Interdisciplinary approach to design, performance, and quality management in a multicenter newborn hearing screening project

Abstract

Previously presented results of the newborn hearing screening in Hamburg and the perspectives are subsequently discussed. Minimum standards referring a participation of 95% of the neonates and a fail rate of less than 4% hearing-impaired children at the primary screening are fulfilled in Hamburg. Systematic screening of newborn hearing by an interdisciplinary approach provides early identification and intervention for children with permanent unilateral and bilateral hearing loss. But a newborn hearing screening on a voluntary basis alone cannot be maintained in the long run. Further, an anonymous data collection is not sufficient in regard to an uninterrupted tracking of conspicuous and unscreened neonates. A lost-to-follow-up rate of 31.3% at primary screening in Hamburg is much too high and emphasizes the need for a public health approach to a population-based newborn hearing screening with an elaborate and name-based tracking system. The legislation and implementation of a nationwide newborn hearing screening program in Germany and the association of German newborn hearing screening centers are highlighting long efforts of hearing professionals. But the implementation of a newborn hearing screening only makes sense if there exists an efficient tracking system. Sad to say, we are still a long way from the implementation of such a tracking system.

Universal newborn hearing screening, a revolutionary diagnosis of deafness: real benefits and limitations

“…The combination of TEOAE's and a-ABR in a two-stage screening program (a-ABR offered to newborns who failed to pass the initial TEOAE screening) has been found to provide the most favorable combination of specificity, sensitivity, referral rates, and cost effectiveness [5,16,20]. This fact is also supported by four recent studies in Germany, France, and Italy [25][26][27][28].…”

“…Two-step a-ABR screening is related with an initial referral rate of 0.6-2.03% (adequate data from two studies is available [15,17]). The initial referral rate when a two-step TEOAE and a-ABR screening is involved varies between 1.04 and 6.5% (as reported in data from six studies [16,23,[25][26][27][28]). Combined three-staged protocols are related with an initial referral rate of 6.4-8.9% (adequate data from two studies is available [10,20].…”

“…The average initial referral rate in these studies was 3.89%. Five studies (107,560 children) had used transiently evoked otoacoustic emissions (TEOAE's) [5,[10][11][12][13], two studies (15,382 children) automated auditory brainstem response (a-ABR) [14,15], while the remaining 13 studies (564,180 children) had used both screening protocols [16][17][18][19][20][21][22][23][24][25][26][27][28]. The numbers of screened children varied from 1,421 [11] to 148,240 [17], whereas the initial referral rate varied from 0.6% [15] to 16.7% [11].…”

“…Regarding the initial referral rate, a maximum of 4% is considered to be the benchmark, set by the American Academy of Pediatrics and both German consensus papers [34][35][36][37]. One-step TEOAE screening appears to have a rate of about 5.8% (data from only one study is available [16]).…”

“…A recent cost analysis of the UNHS was made by Böttcher et al in Hessen, Germany [33]. The most cost effective protocol in Typically, the UNHS programs use a two-stage approach: TEOAE'S repeated twice, TEOAE's followed by a-ABR or automated a-ABR repeated twice [5,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Children who fail in-hospital screening test are usually referred for repeat testing between 2 and 8 weeks after discharge (second stage).…”