Potential pitfalls of initiating a newborn hearing screening program

Objective: To examine the efficacy of a universal screening program for inf ant hearing. Design: Retrospective analysis. Setting: Tertiary care center. Patients: We examined 2289 (90.2%) of 2537 infants born at our institution from April 1, 1995, to June 30, 1996, for hearing loss (HL). Interventions: We used a 3-stage protocol with transient evoked otoacoustic emissions (TEOAE) in stages 1 and 2 and diagnostic evaluation in stage 3. Infants without reproducible TEOAEs in either ear after stage 2 were referr ed to stage 3. Main Outcome Measures: Specificity of TEOAE, incidence of HL, prevalence of risk factors for HL, cost of TEOAE screening, and identification of barrie rs to universal screening. Results: Of the infants undergoing TEOAE screening, 91.1% passed stage 1. O f infants needing repeated testing, 73.7% passed and 26.2% failed. Of the 4 3 infants referred for diagnostic evaluation, 5 (11.6%) had HL. The combine d incidence of conductive and sensorineural HL was 2.18 per 1000 newborns. The prevalence of at least I risk factor for HL was 10.4%. The estimated co st of TEOAE screening was $24.48 per infant. Ten percent of infants did not undergo screening due to program deficiencies. Conclusions: Screening with TEOAE was sufficiently specific for universal s creening. However, we were unable to achieve truly universal screening. Thi s is probably the reason for our lower incidence of sensorineural HL. We we re unable to continue our universal newborn screening program, due to lack of funding, difficulties with program implementation, and our low incidence of detected HL.