The Effect of Mode of Delivery on Newborn Hearing Screening Results

Effects of Natural Delivery and Cesarean Section on the Result of First Hearing Screening of Newborns

BACKGROUND

Early detection and intervention of hearing issues in newborns are crucial for their auditory and speech development, necessitating newborn hearing screenings. This study aimed to investigate the impact of delivery methods, specifically natural delivery and cesarean section, on newborn hearing screening outcomes.

METHODS AND MATERIAL

A retrospective analysis was conducted on data from 600 newborns delivered at The First Affiliated Hospital of Shaoyang University between January 2020 and January 2023. The initial hearing screenings used the AccuScreen otoacoustic emission instrument. The study examined the influence of delivery method on the pass rates of newborns' first hearing screenings within and beyond 48 h postbirth.

RESULTS

The pass rates for the initial hearing screenings, conducted within and after 48 h of birth, were significantly higher in the natural delivery group compared to the cesarean section group (P < 0.05). Furthermore, multivariate analysis identified the delivery method as a significant factor influencing the pass rates of newborns' first hearing screenings.

CONCLUSIONS

The mode of delivery appears to affect the results of the initial hearing screenings of newborns, though further research is needed to validate these findings.

Parental Consanguinity and Risk for Childhood Hearing Loss: A Retrospective Cohort Study

INTRODUCTION

Genetic causes are responsible for half of the cases of hearing loss, most of them being the result of non-syndromic genetic changes resulting from autosomal recessive inheritance. Parental consanguinity might be an indicator to consider in the diagnosis of these cases. The aim of this study was to assess its importance as a risk factor for childhood hearing loss.

MATERIAL AND METHODS

A retrospective cohort study conducted in a district hospital, between 2014 and 2018. We included all live births born during this period and excluded those with risk factors for childhood hearing loss other than parental consanguinity and those without hearing screening. We formed two study groups: newborns with parental consanguinity and newborns without risk factors. All the participants underwent hearing screening with the primary outcome of this study being the result of the screening. Those with a not normal result or with parental consanguinity also underwent diagnostic audiological evaluation.

RESULTS

Among 8513 live births, we studied 96 newborns with first-degree parental consanguinity and 96 newborns without risk factors. We found a statistically significant difference (p = 0.007) between the groups, with a 'refer' screening result rate of 24% in the group with parental consanguinity and 9.4% in the group without risk factors. We diagnosed one case of sensorineural hearing loss and another of mixed hearing loss in the first group and none of these cases in the second.

CONCLUSION

Parental consanguinity was associated with a higher risk of a refer screening result in newborns, which suggests the need to consider this as a risk factor for childhood hearing loss.

Analysis of the Referral Rates of Newborn Hearing Screening Test According to Childbirth Delivery Methods in Neonatal Care Units

It is known that neonates born by cesarean delivery (CD) may have higher referral rates than those born by vaginal delivery (VD) for newborn hearing screening (NHS). False-positive NHS results can increase costs and parental anxiety. This study analyzed the differences in NHS referral rates according to delivery methods in Level I, II, and III neonatal care units. A retrospective chart review was done for 2322 infants (4644 ears) with delivery records who underwent NHS between 2004 and 2017. The first NHS was performed immediately before discharge when the infant was in good condition via the automated auditory brainstem response (AABR) or automated otoacoustic emissions (AOAE). There were 98 neonates (196 ears) who underwent both AABR and AOAE simultaneously as the first NHS, 30 of which failed. We used a total of 4810 ears in this analysis. Of all enrolled ears, 2075 ears were of neonates born by CD, and 2735 ears were of neonates born by VD. A total of 2460 ears were from patients in Level III neonatal intensive care units (NICU) and 2350 ears were from Level I and II neonatal care units. The overall referral rate was higher in infants born via CD (4.5%) than VD (3.2%). In Level I and II neonatal intensive care units, the referral rate was significantly higher in those born via CD (3.0%) than via VD (1.4%). Further, based on the screening method, AABR (75.8%) was more frequently used than AOAE (24.2%), thereby revealing AABR’s higher referral rate in CD (2.9%) than in VD (1.2%). The referral rate of infants who underwent the NHS within three days of birth was higher in the CD group (3.0%) than in the VD group (1.3%). There was no significant difference in the referral rate depending on the delivery method when infants were hospitalized for more than four days or hospitalized in the NICU. The referral rate according to the delivery methods was significantly higher when the NHS test was performed for healthy newborns in the Level I and II neonatal care units born by CD within 72 h using AABR. Therefore, we recommend that the hearing screening test for newborns delivered by cesarean section be performed after 72 h of age. The results of this study may reduce the false-positive NHS results, unnecessary further tests, and parental anxiety.

The effects of mode of delivery, maternal age, birth weight, gender and family history on screening hearing results: A cross sectional study

Introduction

Congenital hearing impairment is one of the principal issues that make distress to families especially those with a family history of hearing problems. Early detection of hearing impairment can make a difference regarding cognitive, attention, learning, speech, and social and emotional development of babies. Otoacoustic test emission is a very common screening test that can be used to pick up early cases and relieve family stress. We tried to evaluate the factors that may disrupt our results regarding the OAE test.

Methods

A cross-sectional study included infants who were admitted to the nursery unit alone. Infants who were admitted to the NICU unit, infants with craniofacial anomalies, infants with vernix in the external auditory canal, and Infants with Stigmata associated with a syndrome known to include a sensorineural hearing loss were excluded from the study. Both transient evoked otoacoustic emissions (TEOAE) with distortion product otoacoustic emissions (DPOAE) Screening tests were performed by the same professional audiologist experienced in neonatal screening.

Results

A total of 1413 newborns (733 males and 680 females) were included in the study. Among them, 1368 babies (96.8%) passed the first OAE in both ears, while 45 babies (3.2%) didn't pass the first OAE in one or both ears.Significant correlations between the female gender and family history of congenital hearing loss with failure of the first OAE test results. Moreover, vaginal delivery (VD) infants had a 1.5-fold higher failure rates of first OAE test screening results in comparison to caesarian delivery (CD) infants.

Conclusion

Our study demonstrated higher failure rates of the first OAE in female infants, vaginal delivery infants, and infants with a family history of hearing impairment. It is recommended to postpone the first phase of hearing screening for those infants until the first scheduled vaccine appointment to achieve higher compliance attendance, and decrease family stress associated with false-negative results of the test.

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Hearing impairment is a stressful condition that disturbs family quality of life.

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Early detection of hearing impairment can make a difference in child development.

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Otoacoustic test emission is a screening test with considerable reliability.

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Early Otoacoustic test can have false negative results in specific condition.

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Postpone the first phase of hearing screening decrease the family stress.

Our newborn hearing screening results

OBJECTIVE:

The aim of the study was to evaluate the results of neonatal hearing screening in our hospital with the help of literature and to question and reveal the risk factors to gain healthy individuals and to raise awareness for all health workers and the public who are interested in this subject.

METHODS:

A total of 16,388 newborn infants were evaluated between October 2009 and January 2018. All newborns were screened with transient evoked otoacoustic emissions (TEOAEs) test. Risk factors were investigated. The test repetition and auditory brainstem response (ABR) measurements were performed on newborns who could not pass the TEOAE test and the newborns in the risky group after 15 days.

RESULTS:

A total of 116 newborns (0.7%) were suspected to have hearing loss. Twenty-seven newborns (0.16%) were found to be in intensive care unit. Twelve newborns (0.07%) had permanent hearing loss. Then, in order: 9 newborns (0.05%) had received phototherapy and 7 newborns (0.04%) were born to consanguineous marriages. In addition, 3 newborns (0.02%) had a low birth weight and 1 newborn (0.006%) had a history of fever.

CONCLUSION:

Screening tests should be performed in all newborns for early detection of hearing loss. Even though frequency of hearing loss is higher in newborns with risk factors, the treatment should be started within 6 months, the latest, and newborns should be referred for rehabilitation and training.

Perinatal factors influencing the neonatal hearing screening results

Background

Previous studies have indicated that the majority of cases with “failed” results related to transient evoked otoacoustic emissions (OAE) test have the normal hearing. The present study aimed to assess the possible relationships between perinatal factors and the false-positive OAE results.

Methods

A case-control study was carried out in an Iranian Hospital in 2020. Based on the OAE results on the first day of life, newborns were divided into 2 groups; Control group included subjects with “Pass” OAE results. Every neonate with “Fail” OAE result was referred for auditory brainstem response (ABR). Neonates with bilateral fail OAE but normal ABR results (false-positive OAE) were considered as the case group. All recorded data were analyzed to assess the possible correlations between maternal/neonatal factors and the false-positive OAE results.

Results

One hundred and eighty-one neonates entered the study. Of all included neonates, 87 (48.1%) cases showed bilateral fail OAE and 94 (51.9%) subjects passed the OAE test. Normal ABR results (false-positive OAE) were observed in all cases with bilateral fail OAE. Comparisons of variables affecting the OAE results showed that of all perinatal factors, neonate’s sex (p = 0.046) and cesarean section (p = 0.003) were the only influencing factors that increased the risk of false-positive OAE results.

Conclusion

Based on the results, the cesarean section delivery and neonate’s male sex increased the risk of false-positive results related to OAE test. Implementing other screening tests such as ABR or Automated ABR as the initial screening test could be suggested for such cases.

Effect of delivery mode on neonate auditory brainstem responses to air- and bone-conducted stimuli

OBJECTIVES

The object of this study was to examine if caesarean section delivered neonates have different middle ear function relative to neonates with vaginal delivery.

METHODS

Auditory brainstem responses (ABRs) were examined in caesarean section delivered (n = 23) and vaginally delivered (n = 29) neonates. ABRs were also evoked with air- and bone-conducted stimuli (i.e., clicks and CE-Chirps) and presented at a screening intensity level (i.e., 30 dB nHL). Wave V latencies and amplitudes were examined as a function of mode of delivery and stimuli.

RESULTS

Statistically significant longer wave V latencies evoked with air-conducted stimuli were seen in caesarean section delivered neonates (p = .042). There was no statistically significant difference in wave V latencies with bone-conducted stimuli among the two groups of neonates (p = .42). There were no significant differences in wave V amplitude between neonates with caesarean section and vaginal delivery for air-conducted (p = .42) stimuli. Wave V amplitudes were not significantly different as a function of mode of delivery with CE-Chirp stimulus (p = .41). Wave V amplitudes were significantly larger for the caesarean section delivered neonates with the bone-conducted click stimulus (p = .036).

CONCLUSIONS

The ABR wave V latency disparity with air- and bone-conducted stimuli support the notion that differences in middle ear function exist between the two groups of newborns. It was speculated that delayed fluid resorption in the middle ear exists in neonates with caesarean section delivery compared to those with vaginal delivery.

The Effect of Anesthesia Type During Delivery on Neonatal Otoacoustic Emission Hearing Test Results: A Tertiary Center Experience

BACKGROUND

Hearing is essential for the healthy development of an infant as language is one of the main stimulants of intellectual capacity. We investigate the effect of anesthesia type during delivery on neonatal otoacoustic emission (OAE) hearing test results.

METHODS

This retrospective cross-sectional study includes 1,493 healthy, full-term (39/0-40/6 gestational weeks) newborns of healthy women and who were delivered by cesarean section. Newborns were divided into 2 groups based on their anesthesia type during delivery: 1) general anesthesia group (n=160), and 2) spinal anesthesia group (n=1333). Maternal age, anesthesia type, birth weight, gestational age at birth, neonatal gender, 1^st-5^th minute APGAR scores, and OAE results were compared between the groups.

RESULTS

1287 (86.2%) newborns were reported to have passed the first step of OAE; 206 (13.8%) newborns were reported to have failed the first step and passed the second test. In the general anesthesia group, 133 (83.1%) of the newborns passed the first OAE test and 27 (16.9%) newborns had false-positive results. In the spinal anesthesia group, 1,154 (86.6%) of the newborns passed the first OAE test and 179 (13.4%) newborns had false-positive results. The difference between the 2 groups by false-positive values was found to be statistically significant (p<0.001).

CONCLUSIONS

Type of delivery anesthesia may have an effect on the false-positive rates of OAE test results.

Risk factors for non-participation in the Danish universal newborn hearing screening program: A population-based cohort study

OBJECTIVE

To explore risk factors for non-participation for the Danish universal newborn hearing screening program, including socioeconomic demographic and peripartum conditions. Furthermore, the participation rate between children with medical risk factors for congenital hearing loss and healthy newborns was analyzed.

METHODS

The study was register-based and included all live births in Denmark between January 1st, 2008 and December 31st, 2011, in total 251,081 children. Potential risk factors were extracted from eight Danish national registers and analyzed via logistic regression models.

RESULTS

With respect to the participation rate, the strongest predictors of non-participation were increased maternal parity (from OR: 0.85; 95% CI: 0.82-0.89; p<0.0001 to OR: 0.43; 95% CI: 0.38-0.47; P<0.0001), low socio-economic status, including income, (from OR: 1.16; 95% CI: 1.09-1.23; p<0.0001 to OR: 1.46; 95% CI: 1.37-1.56; p<0.0001) and home birth (OR: 0.58; 95% CI: 0.42-0.80; p=0.001). Children with a medical risk factor for congenital hearing loss had a 1.97% lower participation rate. Assisted ventilation and admission to a newborn intensive care unit for > 48 hours were identified as independent risk factors of non-participation for this group (OR: 0.65; 95% CI: 0.52-0.80; p<0.0001 and OR: 0.92; 95% CI: 0.85-0.99; p=0.036, respectively).

CONCLUSION

In order to improve the participation rate, a national screening database in conjunction with a stronger collaboration between screening units and other health care professionals who are in contact with the family during the newborn period is warranted.

Comparison of hearing screening results of Syrian refugees and Turkish newborns

OBJECTIVE

To analyze Turkish (Host) and Syrian (Refugee) newborn hearing screening results and factors of risk.

METHODS

All newborns between 02.12.2017 and 31.06.2019 were screened with Automated Auditory Brainstem Response (AABR) test. A total of 874 newborns were examined (172 refugee and 702 host newborns). All screened patients were questioned in terms of consanguineous marriage, speech disorder in family, delivery method (normal vaginal birth/caesarean birth), birth weight, birth week, newborn intensive care unit (ICU) necessity, newborn icterus and phototherapy.

RESULT

As for the host newborns, 360 (51.3%) passed ABR screening, 161 (23%) failed in either one ear, and 181 (25.8%) failed both ears. As for the refugee newborns, 60 (34.9%) passed ABR screening, 38 (22.1%) failed in either one ear, and 74 (43.0%) failed both ears. There was a significant statistical difference between host and refugee newborns' ears in terms of hearing loss detected in the screening test (p = 0.017). In terms of delivery method, the caesarean rate was higher in refugees, and a statistically significant difference existed between two groups (p = 0.023). There was a significant difference between refugee newborns and host newborns in terms of newborn ICU necessity rate (p = 0.014).

CONCLUSIONS

It was demonstrated clearly that hearing screening test results between the two groups were affected by low socio-economic level when host and refugees newborns were compared. In line with the findings of this study, it should be taken into account that bad living conditions depending on war and immigration throughout pregnancy, delivery method, and the need for newborn ICU in the newborn period may affect hearing results in newborns significantly.

Effects of vaginal birth versus caesarean section on hearing screening results in a large series from the Aegean region

Objective: To evaluate the effects of caesarian section (CS) versus vaginal birth (VB) delivery techniques on results from neonatal hearing screening tests (NHSTs).Design: Retrospective analysis.Study sample: A total of 10,767 neonates divided into two groups according to delivery technique underwent NHSTs. Those who failed TEOAE or AABR were sent for diagnostic ABR examination.Results: A total of 5620 of 6044 (92.9%) of the neonates in the CS group passed the TEOAE test bilaterally and 424 (7.1%) failed either unilaterally or bilaterally. In the VB group, 4496 of 4723 (95.1%) neonates passed the TEOAE test bilaterally, while the remaining 227 (4.9%) failed the test either unilaterally or bilaterally. Bilateral passing rate of TEOAE test results was significantly higher in the VB group than the CS group (p < 0.05). The AABR failure rate (unilaterally or bilaterally) was 1% in the CS group, which was significantly higher than that in the VB group (0.6%). Diagnostic ABR bilateral pass rate was not statistically different between the groups.Conclusions: Delivery method was shown to affect the results of NHSTs. We found that the rates of failing the TEOAE and screening AABR examinations were higher among neonates born by CS compared to VB.