ABR hearing screening for high-risk infants

Objective: The goals of this investigation were to determine the outcome of a high-risk newborn auditory brainstem response hearing screening program at this institution and to determine the clinical characteristics of the target population with special emphasis on the relationship between risk criteria and bearing status. Study Design: This study involved the prospective screening of newborns with risk indicators and a retrospective analysis of results accumulated over a 10-year period. Setting: The study was conducted either in the newborn nursery or outpatient audiology clinic of a tertiary health care center. Patients: Patients were 2,103 newborns presenting with one or more risk indicators for significant congenital hearing loss or delayed onset/progressive sensorineural hearing loss. Interventions: Diagnostic interventions involved auditory brainstem response screening at two intensity levels (25 dB and 65 to 75 dBnHL). Main Outcome Measures: The main outcome measure was incidence of significant, nonmedically treatable hearing loss in this population. A secondary outcome measure was determination of incidence of hearing loss in association with different risk indicators. Results: One hundred fourteen (5.4%) infants were diagnosed with bilateral hearing loss. Twenty-three infants (1%) presented with unilateral hearing loss. Sixty seven (49%) of the 137 infants diagnosed with hearing loss presented with greater than moderate hearing loss. Nine (13.4%) of these 67 patients presented with delayed onset hearing loss that was diagnosed at appointments subsequent to the initial screening. The largest percentage of diagnosed hearing loss was found in the "craniofacial anomalies" category. Conclusions: Auditory brainstem response hearing screening of newborns at risk for significant hearing loss is a clinically efficient and cost effective approach to early detection of significant hearing loss. For this program, the calculated cost to diagnose one hearing impaired infant from this population is $3000.