Universal Hearing Screening in Newborns Using Otoacoustic Emissions and Brainstem Evoked Response in Eastern Uttar Pradesh

Abstract

The objectives were to determine the incidence of hearing impairment in a standardized population of neonates and to determine the significance of association of epidemiological and risk factors with neonatal hearing loss. A cohort of 600 newborns was selected for study and divided into two groups—525 in ‘No Risk’ group and remaining 75 in ‘At Risk’ group. The study protocol was carried out in three steps: (a) Screening of Hearing Loss with TOAE, done from 36 h after birth to 28 days of life, (b) Re-screening of hearing loss in newborns (of 4–12 weeks of age), who were tested positive for hearing loss in the first screening, done with DPOAE, (c) Confirmation of hearing loss with BERA, in those who were tested positive in both the first and second screening. In the study the incidence of hearing impairment in 600 infants screened was 6.67 per 1000 screened; 3.81 per 1000 screened in the Not at Risk group and 26.67 per 1000 screened in At Risk group. In At Risk group, admitted to the NICU, severe birth asphyxia and hyperbilirubinemia were found to be major risk factors. Loss to follow up was more in Not at Risk group and False Positive cases with TEOAE were more than DPOAE. BERA was found to be must for confirmation of hearing loss. Neonatal Hearing Screening of only At Risk population is likely to miss some hearing loss. Universal Hearing Screening should be the preferred strategy. Good follow up in the ‘At Risk’ group suggests that initial interventions in NICU had sensitized the parents for the possibility of hearing loss. This study recommends the introduction of two stage neonatal screening–rescreening protocol, using OAE and BERA, in the country in phased manner.