Neonatal Hearing Rescreening in a Second-Level Hospital: Problems and Solutions

Abstract

Second-level hospitals face peculiarities that make it difficult to implement hearing rescreening protocols, which is also common in other settings. This study analyzes the hearing rescreening process in these kinds of hospitals. A total of 1130 individuals were included; in this cohort, 61.07% were hospital newborns who failed their first otoacoustic emission test after birth (n = 679) or were unable to perform the test (n = 11), and who were then referred to an outpatient clinic. The remaining 38.93% were individuals born in another hospital with their first test conducted in the outpatient clinic (n = 440). A high number of rescreenings were made outside of the recommended time frame, mainly in children referred from another hospital. There was a high lost-to-follow-up rate, especially regarding otolaryngologist referrals. Neonatal hearing screening at second-level hospitals is difficult because of staffing and time constraints. This results in turnaround times that are longer than recommended, interfering with the timely detection of hearing loss. This is particularly serious in outpatient children with impaired screening. Referral to out-of-town centers leads to unacceptable follow-up loss. Legislative support for all these rescreening issues is necessary. In this article, these findings are discussed and some solutions are proposed.

Keywords: auditory potentials; hearing loss; neonatal hearing screening; otoacoustic emissions; rescreening.

Figure 1

Percentage of internal and external newborns screened by year studied.

Figure 2

Mean number of days from birth to the first outpatient hearing loss test by year. The red line represents the desired limit for screening.

Figure 3

Median age at which each hearing screening test is performed in internal and external neonates.

Figure 4

Distribution of the margin of days per test in internal neonates. The blue line represents the desired limit for screening. The red line represents the desired limit for ENT evaluation. Grey zones represent the distribution of cases.

Figure 5

Distribution of the margin of days per test in external neonates. The blue line represents the desired limit for screening. The red line represents the desired limit for ENT evaluation. Grey zones represent the distribution of cases.