Comparison of Newborn Hearing Screening in Well-Baby Nursery and NICU: A Study Applied to Reduce Referral Rate in NICU

Abstract

ObjectivesTo determine whether newborn hearing screening in a well-baby nursery (WBN) and neonatal intensive care unit (NICU) nursery: 1) meet three targeted, screening, referral, and diagnostic follow-up rates; 2) compare the average age of diagnosis for infants admitted to the WIN and NICU; and 3) determine prevalence of hearing loss in neonatal population; and 4) try to find a practical newborn hearing screening time algorithm to reduce refer rate in NICUMaterials and MethodsIt examined 15,624 newborns in the WBN (13,676) and NICU (1948) screened for congenital HL using AABR. The variables analyzed in it were the screening rate, referral rate, follow-up rate, diagnostic rate and diagnostic age, prevalence rate, degrees of congenital bilateral HL. The study was approved by the hospital’s institutional review board (13MMHISO23).ResultsThe screening rates were 99.8% and 99.6% in the WBN and NICU groups, respectively, without significant difference. The referral rates were 0.7% and 2.8% in the WBN and NICU groups, with significant difference. Furthermore, the diagnostic follow-up rates were 76.7% and 89.1% in the WBN and NICU groups, without significant difference. The average initial diagnostic ages were 1.9 months and 3.8 months in the WBN and NICU groups, with significant difference. The prevalence of congenital bilateral hearing loss were 0.27% and 1.6% in the WBN and NICU groups, with significant difference.ConclusionThe screening, referral and follow-up rate in the WBN and NICU groups were equivalent to the quality indicators. For NICU group, screening and diagnostic follow up were performed later than those in WBN group; however the lower referral rate in our NICU group was successfully achieved in this study and can be applied clinically. The prevalence of congenital bilateral hearing loss was higher in the NICU group than in the WBN group.

Outcomes of Automated Auditory Evoked Potential Performed in Different Settings and the Factors Associated with Referred Cases

“…This study showed the average age of diagnosis to be 2.7 months, in agreement recent study by Li et al, 18 whose mean was similar to that of neonates coming from the neonatal ICU and the nursery.…”

“…The early diagnosis aims to reduce the consequences that hearing loss can bring, and the more reliable the result is, the more effective the hearing screening program becomes. 17 18 …”

“…Thus, it is emphasized that the retest should be done with automated BAEP in an attempt to reduce the number of cases referred for diagnosis. 18 19 …”

Comparison of newborn hearing screening results between well babies and neonates admitted to the neonatal intensive care unit for more than 5 days: Analysis based on the national database in Korea for 9 years

“…There have been studies comparing NICU and healthy neonates in several countries and reporting associated risk factors. But few studies have been conducted in a large population with national database as this study, and a total of 524,371 newborns (WBG with 506,634 newborn and HRG who were admitted in NICU more than 5 days with 17,737 newborns) was enrolled [9,[13][14][15]. The purpose of this study was to compare NHS results between healthy newborns and infants who were admitted to the NICU for more than 5 days, to analyze the associated factors necessary to manage the national NHS program and to establish effective policy to support hearing impaired children.…”

“…From 2010 and on, the nationwide coupon-mediated NHS program collected data from enrolled newborns and identified details whether they were admitted to NICU for more than 5 days, which is one of the high-risk factors for HL according to JCIH 2007. The referral rate is mentioned to be much higher in NICU neonates (2.8-9.2%) [6][7][8][9], and the incidence of congenital HL is reported to be 2 to 4/100 in NICU neonates which is much higher than 1.8 to 3/1000 in well-babies [10][11][12]. Accordingly, it is necessary to track and manage NHS in NICU neonates.…”