involved in the process should first understand what challenges may arise. Québec's experience with this process may provide useful lessons for other health care systems.

[Newborn hearing screening in Germany-results of the 2011/2012 and 2017/2018 evaluations]

BACKGROUND

Newborn hearing screening (NHS) was introduced nationwide by the Federal Joint Committee (Gemeinsamer Bundesausschuss, G‑BA) in 2009. In this process, quality targets were also set in the pediatrics directive. In order to review the quality NHS in Germany, the G‑BA commissioned a consortium to conduct an initial evaluation for the years 2011 and 2012 and a follow-up evaluation for 2017 and 2018.

METHODS

The evaluations were based on NHS screening parameters (Sammelstatistiken) that must be documented by all obstetrics and neonatology departments as NHS providers and can also be compiled through cooperation with hearing screening centers (HSCs). Additional data were collected through questionnaires and interviews and routine data were used to evaluate the screening process.

RESULTS

In 13 federal states, a total of 15 HSCs are involved in the screening process. Across Germany, an NHS screening rate of 86.1% was documented in 2018 (82.4% in 2012), but this differed significantly between the federal states. The specified quality targets could not yet be implemented everywhere. For example, only less than half of the obstetric departments achieved the specified screening rate of over 95%. A comparison of data from the follow-up evaluation and the first evaluation showed that the structural quality of NHS had improved, while the process quality remained the same or had deteriorated. The refer rate (children who were discharged without passing the screening) increased from 5.3% to 6.0%.

DISCUSSION

To improve the quality of NHS, HSCs should be established nationwide and a second screening should be carried out more consistently before discharge in the case of a refer result in the initial screening.

Evaluation of the Design and Development of the HeLe Newborn Hearing Screening Tele-Audiology Systems for the Philippines

Introduction

There is increasing interest in innovation development and management in the Philippines, especially in the last decade. In the advocacy for universal hearing health, the HeLe, "Hearing for Life'' Research Program was implemented. HeLe developed novel telehealth technologies and field tested a proof-of-concept service delivery model to improve provision of newborn hearing screening and intervention services in the Philippines.

Objective

As the HeLe research period concludes, this appraisal was organized to document and assess the health information technology systems of the HeLe.

Methods

The evaluation follows the elements of the Centers for Disease Control and Prevention (CDC) guidelines for evaluation of public health surveillance systems. It centers on the status of the eHealth-based components of the HeLe NHS interventions: HeLe NHS module in the Community Health Information Tracking System (CHITS) electronic medical records system, the Tele-Audiology module in National Telehealth System (NTS), and the HeLe NHS registry. The evaluation is based on interviews of key HeLe research staff and documentation review.

Results

The HeLe system has a stable, SQL-Server-based architecture. It is a secure, web-based system with clean separation of back-end database and front-end Web, using Secure Socket Layer (SSL) technology. Standardization of data via mapping ensures reliable, comparable measures. HeLe demonstrates that NHS data collected by the HeLe NHS device can be sent to, stored in, and extracted from the CHITS electronic medical record system and exchanged across platforms. Where actual patient and NHS data were available, this HeLe system is validated to be efficacious to capture and seamlessly exchange data across various eHealth platforms. These eHealth technologies are described to be at Technology Readiness Level 5, "technologies are validated in a relevant environment". The HeLe program, however, needs to address completeness in documentation as a standard practice, if only to ensure better management of risks introduced by novel eHealth systems in patient care. The CDC public health surveillance checklist used for this assessment is useful in identifying gaps in research management for the HeLe inventors. It is recommended to be incorporated to be standard and implemented early in the next iteration of the HeLe research.

Conclusions

Overall, the HeLe technologies, in this initial stage of research, have achieved the purpose for which they were developed. As a novel technology-based NHS system, HeLe is a potentially powerful tool to assist in monitoring newborn hearing disease caseloads by community-based primary care clinics, NHS facilities, and hospitals that provide definitive medical services. As other health systems strengthening reforms take root in the Philippines, secure exchange of data electronically across the country would depend on sound technologies, including those used in hearing health. This paper can be instructive to the emerging research community in the eHealth and biomedical development space especially in resource-challenged settings. Likewise, lessons can reinforce institutional support from research agencies, clinicians, and state/ county or subnational health departments for policy and resource mobilization to better manage those identified with congenital hearing loss.

Spoken Expressive Vocabulary in 2-Year-Old Children with Hearing Loss: A Community Study

Through a cross-sectional community study of 2044 children aged 2 years, we (1) examine the impact of hearing loss on early spoken expressive vocabulary outcomes and (2) investigate how early intervention-related factors impact expressive vocabulary outcomes in children with hearing loss predominantly identified through universal newborn hearing screening. We used validated parent/caregiver-reported checklists from two longitudinal cohorts (302 children with unilateral or bilateral hearing loss, 1742 children without hearing loss) representing the same population in Victoria, Australia. The impact of hearing loss and amplification-related factors on vocabulary was estimated using g-computation and multivariable linear regression. Children with versus without hearing loss had poorer expressive vocabulary scores, with mean scores for bilateral loss 0.5 (mild loss) to 0.9 (profound loss) standard deviations lower and for unilateral loss marginally (0.1 to 0.3 standard deviations) lower. For children with hearing loss, early intervention and amplification by 3 months, rather than by 6 months or older, resulted in higher expressive vocabulary scores. Children with hearing loss demonstrated delayed spoken expressive vocabulary despite whole-state systems of early detection and intervention. Our findings align with calls to achieve a 1-2-3 month timeline for early hearing detection and intervention benchmarks for screening, identification, and intervention.

[Genetics of pediatric hearing loss]

With the rapid development of sequencing technology and bioinformatics, the genetic research and related clinical practice of pediatric hearing loss have also made significant progress. This review summarized and analyzed the genetic causes of hearing impairment in children and the research progress of related genetic diagnosis and screening, in order to provide reference for the prevention and treatment of pediatric hearing loss and related research.

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.

Technology assisted language intervention (TALI) for children who are deaf/hard of hearing: promising impact on pragmatic skills

Children who are deaf and hard of hearing (DHH) often demonstrate pragmatic language difficulties which can impact academic and social outcomes. This randomized control trial for DHH children, ages 3-12 years, explored the Technology-Assisted Language Intervention (TALI), incorporating augmentative and alternative communication technology (AAC) into traditional speech/language therapy, compared to treatment-as-usual (TAU) to determine impact on pragmatics. Pragmatic outcome measures included parent reported Pragmatics Profile of the CELF-5 (for children age ≥5 years) and CELF-P Descriptive Pragmatics Profile (for children <5 years) in addition to parent reported Social and Communication domains of the Vineland Adaptive Behavior Scales,Third Edition (VABS). Over 24 weeks, children ≥5 years in the TALI made significantly more progress (increase in raw scores) on the Pragmatics Profile compared to children in TAU (12.7 points vs. -6.0 points; p = 0.04) and also showed significant gains on two of the three subscales. For children ≥5 years, no significant VABS changes were seen in either intervention group. For children <5 years, there were no statistically significant differences in growth on the CELF-P total pragmatics raw score or on any subdomain. However, children in TALI had significant increases in the mean VABS Communication (86.7-99.1) and Social domain standard scores (91.8-97.4;p = 0.01), while gains for children in TAU on the Communication and Social domain standard scores were not statistically significant. These promising results support the need for additional research exploring the effectiveness of AAC supported speech/language therapy to enhance DHH children's pragmatic language skills.

Trial registration

ClinicalTrials.gov identifier: NCT02998164.

Effectiveness of universal newborn hearing screening: A systematic review and meta-analysis

Background

Permanent bilateral hearing loss (PBHL) is a serious condition in newborns, with a prevalence of at least one per 1000 live births. However, there has been no recent systematic review and meta-analysis of the effectiveness of universal newborn hearing screening programs (UNHS).

Methods

We registered our study protocol on PROSPERO CRD42020175451. Primary outcomes were any identification of PBHL (ie, PBHL diagnosed at any time), age of identification of PBHL, and neurodevelopment. Two reviewers searched standard databases to March 2022 and extracted data. We used fixed and random effects meta-analysis to pool data and graded the certainty of evidence using standard methods.

Results

The search retrieved 2834 records. We identified five studies reporting on the effects of UNHS vs no UNHS in 1 023 610 newborns. The relative risk of being identified with PBHL before nine months in infants with UNHS compared to infants without UNHS was 3.28 (95% confidence interval (95% CI) = 1.84, 5.85, one study, 1 023 497 newborns, low certainty evidence). The mean difference in the age of identification of PBHL in infants with UNHS compared to infants without UNHS was 13.2 months earlier (95% CI = -26.3, -0.01, two studies, 197 newborns, very low certainty evidence). The relative risk of infants eventually being identified with PBHL in infants with UNHS compared to infants without UNHS was 1.01 (95% CI = 0.89, 1.14, three studies, 1 023 497 newborns, low certainty evidence). At the latest follow-up at 3-8 years, the standardised mean difference (SMD) in receptive language development between infants with UNHS compared to infants without UNHS was 0.60 z scores (95% CI = 0.07, 1.13, one study, 101 children, low certainty evidence) and the mean difference in developmental quotients was 7.72 (95% CI = -0.03, 15.47, three studies, 334 children, very low certainty evidence). The SMD in expressive language development was 0.39 z scores (95% CI = -0.20, 0.97, one study, 87 children, low certainty evidence) and the mean difference in developmental quotients was 10.10 scores (95% CI = 1.47, 18.73, 3 studies, 334 children, very low certainty evidence).

Conclusions

UNHS programs result in earlier identification of PBHL and may improve neurodevelopment. UNHS should be implemented across high-, middle-, and low-income countries.

Registration

PROSPERO (CRD42020175451).

Association Between Expanded Genomic Sequencing Combined With Hearing Screening and Detection of Hearing Loss Among Newborns in a Neonatal Intensive Care Unit

IMPORTANCE

Hearing loss is a global social burden. Early identification of hearing loss missed by newborn hearing screening tests in the neonatal intensive care unit is crucial.

OBJECTIVE

To assess the association between expanded genomic sequencing combined with hearing screening and detection of hearing loss as well as improvement in the neonatal intensive care unit.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study was performed between August 8, 2016, and December 31, 2020, among 8078 newborns admitted to the neonatal intensive care unit of the Children's Hospital of Fudan University in Shanghai, China. Follow-up for hearing status was performed via telephone interviews between September 1 and November 30, 2021.

EXPOSURES

A hearing screening test and the expanded genomic sequencing targeting 2742 genes were administered to each patient. Those who failed the hearing screening test or had positive genetic findings were referred for diagnostic audiometry at a median of 3 months of age.

MAIN OUTCOMES AND MEASURES

The primary outcome was hearing loss missed by hearing screening test. Secondary outcomes were genetic findings and benefits associated with the expanded genomic sequencing for clinical management of patients in the neonatal intensive care unit.

RESULTS

Of 8078 patients (4666 boys [57.8%]; median age, 6.3 days [IQR, 3.0-12.0 days]), 52 of 240 (21.7%) received a diagnosis of hearing loss. Expanded genomic sequencing combined with hearing screening was associated with a 15.6% increase (7 of 45 patients) in cases of diagnosed hearing loss that were missed by hearing screening. Of the 52 patients with hearing loss, genetic factors were identified for 39 patients (75.0%); GJB2 and SLC26A4 were the most common genes identified. Patients with genetic findings experienced a more severe degree of hearing loss than those without genetic findings (21 profound, 4 severe, 7 moderate, and 7 mild vs 2 severe, 4 moderate, and 7 mild; P = .005), with more bilateral hearing loss (39 of 39 [100%] vs 9 of 13 [69.2%]; P = .003). Clinical management strategies were changed for patients who underwent genomic sequencing combined with hearing screening.

CONCLUSIONS AND RELEVANCE

This study suggests that expanded genomic sequencing combined with hearing screening may be effective at detecting hearing loss among patients in the neonatal intensive care unit.

Follow-up on children with suspected bilateral congenital hearing loss identified through universal newborn hearing screening program in Taiwan: A national-based population study

OBJECTIVE

This investigation was to ascertain the performance of the UNHS in Taiwan.

METHODS

The predefined questionnaire was delivered on the phone in 2016. The descriptive analysis was applied to the research data. 941 neonates in birth cohorts 2013-2014 who were documented as a bilateral referral in the national UNHS tracking system were targeted. The respondents were either caregivers or family members.

RESULTS

40.3% of 941 children were lost to follow-up, and 66.24% of 363 children were diagnosed with SNHL. 45.15% of 163 children used hearing amplification device(s). 77.46% of hearing amplification device users and 7.51% of non-users participated in the auditory training courses. By six months of age, 38.51% and 22.58% of children diagnosed with bilateral SNHL commenced the hearing amplification device fitting and the auditory training courses, respectively.

CONCLUSIONS

More efforts are needed to enhance the performance of the UNHS to achieve national goals stated in the 2014 Taiwan UNHS Revised Guidelines and the well-known benchmarks set by the JCIH in 2007. The development of an electronic tracking system for storing and sharing information on the follow-up on children with congenital hearing loss was as significant as the improvements in the understanding of early hearing detection and intervention of the public and stakeholders.

Prevalence of Hearing Loss in Dutch Newborns; Results of the Nationwide Well-Baby Newborn Hearing Screening Program

Background: Few studies report prevalence rates of hearing loss in newborns for nationwide populations. The Dutch well-baby newborn hearing screening covers almost all eligible children and has high participation rates for follow-up screening rounds and diagnosis. This allows calculating reliable prevalence rates of permanent neonatal hearing loss specified by severity. Methods: Results from the well-baby newborn hearing screening program and diagnostic follow-up of referred children from 2015 to 2019 were included in calculating prevalence rates. Hearing loss was classified according to the degree of severity. Results: A total of 99.7% of 833,318 children eligible for screening were included. A total of 0.3% were referred for audiological diagnostics. Permanent bilateral hearing loss of ≥40 dB was diagnosed in 23.7% of them and unilateral hearing loss in 14.4%. A prevalence rate of 1.23 per 1000 children was found, 0.46 for unilateral hearing loss and 0.76 for bilateral hearing loss. Moderate hearing loss is most common in children with bilateral hearing loss (0.47), followed by profound (0.21) and severe (0.06) hearing loss. In children with unilateral hearing loss, prevalence rates are the highest for profound hearing loss (0.21), followed by moderate (0.16) and severe (0.09) hearing loss. A total of 87.5% of the children were diagnosed within the age of 3 months. Conclusions: Because of the high quality of the Dutch well-baby hearing screening program, reported results approximate true prevalence rates of permanent hearing loss by severity.

Twelve years of neonatal hearing screening: audiological and etiological results

PURPOSE

Most developed countries have implemented some form of universal newborn hearing screening program. Early identification and rehabilitation of congenital hearing loss is important in functional outcome, and the need to identify the cause of hearing impairment has become clear. We aimed to evaluate audiological and etiological outcomes in a large group of patients with failed neonatal hearing screening.

METHODS

We performed a retrospective chart analysis of patients who were referred to our tertiary referral center after failing neonatal hearing screening during a 12-year period (2007-2019). Screening was based on automated auditory brainstem response (AABR) or a combined approach of AABR and auditory steady-state response (ASSR) with chirp stimulus. Extensive audiometric testing was performed to confirm and determine the type and degree of hearing loss. In case of permanent hearing loss, a standardized etiological protocol was followed to determine the cause.

RESULTS

Of the 802 referred newborns, hearing loss was confirmed by diagnostic ABR in 78%. Main causes of hearing loss included otitis media with effusion (56%, higher in patients screened by AABR/ASSR compared to AABR), a genetic disorder (12%), congenital cytomegalovirus infection (cCMV, 5%) and atresia/stenosis of the external ear canal (5%). Of the patients with permanent hearing loss, 15% showed changes in hearing loss severity over time.

CONCLUSION

In the majority of newborns referred after failing universal neonatal hearing screening, hearing loss could be confirmed. The leading cause was reversible hearing loss due to otitis media with effusion, but hearing loss proved permanent in about 35% of referred newborns, with genetics as predominant cause. Follow-up of congenital hearing loss patients is important as deterioration as well as improvement was observed over time.