Second stage of Universal Neonatal Hearing Screening A way for diagnosis and
beginning of proper treatment for infants with hearing loss
Magdalena Lachowska *, Paulina Surowiec, Krzysztof Morawski, Katarzyna Pierchaa,
Kazimierz Niemczyk
Department of Otolaryngology, Hearing Implant Center, Medical University of Warsaw, Warsaw, Poland
A R T I C L E I N F O
A B S T R A C T
Article history:
Received 26 November 2012
Accepted 5 September 2013
Available online 25 March 2014
Purpose: To analyze retrospectively the results of hearing testing in infants at the second stage of the
Polish Universal Neonatal Hearing Screening Program carried out in the Department of Otolaryngology
at the Medical University of Warsaw.
Material/methods: A total of 351 infants referred to our Department for the second stage of UNHS were
included in the study. There were 39.60% infants referred due to positive result of hearing screening at
the rst stage of the Program performed in neonatal units, 55.27% with negative screening but risk
factors present, and 5.13% without any tests due to equipment failure in the maternity unit.
Results: Risk factors were identied in 86.61% of the infants. The most frequent ones were
hyperbilirubinemia (71.51%), premature birth (63.25%), and ototoxic medication (62.11%). Otoacoustic
emission test showed fail results in 17.66% of the infants, and auditory brainstem responses conrmed
hearing loss in 16.81%. Correlation between risk factors and conrmed hearing loss was found for
hyperbilirubinemia, low birth weight, intensive therapy for at least 7 days, low Apgar scores, and
craniofacial abnormalities.
Conclusions: The early identication of infants with hearing loss is essential for early intervention. Not
only infants who fail the initial screening but also the ones with risk factors of hearing impairment
should be referred to the centers that are capable of providing the necessary diagnostic services required
for the second stage of the UNHSP. Those two steps are needed to both minimize the risk of overlooking a
child with hearing loss and properly diagnose hearing impairment.
2014 Medical University of Bialystok. Published by Elsevier Urban & Partner Sp. z o.o. All rights
reserved.
Keywords:
Screening
Hearing loss
Infants
Early detection
Otoacoustic emission
Auditory brainstem response
1. Introduction
High incidence of hearing loss among newborns draws our
attention. Current statistics indicate an overall hearing impairment
rate of 13 in 1000 live births in healthy newborns nursery and 24
in 100 in neonatal intensive care units. Hearing impairment in
children, undiagnosed or diagnosed with delay, may negatively
result in childs language, cognitive, social, emotional, and
academic development. The hearing loss itself and its mentioned
negative results may signicantly affect the childs quality of life.
When hearing impairment is diagnosed early and proper
intervention is undertaken, children with hearing loss are likely
http://dx.doi.org/10.1016/j.advms.2014.02.002
1896-1126/ 2014 Medical University of Bialystok. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.
91
92
Table 2
ABR thresholds results for infants with conrmed hearing loss.
Hearing loss threshold
40 dBnHL
70 dBnHL
3. Results
In the analyzed group of 351 infants, 194 (55.27%) were males
and 157 (44.73%) were females. One hundred and thirty-nine
(39.60%) infants were referred to our Department due to the failing
result of the hearing screening test at the rst stage of the Program
performed in a neonatal unit (positive hearing screening test
results). One hundred and ten of them, aside from those results,
presented at least one risk factor. Other 194 (55.27%) infants with
negative screening results at the rst stage were referred due the
hearing loss risk factors alone. The last 18 (5.13%) were referred to
the second stage without any tests at the rst stage due to
equipment failure in the maternity unit. The mean age of all infants
tested in our Department was 3.5 months (SD = 0.94).
We identied risk factors in 304 infants (86.61%) and found that
the majority (256 infants, 72.93%) presented with more than one
risk factor. As shown in Fig. 1, the most frequent risk factors
(prevalence in more than 50% of analyzed infants) observed in the
studied group were hyperbilirubinemia (71.51%), premature birth
(63.25%), and ototoxic medication (62.11%). Less frequent (20
50%) risk factors were low birth weight (31.62%), intensive therapy
for at least 7 days (27.07%), and mechanical ventilation for at least
5 days (22.22%).
DPOAE diagnostic test performed in our Department showed
fail results in 62 infants (17.66%). Testing with ABR method to
establish hearing thresholds conrmed hearing loss in 59 infants
(16.81%) (Table 1), unilateral in 32 infants and bilateral in 27
(Table 2). This means that there were false-positive results at the
rst stage of the Program. Of 139 positive results from the rst
stage, 24 (17.26%) were conrmed as hearing loss at the second
stage, which makes 115 to be false positive (82.73% false positive).
Of 194 infants referred due to the risk factors alone, 35 (18.04%)
were diagnosed with hearing loss presenting thresholds
40 dBnHL. All 59 infants with conrmed hearing loss were
further referred to the third stage meeting the third goal of the
Program the proper treatment. Among those 59 infants with
Number of infants
Unilateral
hearing loss
Bilateral
hearing loss
32
7
27
6
59
13
Table 1
Prevalence of positive and negative hearing loss test results in studied group of infants (n = 351). Outcomes of hearing screening at the second and/or third day of life in the
maternity unit (rst stage of the program), and at the second stage of the Program DPOAE as diagnostic test and ABR click to conrm hearing loss. Out of 351 infants referred
to the second stage, 18 (5.13%) were not tested due to equipment failure at the maternity unit.
TEOAE neonatal screening at 2nd3rd day of
life (results from rst stage)
Test result
Number of neonates
Test result
Number of infants
Test result
Number of infants
Pass
Refer
194 (55.27%)
139 (39.60%)
Pass
Refer
289 (82.34%)
62 (17.66%)
Normal hearing
Hearing loss
292 (83.19%)
59 (16.81%)
93
Table 3
Correlation between risk factors and conrmed hearing loss (DPOAE and ABR) at the second stage of the Program.
Risk factor
Tau
Gamma
251
222
218
111
95
87
78
57
26
12
7
5
5
304
S0.071*
0.011
0.021
0.104*
0.086*
0.007
0.052
0.112*
0.018
0.083*
0.045
0.010
0.054
0.047
0.048*
0.763
0.551
0.004*
0.017*
0.853
0.150
0.002*
0.609
0.020*
0.210
0.774
0.131
0.189
S0.200*
0.030
0.059
0.276*
0.237*
0.021
0.156
0.340*
0.089
0.442*
0.336
0.108
1.000
0.169
0.048*
0.763
0.551
0.004*
0.017*
0.853
0.150
0.002*
0.609
0.020*
0.210
0.774
0.131
0.189
94
[7]
[8]
5. Conclusions
[9]
[16]
Conict of interests
[17]
[18]
Financial disclosure
The authors state that there is no nancial support to be
disclosed.
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