Controlled trial of universal neonatal screening for early identification of permanent childhood hearing impairment: coverage, positive predictive value, effect on mothers and incremental yield

Object: Congenital bilateral permanent childhood hearing impairment (PCHI) impairs communication skills and, in some cases, mental health and employme nt prospects. Management of PCHI within the first year of life can alleviat e most of its adverse effects. We investigated whether neonatal screening o f all babies born in hospital, in addition to the standard Health Visitor D istraction Test (HVDT), would increase the rates of early diagnosis. Method s: Between 1993 and 1996, two teams of four part-time testers and equipment moved between two pairs of hospitals to achieve four periods with neonatal screenings and four without neonatal screening, each of 4-6 mo duration in each hospital. Babies did or did not undergo neonatal screening dependent on the periods during which they were born. We used a transient evoked oto- acoustic emissions (TEOAE) test followed, in infants who failed this test, by an automated auditory brainstem response (AABR) test on the same day. We referred babies with positive results for audiological assessment. Results : 53781 infants were included in the trial, including 25609 born during per iods of neonatal screening. The neonatal screen achieved 87% coverage of in born births, with a false alarm rate of 1.5%, and an overall yield from the screen of 90 cases of bilateral PCHI greater than or equal to 40dB HTL per 100000 target population, equivalent to 80% of the expected prevalence of the condition in the population. Seventy-one more babies with moderate or s evere PCHI per 100000 target population were referred before age 6 mo durin g periods with neonatal screening than during periods without. Early confir mation and management of PCHI were significantly increased. The false-negat ive rate of neonatal screenings was significantly lower than that of HVDT s creening (4% vs 27%). Conclusions: Neonatal screening is effective in ident ification of congenital PCHI and may be particularly useful for babies with moderate and severe PCHI for whom early management may have the most benef it.