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Challenges of Implementing Universal Newborn Hearing Screening at a Tertiary Care Centre from India

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Abstract

Objectives

To report experience of implementing universal newborn hearing screening (UNHS) in a tertiary care neonatal unit, identify risk factors associated with failed two-step automated acoustic brainstem response (AABR) screen and evaluate cost of AABR.

Methods

This was a prospective study of UNHS outcomes of all live births with two step AABR using BERAphone MB11®. Outcome measures were screening coverage, refer, pass and lost to follow up rates and cost of AABR using micro-costing method. To identify risk factors for failed screening, authors performed multivariate logistic regression with failed two-step AABR screen as dependent variable and baseline risk factors significant on univariate analysis as predictors.

Results

Screening coverage was moderate (84 %), with 2265 of total 2700 eligible infants screened with initial AABR (mean gestation 37.2 ± 2.3 wk; birth weight 2694 ± 588 g; 305 received nursery care). A total of 273 of 2265 infants were “refer” on first screen. Second screen was done on 233, of which 58 were “refer”. Of these, 35 underwent conventional ABR, of which 5 were diagnosed to have hearing impairment. Only 2 could get hearing aid. Overall, a total of 2197 (81.4 %) infants passed, 496 (18.4 %; excluding 2 deaths) were lost to follow up at various stages, and 5 (0.2 %) were diagnosed with hearing impairment, all of whom were high risk. Average cost of AABR was INR 276 per test. No factor emerged as significant on multivariate analysis.

Conclusions

UNHS is feasible to implement, but significant lost to follow up and non-linkage with appropriate rehabilitation services limit its utility. Cost effectiveness of UNHS compared to high risk based screening needs to be determined.

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Acknowledgments

The authors would like to thank Ms. Ritu, technician in ENT for doing conventional ABR for the index infants.

Contributions

SG conceptualized and wrote manuscript, SS did AABR and follow up, CPY helped with statistical analysis, AT provided logistic support and also reviewed manuscript, MS, RA, AKD and VKP critically reviewed the manuscript. TS did the cost analysis and MJS provided study oversight and critically reviewed the manuscript. RA will act as guarantor for this paper.

Conflict of Interest

None.

Source of Funding

Indian Council of Medical Research (ICMR), Delhi.

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Authors and Affiliations

  1. Newborn Health Knowledge Centre (NHKC), Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India

    Shuchita Gupta, Sandhya Sah, Tapas Som, Manju Saksena, M. Jeeva Sankar, Ramesh Agarwal, Ashok K. Deorari & Vinod K. Paul

  2. Department of Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

    Chander Prakash Yadav

  3. Department of ENT, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

    Alok Thakar

Authors
  1. Shuchita Gupta
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  2. Sandhya Sah
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  3. Tapas Som
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  4. Manju Saksena
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  5. Chander Prakash Yadav
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  6. M. Jeeva Sankar
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  7. Alok Thakar
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  8. Ramesh Agarwal
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  9. Ashok K. Deorari
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  10. Vinod K. Paul
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Corresponding author

Correspondence to Ramesh Agarwal.

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Gupta, S., Sah, S., Som, T. et al. Challenges of Implementing Universal Newborn Hearing Screening at a Tertiary Care Centre from India. Indian J Pediatr 82, 688–693 (2015). https://doi.org/10.1007/s12098-015-1688-4

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  • DOI: https://doi.org/10.1007/s12098-015-1688-4

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