A regional-based newborn hearing screening program: the Emilia-Romagna model after ten years of legislation
Keywords:
Newborn hearing screening, hearing loss, children, regional legislation, epidemiologyAbstract
Background. Hearing loss, occurring in 1-3/1,000 newborns in the well-babies population, is one of the most common congenital diseases, and hearing screening at birth still represents the only means for its early detection. Since 2011 the Emilia Romagna Regional Health Agency has recommended Newborn Hearing Screening for all babies at its birth points and for newborns moving to the region. The aims of this study are to analyze the results of this regional-based Newborn Hearing Screening program and to discuss the impact of the legislative endorsement on the organization.
Material and methods. This is an observational retrospective chart study. The recordings of well-babies and babies at Neonatal Intensive Care Units were collected during the period from January 1st 2015 to December 31st 2020. The following data were included: Newborn Hearing Screening coverage, percentage of refer at otoacoustic emissions, prevalence and entity of hearing loss, unilateral/bilateral rate, presence of audiological risk factors.
Results. More than 99% of a total of 198,396 newborns underwent the Newborn Hearing Screening test during the period January 1st 2015 to December 31st 2020, with a coverage ranging between 99.6% and 99.9%. Overall, the percentage of confirmed hearing loss cases was about 17-30 % of refer cases, 745 children received a diagnosis of hearing loss (prevalence 3.7/1,000). Considering profound hearing loss cases, these represent 13% of bilateral hearing loss.
Conclusions. A regional-based Newborn Hearing Screening program is valuable and cost-effective. In our experience, the centralization of the data system and of the data control is crucial in order to implement its efficiency and effectiveness. Healthcare policies, tracking systems and public awareness are decisive for a successful programme implementation.
References
1. van Beeck Calkoen EA, Engel MSD, van de Kamp JM, et al. The etiological evaluation of sensorineural hearing loss in children. Eur J Pediatr. 2019 Aug; 178(8): 1195-205. doi:10.1007/s00431-019-03379-8. Epub 2019 May 31.
2. Neumann K, Mathmann P, Chadha S, Euler HA, White KR. Newborn Hearing Screening Benefits
Children, but Global Disparities Persist. J Clin Med. 2022 Jan 5; 11(1): 271. doi: 10.3390/ jcm11010271.
3. Cupples L, Ching TYC, Leigh G, et al. Language development in deaf or hard-of-hearing children with additional disabilities: type matters! J Intellect Disab Res. 2018 Jun; 62(6): 532-43. doi:
10.1111/jir.12493.
4. Jenks CM, DeSell M, Walsh J. Delays in Infant Hearing Detection and Intervention During the COVID-19 Pandemic: Commentary. Otolaryngol Head Neck Surg. 2022 Apr; 166(4): 603-4. doi: 10.1177/01945998211067728. Epub 2021 Dec 21.
5. Ching TYC, Dillon H, Leigh G, Cupples L. Learning from the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study: Summary of 5-year findings and implications. Int J Audiol. 2018 May; 57(Suppl 2): S105S111. doi: 10.1080/14992027.2017.1385865. Epub 2017 Oct 12.
6. Yoshinaga-Itano C, Sedey AL, Coulter DK, Mehl AL. Language of early- and later-identified children with hearing loss. Pediatrics. 1998 Nov; 102(5): 1161-71. doi: 10.1542/ peds.102.5.1161.
7. Korver AM, Konings S, Dekker FW, et al. Newborn hearing screening vs later hearing screening and developmental outcomes in children with permanent childhood hearing impairment. JAMA. 2010 Oct 20; 304(15): 1701-8. doi: 10.1001/jama.2010.1501.
8. Malesci R, Del Vecchio V, Bruzzese D, et al. Performance and characteristics of the Newborn Hearing Screening Program in Campania region (Italy) between 2013 and 2019. Eur Arch Otorhinolaryngol. 2022 Mar; 279(3): 1221-31. doi: 10.1007/s00405-021-06748-y. Epub 2021 Mar 25.
9. Joint Committee on Infant Hearing. Year 2019 position statement: principles and guidelines for early hearing detection and intervention programs. JEHDI. 2019; 4(2): 1-44.
10. Bubbico L, Ferlito S, Antonelli G, Martini A, Pescosolido N. Hearing and Vision Screening
Program for newborns in Italy. Ann Ig. 2021 SepOct; 33(5): 433-42. doi: 10.7416/ai.2020.2401. Epub 2020 Dec 11.
11. Giunta della Regione Emilia Romagna. GPG/2011/498. Screening uditivo neonatale e percorso clinico ed organizzativo per i bambini affetti da ipoacusia in Emilia-Romagna. Approvazione linee guida per le aziende sanitarie. 23 maggio 2011, n. 694. BUR Emilia Romagna 6 July 2011: 18-49.
12. Alzahrani M, Tabet P, Saliba I. Pediatric hearing loss: common causes, diagnosis and therapeutic approach. Minerva Pediatr. 2015 Feb; 67(1): 75-90. Epub 2014 Oct 14.
13. Wroblewska-Seniuk KE, Dabrowski P, Szyfter W, Mazela J. Universal newborn hearing screening: methods and results, obstacles, and benefits. Pediatr Res. 2017 Mar; 81(3): 415-22. doi: 10.1038/pr.2016.250. Epub 2016 Nov 18.
14 World Health Organization (WHO). Hearing Screening: Considerations for Implementation. Geneva, Switzerland: WHO; 2021. Available on: https://www.who.int/publications/i/ item/9789240032767 [Last accessed: 2022, May 29].
15. Mehl AL, Thomson V. Newborn hearing screening: the great omission. Pediatrics. 1998 Jan; 101(1): E4. doi: 10.1542/peds.101.1.e4.
16. Hyde ML. Newborn hearing screening programs: Overview. J Otolaryngol. 2005; 34 (Suppl. 2): S70-S78.
17. Holzinger D, Binder D, Raus D, Palmisano G, Fellinger J. Development and Implementation of a Low-Cost Tracking System after Newborn Hearing Screening in Upper Austria: Lessons Learned from the Perspective of an Early Intervention Provider. Children (Basel). 2021 Aug 28; 8(9): 743. https://doi.org/10.3390/ children8090743.
18. Akinpelu OV, Peleva E, Funnell WR, Daniel SJ. Otoacoustic emissions in newborn hearing screening: a systematic review of the effects of different protocols on test outcomes. Int J Pediatr Otorhinolaryngol. 2014 May; 78(5): 711-7. doi: 10.1016/j.ijporl.2014.01.021. Epub 2014 Jan 27.
19. Yang HC, Sung CM, Shin DJ, Cho YB, Jang CH, Cho HH. Newborn hearing screening in prematurity: fate of screening failures and auditory maturation. Clin Otolaryngol. 2017 Jun; 42(3): 661-7. doi: 10.1111/coa.12794. Epub 2016 Dec 7.
20. Sato T, Nakazawa M, Takahashi S, Mizuno T, Ishikawa K, Yamada T. Outcomes of regionalbased newborn hearing screening for 35,461 newborns for 5 years in Akita, Japan. Int J Pediatr Otorhinolaryngol. 2020 Apr; 131: 109870. doi: 10.1016/j.ijporl.2020.109870. Epub 2020 Jan 10.
21. Chiou ST, Lung HL, Chen LS, Yen, et al. Economic evaluation of long-term impacts of universal newborn hearing screening. Int J Audiol. 2017 Jan; 56(1): 46-52. doi: 10.1080/14992027.2016.1219777. Epub 2016 Sep 6.
22. Sharma R, Gu Y, Ching TYC, Marnane V, Parkinson B. Economic evaluations of childhood hearing loss screening programmes: A systematic review and critique. Appl Health Econ Health Policy. 2019 Jun; 17(3): 331-57. doi: 10.1007/ s40258-018-00456-1.
23. Joint Committee on Infant Hearing. Year 2007 position statement: principles and guidelines for early hearing detection and intervention programs. Pediatrics. 2007 Oct; 120(4): 898-921. doi: 10.1542/peds.2007-2333.
24. Bussé AML, Hoeve HLJ, Nasserinejad K, Macke AR, Simonsz HJ, Goedegebure A. Prevalence of permanent neonatal hearing impairment: Systematic review and Bayesian meta-analysis. Int J Audiol. 2020 Jun; 59(6): 475-85. doi: 10.1080/14992027.2020.1716087. Epub 2020 Feb 3.
Downloads
Published
Issue
Section
License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.