Newborn hearing screening in youth health care in the Netherlands: National results of implementation and follow-up.

OBJECTIVE: The aim of this study is to investigate whether the quality of the Dutch, community based, universal newborn hearing screening programme is consistent over time. DESIGN: Universal newborn hearing screening data from three cohorts are compared on a number of quality targets concerning the outcome of the screening and the process of the screening in a three stage, community based, hearing screening programme. STUDY SAMPLE: A total of 552 820 children entered the study (189 794 in 2002-2006; 181 574 in 2008, and 181 452 in 2009). RESULTS: Participation in the programme is high from implementation onwards and increases over time for all screen stages to percentages above 99%. Refer rates are within quality targets and they are consistent over time. The screening is completed within 42 days of birth for 91.5% of the children in the last cohort. Of all children screened, 0.29% to 0.30% are referred to a speech and hearing centre. Participation in diagnostic testing is 93.3% to 95.2%. Of all referred children 77% to 85% receive a diagnosis within 122 days of birth. CONCLUSIONS: A good quality neonatal hearing screening programme in youth health care has been established in the Netherlands. However, both participation in diagnostic testing after a positive screen result and the timing of the diagnostic testing can still be improved.

Examination of long-lasting parental concern after false-positive results of neonatal hearing screening.

OBJECTIVE: To investigate whether false-positive outcomes on neonatal hearing screening cause long-lasting parental concerns. METHODS: A general population of parents whose children had participated in the universal neonatal hearing screening (UNHS) programme were examined. Parents filled out a questionnaire 6 months after UNHS. Outcomes were compared for all parents whose child tested positive or inconclusive in at least one of three tests but afterwards proved not to have hearing impairment (cases, n = 154) and a random sample of parents whose child passed the first test (controls, n = 288). Parental anxiety as measured with the State-Trait Anxiety Inventory (STAI), attitude towards the child (child health rating and experienced problems) and sensitivity to hearing problems were measured. RESULTS: Median STAI score was equal for cases and controls. Parental attitudes toward the child also did not differ. The difference in the proportion of parents who worried about their child's hearing was statistically significant between cases and controls (p = 0.001) and varied with the number of screens; 4% of controls were worried about the child's hearing, as compared to 10% of cases whose children were tested twice, and 15% of cases whose children were tested three times. CONCLUSIONS: False-positive UNHS test results do not cause long-term general parental anxiety. However, 6 months after screening, a considerable proportion of parents continued to experience hearing-specific worries regarding their child.

Costs of different strategies for neonatal hearing screening: a modelling approach.

OBJECTIVE: To compare the cost effectiveness of various strategies for neonatal hearing screening by estimating the cost per hearing impaired child detected. DESIGN: Cost analyses with a simulation model, including a multivariate sensitivity analysis. Comparisons of the cost per child detected were made for: screening method (automated auditory brainstem response or otoacoustic emissions); number of stages in the screening process (two or three); target disorder (bilateral hearing loss or both unilateral and bilateral loss); location (at home or at a child health clinic). SETTING: The Netherlands TARGET POPULATION: All newborn infants not admitted to neonatal intensive care units. MAIN OUTCOME MEASURE: Costs per child detected with a hearing loss of 40 dB or more in the better ear. RESULTS: Costs of a three stage screening process in child health clinics are 39.0 pounds (95% confidence interval 20.0 to 57.0) per child detected with automated auditory brainstem response compared with 25.0 (14.4 to 35.6) pounds per child detected with otoacoustic emissions. A three stage screening process not only reduces the referral rates, but is also likely to cost less than a two stage process because of the lower cost of diagnostic facilities. The extra cost (over and above a screening programme detecting bilateral losses) of detecting one child with unilateral hearing loss is 1500-4000 pounds. With the currently available information, no preference can be expressed for a screening location. CONCLUSIONS: Three stage screening with otoacoustic emissions is recommended. Whether screening at home is more cost effective than screening at a child health clinic needs further study.

[Neonatal hearing screening]. / Neonatale gehoorscreening.

Approximately 1 to 2 per thousand live-born infants suffer from a serious perceptive hearing loss. Normal hearing from birth is essential for optimal human development (language and speech, social and emotional development, communicative skills and learning). The earlier the hearing loss is diagnosed the better the prognosis for the infant with a hearing impairment. Suitable methods are now available for neonatal hearing screening: automated measurement of auditory brain stem response and measurement of oto-acoustic emissions. Screening must be viewed as only the first step in a program of diagnosis, treatment and habilitation of these children. The ultimate goal of the implementation of neonatal hearing screening is: identification of bilateral hearing losses before the age of 3 months and start of therapy and counselling before the age of 6 months.