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The newborn with hearing loss: detection in the nursery.

BACKGROUND
Early detection of hearing loss coupled with appropriate early intervention is critical to speech, language, and cognitive development. These competencies serve as the foundation for later academic skills. For these reasons, many states are undertaking aggressive efforts to screen all newborns before hospital discharge. Universal detection of hearing loss in newborns is a three-stage process composed of 1) the birth admission screen, 2) follow-up and diagnosis, and 3) intervention services. Breakdown at any stage jeopardizes the entire effort. The goals of this research are to examine the birth admission screen by reviewing outcome measurements for 54 228 Texas newborns and to evaluate factors that impact outcomes positively or negatively.


METHODOLOGY
All newborns were screened for hearing loss using a physiologic test of auditory function; either screening auditory brainstem responses or transient evoked otoacoustic emissions. Screening occurred in the newborn and intensive care nurseries, before hospital discharge in 9 sites as part of the nursery protocol. Patients. A total of 54 228 newborns were available for screening.


OUTCOME MEASURES
Four measures were evaluated and are reported: the number of births screened, the number of newborns who passed the screen before discharge, the number of infants who returned for follow-up, and the number of infants identified with hearing loss. A Birth Screening Performance Index is also calculated.


RESULTS
Results are reported for calendar years 1994, 1995, 1996, and through June 1997. A total of 54 228 newborns were available for screening; 52 508 were screened before hospital discharge during their birth admission and 50 721 passed this screen. Infants returning for follow-up screen as outpatients numbered 1224. Over this 31/2-year span, 113 infants who failed the birth admission screening had hearing loss that was sensorineural in nature. From these data, the estimated incidence of hearing loss is 3.14/1000 infants.


CONCLUSIONS
Screening in the nursery with low false-positive rates can be achieved when three elements are present: audiology involvement, hospital support, and automated data and information management. Follow-up measures need improvement. Better tracking methods may help assure that at-risk newborns are connected to services.