PEDIATRICS Vol. 122 No. 1 July 2008, pp. e266-e276 (doi:10.1542/peds.2007-1422)
REVIEW ARTICLE |
Universal Newborn Hearing Screening: Systematic Review to Update the 2001 US Preventive Services Task Force Recommendation
a Oregon Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology
b Department of Medicine, Oregon Health & Science University, Portland, Oregon
c Women and Children's Health Research Center, Providence Health and Services, Portland, Oregon
OBJECTIVE. This review is an update for the US Preventive Services Task Force on universal newborn hearing screening to detect moderate-to-severe permanent, bilateral congenital hearing loss. We focus on 3 key questions: (1) Among infants identified by universal screening who would not be identified by targeted screening, does initiating treatment before 6 months of age improve language and communication outcomes? (2) Compared with targeted screening, does universal screening increase the chance that treatment will be initiated by 6 months of age for infants at average risk or for those at high risk? (3) What are the adverse effects of screening and early treatment?
METHODS. Medline and Cochrane databases were searched to identify articles published since the 2002 recommendation. Data from studies that met inclusion criteria were abstracted, and studies were rated for quality with predetermined criteria.
RESULTS. A good-quality retrospective study of children with hearing loss indicates that those who had early versus late confirmation and those who had undergone universal newborn screening versus none had better receptive language at 8 years of age but not better expressive language or speech. A good-quality nonrandomized trial of a large birth cohort indicates that infants identified with hearing loss through universal newborn screening have earlier referral, diagnosis, and treatment than those not screened. These findings are corroborated by multiple descriptive studies of ages of referral, diagnosis, and treatment. Usual parental reactions to an initial nonpass on a hearing screen include worry, questioning, and distress that resolve for most parents. Cochlear implants have been associated with higher risks for bacterial meningitis in young children.
CONCLUSIONS. Children with hearing loss who had universal newborn hearing screening have better language outcomes at school age than those not screened. Infants identified with hearing loss through universal screening have significantly earlier referral, diagnosis, and treatment than those identified in other ways.
Key Words: evidence-based medicine • hearing impairment • hearing screening • newborn screening • systematic reviews
Abbreviations: USPSTF—US Preventive Services Task Force • UNHS—universal newborn hearing screening • PCHL—permanent congenital hearing loss • JCIH—Joint Committee on Infant Hearing • OAE—otoacoustic emission • ABR—auditory brainstem response • CI—confidence interval • NNS—number needed to screen
Accepted Jan 14, 2008.
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