“…Furthermore, only two recent literature reviews exist, and findings are mixed. For example, one meta-analysis completed by Vos, Senterre, Lagasse, Group, and Leveque (2015) evaluated risk factor studies from the years 2000 to 2015 by using the grading of recommendations, assessment, development, and evaluation (GRADE) assessment method to determine the level of evidence and strength of recommendation for each risk factor (Guyatt et al, 2008). Results revealed the following evidence levels for associations between a given risk factor and delayed-onset hearing loss: (a) Strong levels included congenital cytomegalovirus (CMV), toxoplasmosis, syphilis, or rubella; (b) moderate levels included a family history of hearing loss, hyperbilirubinemia, meningitis, or extracorporeal membrane oxygenation (ECMO) therapy; (c) weak levels included low Apgar scores; and (d) very low levels included congenital herpes, low birth weight, neonatal intensive care unit (NICU) stay, assisted ventilation, or ototoxic drugs.…”