Potential pitfalls of initiating a newborn hearing screening program.

OBJECTIVE To examine the efficacy of a universal screening program for infant hearing. DESIGN Retrospective analysis. SETTING Tertiary care center. PATIENTS We examined 2289 (90.2%) of 2537 infants born at our institution from April 1, 1995, to June 30, 1996, for hearing loss (HL). INTERVENTIONS We used a 3-stage protocol with transient evoked otoacoustic emissions (TEOAE) in stages 1 and 2 and diagnostic evaluation in stage 3. Infants without reproducible TEOAEs in either ear after stage 2 were referred to stage 3. MAIN OUTCOME MEASURES Specificity of TEOAE, incidence of HL, prevalence of risk factors for HL, cost of TEOAE screening, and identification of barriers to universal screening. RESULTS Of the infants undergoing TEOAE screening, 91.1% passed stage 1. Of infants needing repeated testing, 73.7% passed and 26.2% failed. Of the 43 infants referred for diagnostic evaluation, 5 (11.6%) had HL. The combined incidence of conductive and sensorineural HL was 2.18 per 1000 newborns. The prevalence of at least 1 risk factor for HL was 10.4%. The estimated cost of TEOAE screening was $24.48 per infant. Ten percent of infants did not undergo screening due to program deficiencies. CONCLUSIONS Screening with TEOAE was sufficiently specific for universal screening. However, we were unable to achieve truly universal screening. This is probably the reason for our lower incidence of sensorineural HL. We were unable to continue our universal newborn screening program, due to lack of funding, difficulties with program implementation, and our low incidence of detected HL.