Universal newborn hearing screening in an inner-city, managed care environment

Objectives/Hypothesis: Universal neonatal hearing screening (UNHS) programs aim to identify and treat educationally significant hearing loss in the fi rst months of life, Several states have mandated UNHS for all newborns. Suc h programs have been successful in small, homogeneous populations, As large r states attempt to implement such programs, important obstacles have arise n, particularly in sparsely populated rural environments and in the inner c ity, where poverty, unstable living situations, and inadequate access to he alth care make follow-up of infants failing initial testing difficult, Stud y Design: We performed a prospective longitudinal study examining the effec ts of increasingly complex and expensive interventions designed to ensure t hat children failing initial. hearing screening returned for complete evalu ation and habilitation, Methods: A UNHS program based on transient evoked o toacoustic emissions testing was implemented at Temple University Hospital, with 2,000 births per year. At 6 months into the program, efficacy was ass essed and modifications in follow-up methodology were made in an attempt to improved rate of return of infants failing newborn screening. The effect o f these interventions was reassessed 6 months later. Results: In its first 12 months, the Temple University Infant and Young Child Hearing Interventio n Initiative successfully screened 95% (2,031) of all newborns using transi ent evoked otoacoustic emissions. Collecting a complete database profile fo r each newborn, establishing rapport with the family, and offering immediat e follow-up appointments yielded a 61% return rate after discharge. The add ition of a dedicated project secretary, free daycare for siblings, and cab vouchers for transportation and the elimination of a requirement for health maintenance organization referrals increased follow-up yield to 75%, Concl usion: Given adequate resources and planning, UNHS can be successful, even in economically depressed environments.