USPSTF Recommends Universal Screening for Hearing Loss in Newborns
By Barbara Bittner
8/7/2008
All newborns should be screened for hearing loss, according to a new recommendation from the U.S. Preventive Services Task Force, or USPSTF. The USPSTF recommends that screening programs be conducted using a one- or two-step protocol, such as otoacoustic emission followed by auditory brainstem response in newborns who fail the first test. The task force members also recommend that all infants be screened before age 1 month; infants who did not pass the screening should undergo evaluation before age 3 months.
Newborns who have specific risk factors for hearing loss (e.g., a neonatal ICU stay of two days or longer, a family history of hereditary childhood sensorineural hearing loss, craniofacial abnormalities) have a 10- to 20-fold higher risk than the general population, according to a clinical summary of the recommendation. However, about half of all newborns who have permanent bilateral congenital hearing loss do not have any known risk factors.
An "Exciting" Recommendation
A. Stevens Wrightson, M.D., an assistant professor in the Department of Family and Community Medicine at the University of Kentucky, Lexington, calls the new USPSTF recommendation "exciting" and says that the "evidence is mounting that there is some improvement seen in children who are screened early" and receive appropriate management.
Wrightson adds that he sees very little downside to screening newborns for hearing loss, pointing out that this screening is called for in many states. One possible hazard of screening, he notes, is the possibility that a false-positive result might increase anxiety for parents. However, he adds, "parent education and follow-up can help" when dealing with any positive testing result.
Wrightson adds that he sees very little downside to screening newborns for hearing loss, pointing out that this screening is called for in many states. One possible hazard of screening, he notes, is the possibility that a false-positive result might increase anxiety for parents. However, he adds, "parent education and follow-up can help" when dealing with any positive testing result.
Mounting Evidence
Permanent congenital hearing loss occurs in one to three per 1,000 live births, a figure that is higher than that for any other condition for which newborns are screened, according to the task force. Children with hearing loss may experience difficulty learning various aspects of verbal communication and delays in language and speech development. They also may demonstrate low educational attainment and have behavior problems, low self-esteem and problems adapting to new situations.
The USPSTF examined evidence showing that newborns who were screened for hearing loss had earlier referral, diagnosis and initiation of treatment than those who were not screened. Infants who had true hearing impairment were referred for treatment before age 6 months at a much higher rate when universal screening protocols were in place than when the screening was not offered (74 percent versus 31 percent, respectively).
In addition, the task force found that language scores among 8-year-old children with bilateral permanent hearing impairment who had been screened for hearing loss as newborns were moderately higher than among those who had not been screened. The age at which children with hearing loss were diagnosed also had a significant effect on their receptive vocabulary, and children who were enrolled in an early child hearing intervention program were better able to learn receptive and expressive language.
The task force found limited evidence on the harms of both screening and treating newborns for hearing loss. Mothers in one fair-quality study showed no difference in anxiety and attitude toward their infants' scores on these screening tests regardless of whether their infants passed or did not pass. Other evidence suggested that among infants who require cochlear implant surgery, a slightly increased risk of meningitis may persist for several years after the surgery.
The USPSTF examined evidence showing that newborns who were screened for hearing loss had earlier referral, diagnosis and initiation of treatment than those who were not screened. Infants who had true hearing impairment were referred for treatment before age 6 months at a much higher rate when universal screening protocols were in place than when the screening was not offered (74 percent versus 31 percent, respectively).
In addition, the task force found that language scores among 8-year-old children with bilateral permanent hearing impairment who had been screened for hearing loss as newborns were moderately higher than among those who had not been screened. The age at which children with hearing loss were diagnosed also had a significant effect on their receptive vocabulary, and children who were enrolled in an early child hearing intervention program were better able to learn receptive and expressive language.
The task force found limited evidence on the harms of both screening and treating newborns for hearing loss. Mothers in one fair-quality study showed no difference in anxiety and attitude toward their infants' scores on these screening tests regardless of whether their infants passed or did not pass. Other evidence suggested that among infants who require cochlear implant surgery, a slightly increased risk of meningitis may persist for several years after the surgery.
AAFP's Position
The AAFP's current stance on screening newborns for hearing loss is that the evidence is insufficient to recommend for or against screening. However, according to Herbert Young, M.D., director of the AAFP Scientific Activities Division, the Academy's Commission on Science will review the new USPSTF recommendation soon and decide whether to change the Academy's take on the issue.
