Authors' objectives:

To identify strengths, weaknesses, and gaps in the evidence supporting universal newborn hearing screening (UNHS) and to compare the additional benefits and harms of UNHS with those of selective screening of high-risk newborns.

Authors' results and conclusions: Good quality studies show from 2041 to 2794 low-risk, and 86 to 208 high-risk, newborns were screened to find 1 case of moderate to profound sensorineural hearing loss (SNHL). The best estimate of positive predictive value is 6.7%. Six percent to 15% of infants who fail the screening tests are subsequently diagnosed with bilateral SNHL. In a trial of UNHS versus clinical screening at 8 months of age, UNHS increased the proportion of infants with moderate to severe hearing loss diagnosed by 10 months of age (57% vs 14%), but did not reduce the rate of diagnosis after 18 months of age. No good-quality controlled study has compared UNHS to selective screening of high-risk newborns. In fair- to poor-quality cohort studies, intervention before 6 months of age was associated with improved language and communication skills by 2 to 5 years of age. These studies had unclear criteria for selecting subjects, and none compared an inception cohort of low-risk newborns identified by screening to those identified in usual care, making it impossible to exclude selection bias as an explanation for the results. In a mathematical model based on the literature review, we estimated that extending screening to low-risk infants would detect 1 additional case before 10 months for every 1441 low-risk infants screened, and result in treatment before 10 months of 1 additional case for every 2401 low-risk infants screened. With UNHS, 254 newborns would be referred for audiological evaluation because of false-positive second-stage screening test results, versus 48 for selective screening.

Authors' recommendations: Modern screening tests for hearing impairment can improve identification of newborns with SNHL, but the efficacy of UNHS to improve long-term language outcomes remains uncertain.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/uspstf/uspsnbhr.htm

Year Published: 2001

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)