Newborn Hearing Screening Test: A Comparison between Infants in Neonatal Intensive Care Unit versus Nursery

Misun Yang; Jin Wha Choi; Ji Sook Kim; So Yoon Ahn; Se In Sung; Yun Sil Chang; Won Soon Park

doi:10.14734/PN.2018.29.03.121

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Yang, Choi, Kim, Ahn, Sung, Chang, and Park: Newborn Hearing Screening Test: A Comparison between Infants in Neonatal Intensive Care Unit versus Nursery

Original Article

Perinatology 2018;29(3):121-127.

Published online: 19 September 2018

DOI: https://doi.org/10.14734/PN.2018.29.03.121

Newborn Hearing Screening Test: A Comparison between Infants in Neonatal Intensive Care Unit versus Nursery

Misun Yang, MD¹, Jin Wha Choi, MD², Ji Sook Kim, MD³, So Yoon Ahn, MD, PhD¹, Se In Sung, MD, PhD¹, Yun Sil Chang, MD, PhD¹, Won Soon Park, MD, PhD¹

¹Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

²Department of Pediatrics, Korea University College of Medicine, Seoul, Korea

³Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea

Correspondence to Yun Sil Chang, MD, PhD Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: +82-2-3410-3539 Fax: +82-2-3410-0043 E-mail: yschang@skku.ed

Received 26 April 20188 June 2018 Accepted 6 July 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

The purpose of this study is to compare the clinical characteristics of newborn hearing test results between infants in well-baby nursery (WBN) versus neonatal intensive care unit (NICU) and to determine the optimal strategies of hearing screening for each group.

Methods

A total of 2,161 newborns admitted to WBN and NICU were enrolled in this retrospective cohort study. Automated audio brainstem response was used for hearing screening test. The screening rates, referral rates, prevalence rates, false positive rates and predictive positive value (PPV) were analyzed for infants in WBN and NICU.

Results

The referral rates of the screening test were 2.2% and 5.0% in WBN and NICU groups (P<0.01); the prevalence rate of congenital hearing loss (HL) were 0.5% and 4.6% in the WBN and NICU groups (P<0.01). The false positive rates and PPV of screening test were 0.9% and 36.8% in WBN; 0.8% and 80% in NICU. Infants with bilateral refer results in both WBN and NICU were at the higher risk of congenital HL, compared with infants with unilateral refer results in WBN who were mostly confirmed to have false positive.

Conclusion

The infants in WBN showed high unilateral referral rate with low prevalence rate of HL. However, the infants with bilateral refer results in WBN and uni- or bi-lateral refer results in NICU had higher prevalence rate of HL, compared with those with unilateral refer results in WBN. Different strategies for hearing screening might be considered in infants in WBN and NICU.

Keywords: Neonatal screening, Hearing loss, Auditory brainstem responses

REFERENCES

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Fig. 1

Flowchart of newborn hearing screening and diagnostic test for well-baby nursery infants. WBN, well-being nursery; AABR, automated audio brainstem response; ABR, audio brainstem response; HL, hearing loss.

Fig. 2

Flowchart of newborn hearing screening and diagnosis test for neonatal intensive care unit in fants. NICU, neonatal intensive care unit; AABR, automated audio brainstem response; ABR, audio brainstem response; HL, hearing loss.

Table 1.

Indications for Infants Who Underwent Diagnostic Test without Screening

	Value
Metabolic encephalopathy, neonatal epilepsy	4 (8.3)
Congenital brain anomaly, cerebral artery infarction, fetal hydrops with hydrocephalus	6 (12.5)
Grades III-IV IVH with posthemorrhagic hydrocephalus	11 (22.9)
Hypoxic-ischemic encephalopathy	6 (12.5)
Periventricular leukomalacia	9 (18.8)
Brain abscess	1 (2.1)
Skull bone fracture	1 (2.1)
In utero infection (congenital CMV infection)	2 (4.2)
Transfer from NICU to general ward	5 (10.4)
Others	3 (6.2)
Total	48

Values are presented as number (%). Abbreviations: IVH, intraventricular hemorrhage; CMV, cytomegalovirus; NICU, neonatal intensive care unit.

Table 2.

Comparison of Newborn Hearing Screening Test in Well-Baby Nursery and Neonatal Intensive Care Unit Infants

	WBN infants	NICU infants	P-value
Coverage rate of screening test	1,332/1,544 (86.3)	524/617 (84.9)	0.64
Referral rate	29/1,332 (2.2)	26/524 (5.0)	<0.01
Bilateral HL	2/1,332 (0.2)	10/524 (1.9)	<0.01
Unilateral HL	27/1,332 (2.0)	16/524 (3.1)	0.23
Coverage rate of diagnostic test	19/29 (65.5)	20/26 (76.9)	0.39
Prevalence rate	7/1,322 (0.5)	26/566 (4.6)	<0.01
Bilateral HL	3/1,322 (0.2)	21/566 (3.7)	<0.01
Unilateral HL	4/1,322 (0.3)	5/566 (0.9)	0.13
False positive rate	0.9%	0.8%	1.00
Bilateral refer	0%	0.2%	0.28
Unilateral refer	0.9%	0.6%	0.77
Predictive positive value	7/19 (36.8)	16/20(80.0)	0.01
Bilateral refer	1/1 (100.0)	7/8 (87.5)	1.00
Unilateral refer	6/18 (33.3)	9/12(75.0)	0.06

Values are presented as number (%). Abbreviations: WBN, well-baby nursery; NICU, neonatal intensive care unit; HL, hearing loss.

Table 3.

Comparison of Risk Factors between Hearing Loss Group and False Positive Group in Well-Baby Nursery Infants

	Total (n=19)	HL group (n=7)	False positive group (n=12)	P-value
Elderly gravida (>35 years)	4 (21.1)	1 (14.3)	3 (25.0)	1.00
Maternal GDM	3 (15.8)	1 (14.3)	2 (16.7)	1.00
Gestational age (weeks)	38.6±1.6	38.1±2.6	39.1±1.0	0.30
Birth weight (g)	3,078±540	2,901±664	3,207±416	0.09
<1,500 g birth weight	4 (21.1)	3 (42.9)	2 (16.7)	0.31
Apgar score, 1 minute	8.7±1.0	8.9±0.4	8.6±1.2	0.56
Apgar score, 5 minutes	9.5±0.8	9.8±0.5	9.4±0.9	0.43
Male	11 (57.9)	4 (57.1)	7 (58.3)	1.00
NSVD	14 (73.7)	4 (57.1)	10 (83.3)	0.31
Chromosome abnormality	1 (5.3)	0 (0)	1 (8.3)	1.00
Craniofacial anomaly	0 (0)	0 (0)	0 (0)	-
Congenital heart disease	2 (10.5)	1 (14.3)	1 (8.3)	1.00

Values are presented as number (%). Abbreviations: HL, hearing loss; GDM, gestational diabetes mellitus; NSVD, normal spontaneous vaginal delivery.

Table 4.

Comparison of Risk Factors between Hearing Loss Group and False Positive Group in Neonatal Intensive Care Unit Infants

	Total (n=20)	HL group (n=16)	False positive group (n=4)	P-value
Elderly gravida (>35 years)	6 (30)	6 (37.5)	0 (0)	0.27
Maternal GDM	0 (0)	0 (0)	0 (0)	-
Maternal preeclampsia	2 (10)	2 (12.5)	0 (0)	1.00
Gestational age (weeks)	32.6±5.1	33.4±5.1	29.1±1.7	0.15
Birth weight (g)	2,032±1,032	2 2,151±1,031	1,558±1,028	0.32
<1,500 g birth weight	11 (55)	8 (50)	3 (75)	0.59
Male	10 (50)	8 (50)	2 (50)	1.00
NSVD	8 (40)	6 (37.5)	2 (50)	1.00
Apgar score, 1 minute	6.6±2.0	6.7±2.1	6.3±1.7	0.70
Apgar score, 5 minutes	8.3±1.3	8.3±1.3	8.0±1.4	0.67
RDS	8 (40)	6 (37.5)	2 (50)	1.00
BPD	8 (40)	7 (43.8)	1 (25)	0.62
Pulmonary hypertension	1 (5)	1 (6.2)	0 (0)	1.00
IVH	16 (80)	12 (75)	4 (100)	0.54
Periventricular leukomalaci	a 2 (10)	1 (6.2)	1 (25)	0.37
Neonatal seizure	5 (25)	4 (25)	1 (25)	1.00
Exposure to ototoxic medications	12 (60)	11 (68.8)	1 (25)	0.26
Sepsis	3 (15)	3 (18.8)	0 (0)	1.00
Chromosome abnormality	2 (10)	2 (12.5)	0 (0)	1.00
Craniofacial anomaly	5 (25)	5 (31.2)	0 (0)	0.53
Congenital heart disease	6 (30)	5 (31.2)	1 (25)	1.00
Congenital infection	0 (0)	0 (0)	0 (0)	-

Values are presented as number (%). Abbreviations: HL, hearing loss; GDM, gestational diabetes mellitus; NSVD, normal spontaneous vaginal.

Table 5.

Causes of Undoing the Hearing Screening Test in Neonatal Intensive Care Unit

	Value
Examination of hearing screening test at other center before admission	22 (23.7)
Transfer to another hospital	10 (10.8)
Refusal of parents	8 (8.6)
Transfer to another department	5 (5.4)
Indications for diagnosis test without screening test	48 (51.5)
Total	93 (100)

Values are presented as number (%).

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