title: Challenges of Implementing Universal Newborn Hearing Screening at a Tertiary Care Centre from India.
abstract: OBJECTIVE
  To report experience of implementing universal newborn hearing screening (UNHS) in a tertiary care neonatal unit, identify risk factors associated with failed two-step automated acoustic brainstem response (AABR) screen and evaluate cost of AABR.
  
  
  METHODS
  This was a prospective study of UNHS outcomes of all live births with two step AABR using BERAphone MB11®. Outcome measures were screening coverage, refer, pass and lost to follow up rates and cost of AABR using micro-costing method. To identify risk factors for failed screening, authors performed multivariate logistic regression with failed two-step AABR screen as dependent variable and baseline risk factors significant on univariate analysis as predictors.
  
  
  RESULTS
  Screening coverage was moderate (84 %), with 2265 of total 2700 eligible infants screened with initial AABR (mean gestation 37.2 ± 2.3 wk; birth weight 2694 ± 588 g; 305 received nursery care). A total of 273 of 2265 infants were "refer" on first screen. Second screen was done on 233, of which 58 were "refer". Of these, 35 underwent conventional ABR, of which 5 were diagnosed to have hearing impairment. Only 2 could get hearing aid. Overall, a total of 2197 (81.4 %) infants passed, 496 (18.4 %; excluding 2 deaths) were lost to follow up at various stages, and 5 (0.2 %) were diagnosed with hearing impairment, all of whom were high risk. Average cost of AABR was INR 276 per test. No factor emerged as significant on multivariate analysis.
  
  
  CONCLUSIONS
  UNHS is feasible to implement, but significant lost to follow up and non-linkage with appropriate rehabilitation services limit its utility. Cost effectiveness of UNHS compared to high risk based screening needs to be determined.
authors: Newborn Health Knowledge Centre (NHKC), Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
authors: Shuchita
authors: S
authors: Gupta
authors: Sandhya
authors: S
authors: Sah
authors: Tapas
authors: T
authors: Som
authors: Manju
authors: M
authors: Saksena
authors: Chander Prakash
authors: CP
authors: Yadav
authors: M Jeeva
authors: MJ
authors: Sankar
authors: Alok
authors: A
authors: Thakar
authors: Ramesh
authors: R
authors: Agarwal
authors: Ashok K
authors: AK
authors: Deorari
authors: Vinod K
authors: VK
authors: Paul
mesh_terms: D016057:Evoked Potentials, Auditory, Brain Stem / Q000502:physiology*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006311:Hearing Disorders / Q000175:diagnosis*; D006801:Humans; D007194:India; D007223:Infant; D007231:Infant, Newborn; D015997:Neonatal Screening / Q000191:economics / Q000379:methods*; D011446:Prospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers
references: Laryngoscope. 2005 Nov;115(11):1957-62
references: 16319605
references: Indian Pediatr. 2011 May;48(5):355-9
references: 21654001
references: Int J Pediatr Otorhinolaryngol. 2008 Aug;72(8):1193-201
references: 18550180
references: J Laryngol Otol. 2007 Jul;121(7):639-43
references: 17112395
references: Pediatrics. 2001 Mar;107(3):E29
references: 11230610
references: Indian J Pediatr. 2007 Jun;74(6):545-9
references: 17595496
references: Laryngoscope. 2011 Oct;121(10):2245-9
references: 21898430
references: Int J Pediatr Otorhinolaryngol. 2004 Jul;68(7):927-34
references: 15183584
references: Pediatrics. 2007 Oct;120(4):898-921
references: 17908777
references: Int J Pediatr Otorhinolaryngol. 2012 Apr;76(4):536-43
references: 22310071
references: Int J Pediatr Otorhinolaryngol. 2003 Oct;67(10):1099-104
references: 14550964
references: Acad Pediatr. 2012 May-Jun;12(3):171-80
references: 22583631
references: Indian Pediatr. 2014 Mar;51(3):215-7
references: 24736910
references: Indian Pediatr. 2014 Mar;51(3):179-83
references: 24277966