title: Newborns at risk of sensorineural hearing loss in low-income countries.
abstract: OBJECTIVE
  To identify factors placing newborns at risk of sensorineural hearing loss (SNHL) in hospital settings and evaluate their usefulness for targeted screening where resources for universal newborn hearing screening are limited.
  
  
  METHODS
  Correlates of pre-discharge screen failure following two-stage universal hearing screening with transient-evoked otoacoustic emissions and automated auditory brainstem response were explored in a tertiary maternity hospital in Lagos, Nigeria.
  
  
  RESULTS
  4115 (88.7%) of 4641 eligible babies were enrolled and of the 3927 who completed screening, 127 (3.2%) failed. Emergency caesarean section, vaginal delivery, 5 min Apgar scores <5 and hyperbilirubinaemia requiring phototherapy emerged as independent risk factors after multivariable logistic regression. While the model's overall discriminative power was low (c statistic = 0.583), the combination of low 5 min Apgar scores and hyperbilirubinaemia requiring phototherapy as possible pre-screening tools showed high specificity (90.7%) and negative predictive value (97.0%).
  
  
  CONCLUSIONS
  Factors associated with the risk of SNHL are of limited predictive value but may guide primary prevention initiatives and serve as pre-screening tools in poorly-resourced settings.
authors.affiliation: Unit of Audiological Medicine, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, London, UK. boolusanya@aol.com
authors.forename: B O
authors.initials: BO
authors.lastname: Olusanya
mesh_terms: D001034:Apgar Score; D003906:Developing Countries; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis* / Q000209:etiology*; D006320:Hearing Tests / Q000379:methods; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000150:complications; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening / Q000379:methods; D009549:Nigeria; D017084:Otoacoustic Emissions, Spontaneous; D012307:Risk Factors