Minimizing False-Positives in Universal Newborn Hearing Screening: A Simple Solution

Abstract

ABSTRACT. Background and Objectives. The falsepositive rates of previously reported universal newborn hearing screening (UNHS) programs range between 2.5% and 8%. Critics of UNHS programs have claimed that this rate is too high and might lead to a number of the negative effects produced by false-positive screening tests, namely emotional trauma, disease labeling, iatrogenesis from unnecessary testing, and increased expense in terms of time and money.We previously reported, based on some preliminary data, that as many as 80% of newborns who failed the initial hearing screen subsequently passed when they were retested the following day, before being discharged from the hospital. We now present the results of this intervention for our entire UNHS program during a 7-month period.Methods. We analyzed data from 3142 non-neonatal intensive care unit infants screened with an automated auditory brainstem response at the Women's Hospital of Greensboro from November 1, 1999 to May 31, 2000. A protocol was developed wherein all infants who failed the initial UNHS were rescreened with another automated auditory brainstem response before hospital discharge. Data collected included pass/fail rates during the inpatient stay as well as follow-up data and risk factors for congenital hearing loss.Results. Confirmed hearing loss occurred in 8 nonneonatal intensive care unit infants, a rate of 2.5/1000. Eighty percent of newborns who failed the initial hearing screen passed on rescreening before hospital discharge. This produced a false-positive rate of 0.8% and a corresponding positive predictive value of 24%. If inhospital rescreening had not occurred, our false-positive rate and positive predictive value would have been 3.9% and 6.1%, respectively.Conclusions. Our simple intervention of rescreening all infants who failed their initial UNHS before hospital discharge reduced the false-positive rate of UNHS to 0.8%. We suggest that this simple, inexpensive intervention should be instituted for all similar UNHS programs. Pediatrics 2001;107(3). URL: http://www.pediatrics.org/ cgi/content/full/107/3/e29; universal newborn hearing screening, screening, false-positive, hearing, audiology, automated auditory brainstem response.

Comparison of two-step transient evoked otoacoustic emissions (TEOAE) and automated auditory brainstem response (AABR) for universal newborn hearing screening programs

“…Our results were consistent with those reported by other researchers [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26].…”

“…However, we do feel, in agreement with Clemens et al [21,37], that retesting within a short interval (i.e., hours) is effective in reducing false positives. This is logical given that ambient sound and myogenetic interference are among the most commonly implicated factors in failed screening.…”

“…In our hearing-screening protocol, we used two steps with TEOAE or two steps with AABR [18,[20][21][22]36]. However, we do feel, in agreement with Clemens et al [21,37], that retesting within a short interval (i.e., hours) is effective in reducing false positives.…”

“…The percent of infants referred for diagnosis also drops considerably with AABR; this reduces expense, anxiety for families [20][21][22]25,30,37,40,42,43] and traveling to the diagnosis center, sometimes quite far from the families' homes. With TEOAE, infants who fail the second screening (2%) and those who pass but have risk factors for hearing loss (3.2%) are referred for diagnosis.…”

“…These rates can even increase in preterm infants [13][14][15] and newborns younger than 48 h up to 60% [16][17][18][19]. AABR tests yield lower first-screening referral rates (1-4%) [7][8][9]11,[20][21][22]. If the program is a two-step screen, the TEOAE referral rate following the second test can drop to 6-7% [10,12,[23][24][25][26].…”