Objective: This review is an update for the U.S. Preventive Services Task Force (USPSTF) on universal newborn hearing screening (UNHS) to detect moderate to severe permanent, bilateral congenital hearing loss. The review focuses on 3 key questions regarding the effectiveness of universal screening and early interventions in improving language and other outcomes in childhood, the effectiveness of universal screening in identifying infants with hearing loss and leading them to early interventions, and adverse effects of screening and early interventions.
Methodology: Literature searches of MEDLINE and Cochrane databases (2000–November 2007) were conducted to systematically identify articles addressing the 3 key questions published since the prior recommendation in 2001. Additional articles were obtained from reference lists of related reviews, studies, editorials, reports, websites, and by consulting experts. Articles were subjected to inclusion and exclusion criteria, data from included studies were abstracted, and studies were rated for quality with pre-determined criteria. Results were summarized descriptively in tables. An outcomes table estimating the number needed to screen was determined using estimates from the most relevant studies.
Results: A good-quality retrospective study of children with hearing loss indicates that those who had early versus late confirmation and those who had undergone UNHS versus none had better receptive language at age 8 years, but not better expressive language or speech. A good-quality nonrandomized trial of a large birth cohort indicates that infants identified with hearing loss through UNHS have earlier referral, diagnosis, and treatment than those not screened. These findings are corroborated by multiple descriptive studies of ages of referral, diagnosis, and treatment. Universal newborn hearing screening programs have low false-positive and referral rates and are generally well accepted and tolerated by parents of newborns. Studies indicate that usual parental reactions to an initial non-pass on a hearing screen include worry, questioning, and distress. These negative emotions resolve for most parents when a diagnostic test is provided with a normal result. Little information exists about the adverse effects of early interventions, although cochlear implants are associated with higher risks for bacterial meningitis in young children.
Conclusions: Children with hearing loss who had UNHS have better language outcomes at school age than those not screened. Infants identified with hearing loss through universal screening have significantly earlier referral, diagnosis, and treatment than those identified in other ways.