Main outcomes of a newborn hearing screening program in Belgium over six years

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Abstract

Objective

To present the outcomes of the newborn hearing screening program in Belgium (French-speaking area) since its implementation and to analyze its evolution between 2007 and 2012 in the neonatal population without reported risk factors for hearing loss.

Methods

The study was descriptive and based on a retrospective analysis of six annual databases (2007–2012) from the newborn hearing screening program. The main outcomes were identified: prevalence of reported hearing impairment; coverage rates (first and second test, follow-up); proportions of conclusive screening tests; referral rate. Each outcome was presented for the six years and by year of birth. Chi-squares were used to study differences in the various outcomes according to time.

Results

Over the six years, 264,508 newborns were considered as eligible for the screening. Hearing impairment was confirmed in 1.41‰ (n = 374) of them, with significant disparities from year to year, between 0.67‰ and 1.94‰. Analysis of the screening process showed that only 92.71% (n = 245,219) of the eligible newborns underwent a first hearing test. This coverage rate varied greatly over time: at the beginning, less than 90% of the newborns had a first test and it rose to almost 95%. After the two screening steps, 2.40% (n = 6340) of the newborns were referred to an ENT doctor; the referral rate slightly decreased during the first years of the program and then stabilized around 2.4%. Over the period, only 62.21% of the referred newborns had a follow-up; the follow-up rate was particularly low for the first year (44.91%) and then strongly increased (+19.52% in 2008) but never exceeded 70%.

Conclusions

Outcome measures for the newborn hearing screening program in Belgium are lower than the benchmarks released by the Joint Committee on Infant Hearing. Nevertheless, the evolution of the outcome measures since the implementation of the program has been positive, particularly during the first years. At some point, most of the outcome measures decreased or at least did not change any further. The motivation and commitment of the professionals have to be supported in a variety of ways to improve outcome measures and thus, the quality of the program.

Introduction

European, American and international groups of experts have recommended the organization of universal newborn hearing screening (UNHS) for years [1], [2], [3], [4]. The main purpose of a UNHS is to lower the age of hearing-impaired children at the time of diagnosis allowing earlier intervention. According to the Joint Committee on Infant Hearing (JCIH), comprehensive audiological assessment should be performed before 3 months of age, and appropriate intervention should begin before 6 months of age [2].

In the well-baby nursery population, prevalence of “significant bilateral hearing impairment” (HI), whose consequences are particularly severe for children’s development, is 1–3 per thousand newborns [5]. However, UNHS programs aim to identify all kinds and degrees of HI among the bilateral or unilateral hearing-impaired newborns [2].

To assess UNHS programs, benchmarks and quality indicators have been released. The JCIH published the most frequently used benchmarks which are primarily related to the outcomes of the implemented UNHS programs, expressed as the minimum proportion of children who should be screened or who should be referred to an ENT doctor, or the proportion of duly followed up newborns, required to be considered as a high-quality program [2], [5].

UNHS programs have been implemented in different countries or areas and a lot of reports and studies have been published about the organization, protocols, and main outcomes of the programs [6], [7], [8], [9], [10]. In Belgium, the Fédération Wallonie-Bruxelles (FWB) (French-speaking area) has implemented a UNHS program since 2007, in collaboration with maternity hospitals.

The objectives of this study were to present the outcomes of the UNHS in the FWB since the beginning of the program and to analyze its evolution between 2007 and 2012 in the neonatal population free of risk factors for hearing loss. Specific outcome measures of UNHS programs, especially those defined by the JCIH, were used to assess the quality of the program and its potential development. In the discussion section, outcomes from the UNHS program in the FWB were compared to those from other UNHS programs.

Section snippets

Study design

Study design was descriptive and based on a retrospective analysis of six annual databases (2007–2012) from the UNHS program in the FWB. The same data management was applied annually to each database, and after the closure of the annual reports no new or updated hearing results or diagnosis were added to the database.

Population

Around 55,000 children were born annually in the FWB. In 2007, the FWB contained 50 maternity hospitals; three maternity wards were closed in 2008, and one more in 2010.

UNHS protocol

Parental refusal, wish to have the screening performed by the Flemish UNHS program or by another institution/ENT doctor

Among the 271,983 children without reported risk factors for hearing loss born between 2007 and 2012 in the participating hospitals, the proportions of parental refusal, parental wish to have the test performed by the Flemish program or by another institution/ENT doctor were 0.59%, 1.41%, and 0.76%, respectively (Fig. 2). Over the six years, the annual proportion of parental refusal regularly decreased, from 1.07% in 2007 to 0.25% six years later. On the other hand, the proportion of parents

Discussion

A major objective of a newborn hearing screening program is to identify children with HI, and to lower the age at the time of diagnosis. In our study, prevalence of HI reported by the UNHS program was 1.41‰ over the six years. This reported prevalence varied over the years: it was rather low in 2007 (0.67‰) and sharply increased to around 1.90‰ in 2008 and 2009. This improvement is due to better collaboration with the ENT doctors about notification of HI in databases: to improve quality data

Conclusion

Outcome measures for the UNHS program in the FWB were slightly lower than the benchmarks released by the JCIH. Nevertheless, despite the difficulty in comparing with other programs, some outcomes from the program in the FWB were similar or higher, while some outcomes (such as screening coverage or follow-up coverage) clearly needed to be improved. Completeness and quality of data particularly deserve the attention of the professionals involved in the program. The evolution of outcome measures

Conflict of interest

The authors declare that they have no competing interests.

Funding source

The Fédération Wallonie-Bruxelles funded the newborn hearing screening program and had no other involvement in this article.

Authorship

Bénédicte Vos participated in the design of the study, performed the data management and the statistical analysis, and drafted the manuscript. Raphaël Lagasse and Alain Levêque participated in the design of the study, in the editing of the manuscript and critically reviewed the text. All authors read and approved the final manuscript.

Acknowledgements

The authors would like to thank the maternity hospitals and their staff for participating in the program and the neonatal blood screening centers. They also would like to thank ISO Translation for the editing of the manuscript.

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