Authors' objectives:

This study aims to ascertain the following - accuracy of the screening test, effectiveness of screening program, effectiveness of early detection, potential adverse effects of screening and early treatment, cost-effectiveness of the Newborn Hearing Screening Program and implications of screening program on the organization.

Authors' results and conclusions: Screening all newborns before discharge increases identification of hearing impaired infants and also increases the chance that diagnosis and treatment will begin before 6 months of age. Screening of high risk infants will identify only 50% of newborns with hearing loss. Otoacoustic Emission (OAE) and Auditory Brainstem Response (ABR) are highly accurate and are superior to just using the Health Visitor Distraction Test. OAE has the shortest time, followed by Automated ABR and the behavior test. Transient Evoked Otoacoustic Emissions/ Automated Auditory Brainstem Response (TEOAE/AABR) combine screens have better specificity and program sensitivity. Positive predictive results are higher for test done on high-risk babies (20%) compared to those without (2.2%). Better results are obtained when test is carried out after 24 hrs. There is not much difference in pass rates when using OAE in infants after 72 hours of age or at 3-4 weeks. Re-screening can reduce false positive and reduce unnecessary referrals for diagnostic hearing assessment. Positive predictive value is also higher with 2 step screening protocol using AABR. Evidence to determine whether earlier treatment resulting from screening leads to clinically important improvement in speech and language skills at age 3 years or beyond is in conclusive because of the design limitations in existing. There is anecdotal evidence that delays in screening will result in anxiety and stress on the family or the child. There are no prospective cohort or controlled trials that have been done to evaluate language outcomes as a result of early intervention. Limited evidence exists that earlier detection and commencement of habitation promotes improved communication and language development in a child.

Authors' recommendations: Screening of infants should be a continuum care till rehabilitation. It is recommended that hospital based targeted screening program for hearing loss be implemented in hospitals where diagnostic and rehabilitation services are available.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.moh.gov.my/

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Malaysia

Organisation Name: Malaysian Health Technology Assessment Unit

Contact Address: Health Technology Assessment Unit, Medical Development Division, Ministry of Health Malaysia, Level 21, PERKIM Building, Jalan Ipoh, 51200 Kuala Lumpur, Malaysia. Tel: 603 4045 7781, Fax: 603 4045 77 40

Copyright: Malaysian Health Technology Assessment Unit (MHTAU)