Hearing tests for all infants may improve outcomes

Universal newborn screening for hearing impairment is more effective than waiting to screen until 8 months of age in achieving early referral for complete hearing assessments, the results of a study in the UK suggest. Early referral for children with hearing loss is believed to be a critical element in minimizing speech impairment by the time the child reaches school age.

Although universal newborn screening for hearing impairment has been recommended by the National Institutes of Health since 1993, the benefit of such programs has been disputed, Dr. Colin Kennedy and his associates explain in the current issue of The Lancet.

The US Preventive Services Task Force advocates population-based studies to provide evidence that these programs are effective.

In the current study, Kennedy, from the University of Southampton, and his associates analyzed the outcome of children who participated in a study conducted between 1993 and 1996 at four participating hospitals.

Four-to-six month periods in which universal newborn screening was carried out were alternated with periods of no newborn screening. During all periods, screening for hearing impairment with the Health Visitor Distraction Test was conducted at 7 to 8 months of age.

In 2003, the researchers identified 66 children from the original group with permanent hearing impairment of 40 decibels or more, which affected both ears. Thirty-one had been born during periods with newborn screening and 35 during periods of no newborn screening. The proportions referred before 6 months of age for hearing assessment were 74 percent and 31 percent, respectively.

“Our report… is the strongest available evidence of the added benefit of universal newborn screening in the early detection of permanent childhood hearing impairment,” Kennedy’s group writes.

They add that they are in the process of conducting cost analyses and assessment of the effects of early intervention on the speech and language of the hearing impaired children.

In a related editorial, Drs. Patricia Mutton and Kenneth Peacock at Children’s Hospital at Westmead in Australia point out that as many as one quarter of affected children develop hearing loss after the newborn period.

This, they say, is a “disturbing finding because it suggests that in an ideal programme there should be further measures to screen hearing in preschools or elementary schools.”

“This additional cost might not be accepted happily by those who control the purse-strings of the public-health budget,” they add.

SOURCE: The Lancet, August 20, 2005.

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