Original Articles
Efficacy of automated auditory brainstem response hearing screening in very preterm newborns

https://doi.org/10.1067/mpd.2001.112646Get rights and content

Abstract

Objective: To investigate the efficacy of an automated auditory brainstem response (AABR) hearing screening method in very preterm newborns in the neonatal intensive care setting. Study design: In this prospective cohort study, 90 consecutive preterm newborns (<32 weeks’ gestational age) had AABR hearing screening weekly from birth until a bilateral pass result was obtained. If the newborn had a unilateral pass result, AABR screening was repeated in the same week. Data were analyzed by using the Kaplan-Meier survival function technique, resulting in a cumulative pass rate curve for postmenstrual age. Cox’s regression method was used to analyze the effect of co-variables, such as sex and growth restriction, on pass rates. Results: Median gestational age was 29.5 weeks (range, 25.3-31.9 weeks), and median birth weight was 1115 g (range, 600-1960 g). Mean age was 6.2 days (SD 4.3) at first test, 15.7 (SD 8.1) at second test, and 21.4 (SD 8.6) at third test. Eighty percent (CI: 70.2%-89.8%) of the newborns passed at 30.3 weeks’ postmenstrual age, 90% (CI: 83.6%-96.4%) passed at 31.2 weeks, and 100% passed at 34 weeks’ postmenstrual age. The attainment of these pass rates correlated to postmenstrual age was not significantly influenced by sex, growth restriction, or gestational age at birth. Postnatal pass rates (in days) were strongly influenced by gestational age. Conclusion: AABR pass rates of >80% can be obtained from 30 weeks’ postmenstrual age. Therefore AABR neonatal hearing screening can be used before discharge from a neonatal intensive care unit. (J Pediatr 2001;138:674-8)

Section snippets

Methods

This prospective cohort study was performed in 2 NICUs in the Netherlands from January 1998 to December 1998. All newborns were included after parental consent was obtained. Inclusion criteria were gestational age <32 weeks with or without any of the at-risk criteria according to the JCIH. Exclusion criteria were congenital malformations or syndromal manifestations known to be associated with congenital hearing loss. After birth, AABR hearing screening was performed weekly until a bilateral

Results

AABR hearing screening was carried out in 90 newborns. No children were excluded. The median gestational age was 29.6 weeks (range, 25.1-31.9 weeks), and the median birth weight was 1115 g (range, 600-1960 g). Fig 1 shows the distribution of risk factors according to criteria of the JCIH.

. Distribution of risk factors according to the JCIH.

First tests were performed 20 times, and second tests were performed 8 times while newborns were receiving ventilatory assistance.

A pass or negative result was

Discussion

In this prospective cohort study, weekly AABR hearing screening showed a pass rate of 80% from 30 weeks’ postmenstrual age on, 90% from 31 weeks on, and a 100% pass rate at 34 weeks’ postmenstrual age in newborns with normal hearing. Gestational age was not a significantly determining factor on pass rates for postmenstrual age.

Neonatal hearing screening is rapidly becoming “standard care” in the United States according to the 1994 JCIH consensus statement.5 The European Consensus Development

References (18)

There are more references available in the full text version of this article.

Cited by (28)

  • Is antenatal corticosteroids exposure associated with hearing loss in preterm infants? A systematic review and meta-analysis

    2023, American Journal of Otolaryngology - Head and Neck Medicine and Surgery
    Citation Excerpt :

    Recent advances in intensive care technology have improved the survival rate of premature infants [4]. However, complications associated with preterm birth, including hearing loss, did not decrease [5,6]. The incidence rate of hearing loss is still varying from 0.2 % to 6.4 % [7].

  • Maturation of the auditory system in normal-hearing newborns with a very or extremely premature birth

    2020, Pediatrics and Neonatology
    Citation Excerpt :

    An automated auditory brainstem response (AABR) hearing screening is advised for screening in the Neonatal Intensive Care Units (NICU) population [Joint Committee of Infant Hearing (JICH) position statement] from 34 weeks' postmenstrual age (PMA) onward.10 However, a longitudinal study among 90 very and extremely preterm babies showed that AABR pass rates of >80% can already be obtained from 30 weeks’ PMA.11 Screening at a relatively low PMA may have the advantage of a low loss to follow-up, but only when the pass rate is sufficiently high.

  • Limitations and drawbacks of the hospital-based universal neonatal hearing screening program: First report from the Arabian Peninsula and insights

    2020, International Journal of Pediatric Otorhinolaryngology
    Citation Excerpt :

    In 1993, the National Institute of Health (NIH) recommended an immediate ABR after a failed initial TEOAE test to reduce the loss to follow up rate at each level because of its high pass rate (96.3%) in comparison to TEOAE (66.7%) when implemented a few hours after birth. Despite its high cost, it is considered the preferred test in cases of early hospital discharge [33–36]. A combination of TEOAE and Automated ABR (AABR) tests as a two-stage screening has been found to have the most favourable combination of specificity, sensitivity, referral rates, and cost-effectiveness [37].

  • Neurodevelopment outcomes

    2020, Environmental Epigenetics in Toxicology and Public Health
  • Newborn hearing screening at the Neonatal Intensive Care Unit and Auditory Brainstem Maturation in preterm infants

    2019, International Journal of Pediatric Otorhinolaryngology
    Citation Excerpt :

    An improper identification and early rehabilitation of hearing loss in infants is known to be responsible for an incomplete/delayed or absent development of speech and language, according to the grade of hearing loss, with negative impact on cognitive development, and with scholastic and social-economic implications [1,15]. The neonatal hearing screening (NHS) protocol for NICU newborns consists in performing a-TEOAE and a-ABR tests, as soon as possible, preferably before discharge [1,16]. a-ABR testing is important in order to identify hearing loss related to auditory neuropathy/dyssynchrony, typically affecting infants in need for NICU care [1,17].

  • Characterization of newborn hearing screening failures in multigestational births

    2018, International Journal of Pediatric Otorhinolaryngology
    Citation Excerpt :

    For children who fail or cannot undergo OAE testing, and for children in whom hearing loss is highly suspected (all NICU infants), auditory brainstem response (ABR) testing is often performed. ABR has limited utility in some pre-term infants, but when performed in infants of at least 34 weeks gestational age, the test has a sensitivity and specificity of 100% and >96%, respectively, making it an ideal test for such studies [7]. The rate of multigestational births (MGB) in the United States is 34.3 births per 1000 [8].

View all citing articles on Scopus

Reprint requests: H. L. M. van Straaten, MD, Isala Clinic, Location Sophia, PO Box 10400, 8025 AR Zwolle, The Netherlands.

View full text