The New York State universal newborn hearing screening demonstration project: Outpatient outcome measures

Objective: To investigate outpatient outcome measures of a multi-center, st ate-wide, universal newborn hearing screening project. Design: Eight hospitals participated in a 3-yr, funded project. Each hospit al designed its own protocol using common criteria for judging whether an i nfant passed a hearing screening. Infants were tested in the hospital, and those either failing the in-hospital screening or who were not tested in th e hospital (missed) were asked to return 4 to 6 wk after hospital discharge for outpatient rescreening, Those infants failing the outpatient rescreeni ng were referred for diagnostic auditory brain stem response testing. Each hospital used its own audiological equipment and criteria to determine whet her a particular infant had a hearing loss. All data were collected and ana lyzed for individual hospitals, as well as totaled across all hospitals. Da ta were analyzed in terms of year of program operation, nursery type, and g eographic region. Results: Seventy-two percent of infants who failed the in-hospital screenin g returned for outpatient testing. The percentage of in-hospital fails retu rning for retesting was significantly higher than the percentage of in-hosp ital misses returning for retesting. The percentage of infants returning fo r retesting increased with successive years of program operation. Some diff erences were noted in the percentage of infants returning for retesting amo ng hospitals and geographic regions of the state, Some differences in outpa tient outcome measures also were noted between infants originally born into the neonatal intensive care unit (NICU) and the well-baby nursery (WBN). T he percentage of infants from the NICU who returned for retesting was sligh tly higher than that for infants from the WBN, The percentage of infants fr om the WBN passing the outpatient rescreening was higher than that for the NICU infants. The overall prevalence of hearing loss was 1.96/1000, with th at in the NICU being 8/1000 and that in the WBN being 0.9/1000. Positive pr edictive value for permanent hearing loss based on inpatient screening was approximately 4% and based on outpatient rescreening was approximately 22%. Conclusions: Several outpatient outcome measures changed with successive ye ars of program operation, suggesting that programs improve over time. Also, some outpatient outcome measures differ between NICU and WBN populations. The differences noted across regions of the state in the percentage of infa nts returning for outpatient retesting require further research to determin e whether differences are due to demographic and/or procedural differences.