Newborn Hearing Screening Success… Patient Care Failure

Abstract

ObjectiveTo assess the efficacy of a newborn hearing screening program in an urban hospital 24 years after a longitudinal study identified failings in its program and recommended solutions.MethodsA hospital‐specific, Pennsylvania database was queried to determine rates of in‐hospital testing, referral, and diagnosis for Temple University Hospital (TUH), and to compare these with reporting sites statewide. At TUH, interviews with newborn hearing screeners and audiologists were conducted to identify barriers to care.ResultsIn the year 2022, 2,006/2,069 newborns (97%) were successfully screened prior to hospital discharge at TUH. (63 babies were never tested). There were 73 who did not pass automated auditory brainstem response testing (ABR) in at least one ear. All of these 73 infants returned for repeat automated ABR testing and 50/73 passed in both ears. 23/2006 (1%) were referred to diagnostic testing. 13/23 were successfully scheduled. 11/23 passed in both ears. 2/13 were found to have hearing losses. 10 infants (43%) were lost to follow‐up and were never diagnosed. Examining lost‐to‐follow‐up rates statewide, we identified a relationship between successful follow‐up and local median family income.ConclusionLegislation on the state level and improvements in audiometric technology have led to highly successful in‐hospital screening with relatively low false‐positive rates. Despite this, inadequate outpatient follow‐up testing and inequities in the American health care system continue to delay audiometric diagnosis and habilitation of congenital hearing loss. Lack of transportation, childcare for siblings, and newborn insurance status impede access to diagnostic testing.Level of evidence: Level 3 evidence—retrospective review comparing cases and controls. Laryngoscope, 2024