 |
|
Universal Newborn Hearing Screening
Summary of Evidence
Diane C. Thompson, MS;
Heather McPhillips, MD, MPH;
Robert L. Davis, MD, MPH;
Tracy A. Lieu, MD, MPH;
Charles J. Homer, MD, MPH;
Mark Helfand, MD, MS
JAMA. 2001;286:2000-2010.
Context Each year, approximately 5000 infants are born in the United States with moderate-to-profound, bilateral permanent hearing loss (PHL). Universal newborn hearing screening (UNHS) has been proposed as a means to speed diagnosis and treatment and thereby improve language outcomes in these children.
Objectives To identify strengths, weaknesses, and gaps in the evidence supporting UNHS and to compare the additional benefits and harms of UNHS with those of selective screening of high-risk newborns.
Data Sources We searched the MEDLINE, CINAHL, and PsychINFO databases for relevant articles published from 1994 to August 2001, using terms for hearing disorders, infants or newborns, screening, and relevant treatments. We contacted experts and reviewed reference lists to identify additional articles, including those published before 1994.
Study Selection We included controlled and observational studies of (1) the accuracy, yield, and harms of screening using otoacoustic emissions (OAEs), auditory brainstem response (ABR), or both in the general newborn population and (2) the effects of screening or early identification and treatment on language outcomes. Of an original 340 articles identified, 19 articles, including 1 controlled trial, met these inclusion criteria.
Data Extraction Data on population, test performance, outcomes, and methodological quality were extracted by 2 authors (D.C.T., H.M.) using prespecified criteria developed by the US Preventive Services Task Force. We queried authors when information needed to assess study quality was missing.
Data Synthesis Good-quality studies show that from 2041 to 2794 low-risk and 86 to 208 high-risk newborns were screened to find 1 case of moderate-to-profound PHL. The best estimate of positive predictive value was 6.7%. Six percent to 15% of infants who are missed by the screening tests are subsequently diagnosed with bilateral PHL. In a trial of UNHS vs clinical screening at age 8 months, UNHS increased the proportion of infants with moderate-to-severe hearing loss diagnosed by age 10 months (57% vs 14%) but did not reduce the rate of diagnosis after age 18 months. No good-quality controlled study has compared UNHS with selective screening of high-risk newborns. In fair- to poor-quality cohort studies, intervention before age 6 months was associated with improved language and communication skills by ages 2 to 5 years. These studies had unclear criteria for selecting subjects, and none compared an inception cohort of low-risk newborns identified by screening with those identified in usual care, making it impossible to exclude selection bias as an explanation for the results. In a mathematical model based on the literature review, we estimated that extending screening to low-risk infants would detect 1 additional case before age 10 months for every 1441 low-risk infants screened, and result in treatment before 10 months of 1 additional case for every 2401 low-risk infants screened. With UNHS, 254 newborns would be referred for audiological evaluation because of false-positive second-stage screening test results vs 48 for selective screening.
Conclusions Modern screening tests for hearing impairment can improve identification of newborns with PHL, but the efficacy of UNHS to improve long-term language outcomes remains uncertain.
Author Affiliations: University of Washington, Seattle (Ms Thompson and Drs McPhillips and Davis); Harvard Pilgrim Health Care, Boston, Mass (Dr Lieu), National Initiative for Children's Healthcare Quality, Boston, Mass (Dr Homer), Oregon Health & Science University, Portland VA Medical Center, Portland (Dr Helfand).
RELATED LETTER
Does Early Identification of Deaf Newborns Lead to Later Improvements in Language Skills?
Robert E. Pickard, Diane C. Thompson, Mark Helfand, Robert L. Davis, Heather McPhillips, Tracy A. Lieu, and Charles J. Homer
JAMA. 2002;287(5):587-588.
EXTRACT
| FULL TEXT
RELATED ARTICLE
October 24/31, 2001
JAMA. 2001;286(16):2033-2034.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Universal Newborn Hearing Screening: Systematic Review to Update the 2001 US Preventive Services Task Force Recommendation
Nelson et al.
Pediatrics 2008;122:e266-e276.
ABSTRACT
| FULL TEXT
Etiologic and Audiologic Evaluations After Universal Neonatal Hearing Screening: Analysis of 170 Referred Neonates
Declau et al.
Pediatrics 2008;121:1119-1126.
ABSTRACT
| FULL TEXT
Cochlear Implants for Children with Severe-to-Profound Hearing Loss
Papsin and Gordon
NEJM 2007;357:2380-2387.
FULL TEXT
Children With Hearing Loss and Increased Risk of Injury
Mann et al.
Ann Fam Med 2007;5:528-533.
ABSTRACT
| FULL TEXT
Health Status and Health-Related Quality of Life Preference-Based Outcomes of Children Who Are Aged 7 to 9 Years and Have Bilateral Permanent Childhood Hearing Impairment
Petrou et al.
Pediatrics 2007;120:1044-1052.
ABSTRACT
| FULL TEXT
Language Ability in Children With Permanent Hearing Impairment: The Influence of Early Management and Family Participation
Watkin et al.
Pediatrics 2007;120:e694-e701.
ABSTRACT
| FULL TEXT
The clinical expert: An empiric oddity
Glick
Journal of the American Dental Association 2007;138:432-434.
FULL TEXT
Universal Newborn Hearing Screening and Early Identification of Deafness: Parents' Responses to Knowing Early and Their Expectations of Child Communication Development
Young and Tattersall
J Deaf Stud Deaf Educ 2007;12:209-220.
ABSTRACT
| FULL TEXT
A Case Study of an Emerging Community-Based Early Hearing Detection and Intervention Program: Part II. Team Building With Otolaryngologists and Pediatricians Using a Survey Approach.
Danhauer et al.
AJA 2006;15:33-45.
ABSTRACT
| FULL TEXT
Hearing screening in the neonatal intensive care unit: follow-up of referrals.
Lieu et al.
AJA 2006;15:66-74.
ABSTRACT
| FULL TEXT
Language Ability after Early Detection of Permanent Childhood Hearing Impairment
Kennedy et al.
NEJM 2006;354:2131-2141.
ABSTRACT
| FULL TEXT
Effectiveness of Population-Based Newborn Hearing Screening in England: Ages of Interventions and Profile of Cases
Uus and Bamford
Pediatrics 2006;117:e887-e893.
ABSTRACT
| FULL TEXT
Infant Hearing Screening: Stakeholder Recommendations for Parent-Centered Communication
Arnold et al.
Pediatrics 2006;117:S341-S354.
ABSTRACT
| FULL TEXT
A Multicenter Evaluation of How Many Infants With Permanent Hearing Loss Pass a Two-Stage Otoacoustic Emissions/Automated Auditory Brainstem Response Newborn Hearing Screening Protocol
Johnson et al.
Pediatrics 2005;116:663-672.
ABSTRACT
| FULL TEXT
Hearing impairment: a population study of age at diagnosis, severity, and language outcomes at 7-8 years
Wake et al.
Arch. Dis. Child. 2005;90:238-244.
ABSTRACT
| FULL TEXT
Making Policy When The Evidence Is In Dispute
Atkins et al.
Health Aff (Millwood) 2005;24:102-113.
ABSTRACT
| FULL TEXT
Rating the strength of scientific evidence: relevance for quality improvement programs
Lohr
Int J Qual Health Care 2004;16:9-18.
ABSTRACT
| FULL TEXT
Screening of newborns for hearing impairment: Statement from the US Preventive Services Task Force
Woolf
BMJ 2003;327:E76-76.
FULL TEXT
Epidemiology of Early Hearing Loss Detection in Hawaii
Prince et al.
Pediatrics 2003;111:1202-1206.
ABSTRACT
| FULL TEXT
Parental Decision Making and the Choice of Communication Modality for the Child Who Is Deaf
Li et al.
Arch Pediatr Adolesc Med 2003;157:162-168.
ABSTRACT
| FULL TEXT
Six month impact of false positives in an Australian infant hearing screening programme
Poulakis et al.
Arch. Dis. Child. 2003;88:20-24.
ABSTRACT
| FULL TEXT
Projected Cost-Effectiveness of Statewide Universal Newborn Hearing Screening
Keren et al.
Pediatrics 2002;110:855-864.
ABSTRACT
| FULL TEXT
Hearing Screening
Sokol and Hyde
Pediatr. Rev. 2002;23:155-162.
FULL TEXT
Does Early Identification of Deaf Newborns Lead to Later Improvements in Language Skills?
Pickard et al.
JAMA 2002;287:587-588.
FULL TEXT
Scientific Assessment of the Utility of Universal Newborn Hearing Screening
Choi and Schoem
AAP Grand Rounds 2002;7:5-6.
FULL TEXT
Universal Newborn Hearing Screening: What Is the Evidence?
JWatch General 2001;2001:2-2.
FULL TEXT
|
