Challenges of Universal Newborn Hearing Screening in a Developing Country-a Double-Edged Sword
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ORIGINAL ARTICLE
Challenges of Universal Newborn Hearing Screening in a Developing Country-a Double-Edged Sword Jaise Jacob1
•
Mary Kurien1 • Sindhusha3 • Pradeep Kumar1 • Lalitha Krishnan2
Received: 14 August 2020 / Accepted: 21 September 2020 Ó Association of Otolaryngologists of India 2020
Abstract Objective to implement Universal Neonatal Hearing Screening (UNHS) in a tertiary academic hospital and identify associated risk factors. Prospective study. Screening tests with Otoacoustic Emissions (OAE) were done among newborns, prior to hospital discharge. In babies who fail OAE twice, Brain Response Audiometry (BERA) was done, failing which they were referred to higher ENT center for repeat testing and hearing rehabilitation. A total 2323 babies were admitted in the neonatal unit during the study period. Only 773 babies (a third) could be screened for the first OAE, two thirds being lost to study right at inception!! Among the 773 neonates, in the ‘‘at risk’’ group of 301 neonates, 31(10%) and in the ‘‘not at risk’’ group of 472 neonates, 30 (6%) were lost to follow up respectively. The occurrence of hearing loss in this study population was 1.3 per 1000. Risk factors were noted in 38.9% of this subgroup with occurrence of hearing loss in ‘‘at risk’’ group being 3.32 per 1000. The implementation of UNHS in a developing country like India, has multiple challenges including infrastructural and non-compliance to follow up. In the meantime, the possibility of compromising ‘at-risk’’ neonates, who are significantly more prone to hearing loss, both neonatal and delayed onset, is an
& Jaise Jacob [email protected] 1
Department of ENT, Pondicherry Institute of Medical Science, Puducherry, India
2
Department of Pediatrics, Pondicherry Institute of Medical Science, Puducherry, India
3
Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
additional grave reality which needs deep considerationin this Herculean task of attaining ‘‘universality’’. Keywords At risk neonates Brain stem evoked response audiometry Otoacoustic emissions Lost to follow up Universal neonatal hearing screening
Introduction Hearing impairment is one of the most prevalent sensory deficits in India affecting approximately 5–6 infants in every 1000 neonates [1].According to the Rehabilitation Council of India 4 out of every 1000 live births have severe to profound hearing loss [2]. Though hearing screening was initially done only for the high-risk neonates, it was not representative as 50% of infants born with hearing loss have no known risk factors [3, 4].Hearing loss, if not detected at an early stage and treated can adversely affect the speech and language development of children [3, 5]. Hence Joint Committee on Infant Hearing (JCIH)in 2007 recommended Universal Neonatal Hearing Screening (UNHS), irrespective of risk factors; for early hearing loss detection and intervention with the 1-3-6 guidelines (diagnose hearing loss by 3 months of age, fitted with he
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