All newborns should be screened in the first month of life to detect those with permanent congenital hearing loss (PCHL), the U.S. Preventive Services Task Force (USPSTF) has recommended as a result of new evidence that screening tests are highly accurate and lead to earlier identification and treatment of infants with hearing loss. The analysis that spurred the recommendation was performed by researchers at the Oregon Evidence-based Practice Center at Oregon Health & Science University.
The Task Force recommended the move to universal screening because half of the children with hearing loss have no identifiable risk factors that could be used in selective screening programs to detect PCHL. Their recommendation carried moderate certainty, they stated, “that the net benefit of screening all newborns for hearing loss is moderate.”
There is good evidence, they said, that newborn hearing screening testing is highly accurate and leads to earlier identification than no screening. There is also good-quality evidence, they said, that early detection improves language outcomes. And the overall risks of complications of screening and treatment, they said, were estimated to be small.
The Task Force, an independent panel of experts sponsored by the Agency for Healthcare Research and Quality (AHRQ), based its conclusion on a study of recent medical literature led by Heidi D. Nelson, M.D., M.P.H., of the Oregon Evidence-based Practice Center (EPC) at Oregon Health & Science University and of Providence Health & Services. The study was conducted under a contract with AHRQ, the unit of the U.S. Department of Health & Human Services charged with improving the quality, safety, efficiency and effectiveness of health care in the United States. The findings are detailed in the July issue of Pediatrics.
“This represents a major practice change affecting millions of newborns,” said Nelson. “Newborn hearing screening has become routine in the postpartum hospital setting in some states, such as Oregon, but this recommendation could bring the whole country up to this standard. It’s well accepted and tolerated by newborns and their parents. The instruments, which are designed specifically for newborns, can easily test and record findings in less than five minutes, usually while babies are asleep,” she said.
Information from a universal newborn hearing screening program initiated in 2000 at Providence St. Vincent Medical Center was presented to the USPSTF to illustrate how well screening can be done in a U.S. health care system. This initiative serves as a pilot program for a Centers for Disease Control and Prevention- sponsored system to track newborns who did not pass the screening test.
Nelson has joint appointments at OHSU and Providence Health & Services. She is a research professor in the OHSU Departments of Medical Informatics and Clinical Epidemiology and Medicine and medical director of the Providence Regional Women and Children’s Program and Health Research Center.
“The rate of PCHL among newborns ranges from 1 to 3 per 1,000 live births,” the researchers reported. “Compared with children with normal hearing, those with hearing loss have more difficulty learning vocabulary, grammar word order, idiomatic expressions, and other aspects of verbal communication. Hearing loss in children is also associated with delayed language, learning, and speech development and with low educational attainment. Hearing disorders have also been associated with increased behavior problems, decreased psychosocial well-being, and poor adaptive skills.”
In 2001 the USPSTF concluded there was insufficient evidence to recommend either for or against universal screening. The evidence that routine screening of newborns led to clinically important improvement in speech and language skills at age 3 years and beyond was inconclusive, they said. Since then, additional studies particularly in the United Kingdom have shown that children with hearing loss who had universal newborn hearing screening have better language outcomes at school age than those not screened. And infants identified with hearing loss through universal screening have significantly earlier referral, diagnosis, and treatment than those identified in other ways.
Universal newborn screening has been mandated in 39 states. The Joint Committee on Infant Hearing (JCIH) has endorsed integrated, interdisciplinary state and national systems of universal screening. JCIH comprises representatives from the American Academy of Pediatrics, the American Academy of Otolaryngology and Head and Neck Surgery, the American Speech Language Hearing Association, the American Academy of Audiology, the Council on Education of the Deaf, and Directors of Speech and Hearing Programs in State Health and Welfare Agencies.
The USPSTF is the leading independent panel of private-sector experts in prevention and primary care and conducts rigorous, impartial assessments of the scientific evidence for a broad range of preventive services. Its recommendations are considered the gold standard for clinical preventive services.
For further information about the USPSTF recommendation, go to: www.ahrq.gov/clinic/uspstf/uspsnbhr.htm
About the Oregon Evidence-based Practice Center
The Oregon Evidence-based Practice Center (Oregon EPC) at OHSU conducts systematic reviews of health care topics for federal and state agencies and private foundations. These reviews report the evidence from clinical research studies and the quality of that evidence for use by policymakers in decisions on guidelines and coverage issues. Directed by Mark Helfand, M.D., M.P.H., the Oregon EPC began in 1997 with funding from the Agency for Healthcare Research and Quality (AHRQ). It is a collaboration of Oregon Health & Science University, the Portland Veterans Affairs Medical Center, and the Kaiser Permanente Center for Health Research. The EPC has received funding from AHRQ, Drug Effectiveness Review Program, and the National Institutes of Health. Investigators come from a wide variety of disciplines within the OHSU Schools of Medicine and Nursing as well as the Portland VAMC and the Kaiser Center for Health Research.