Outcomes with OAE and AABR screening in the first 48 h--Implications for newborn hearing screening in developing countries.
OBJECTIVE
Early discharge of newborns (<24h after birth) from birthing centres is an important barrier to successful newborn hearing screening (NHS) in developing countries. This study evaluated the outcome of NHS within the first 48 h using an automated auditory brainstem response (AABR) device without the need for costly disposables typically required, and transient evoked otoacoustic emissions (TEOAE).


METHODS
NHS was performed on 150 healthy newborns (300 ears) with TEOAE and AABR techniques before discharge at a hospital. A three-stage screening protocol was implemented consisting of an initial screen with TEOAE (GSI AUDIOscreener+) and AABR (BERAphone(®) MB 11). Infants were screened at several time points as early as possible after birth. Infants were only re-screened if either screening technique (TEOAE or AABR) initially yielded a refer outcome. The same audiologist performed all TEOAE and AABR screenings.


RESULTS
Over the three-stage screen AABR had a significantly lower refer rate of 16.7% (24/144 subjects) compared to TEOAE (37.9%; 55/145 subjects). Screening refer rate showed a progressive decrease with increasing age. For both TEOAE and AABR, refer rate per ear screened 24h post birth was significantly lower than for those screened before 24h. For infants screened before 12h post birth, the AABR refer rate per ear (51.1%) was significantly lower than the TEOAE refer rate (68.9%). Overall AABR refer rate per ear was similar for infants screened between 24 to 36 h (20.2%) and 36 to 48 h (18.9%) but significantly lower than for TEOAE (40.7% and 41.9%, respectively). Lowest initial refer rates per ear (TEOAE 25.8%, AABR 3.2%) were obtained after 48 h post birth.


CONCLUSIONS
In light of the early post birth discharge typical in developing countries like South Africa, in-hospital screening with AABR technology is significantly more effective than TEOAEs. AABR screening with a device like the MB 11 is particularly appropriate because disposable costs are negligible.
Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa.
Michelle
M
van Dyk
Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa; Ear Sciences Centre, School of Surgery, The University of Western Australia, Nedlands, WA, Australia; Ear Science Institute Australia, Subiaco, WA, Australia. Electronic address: dewet.swanepoel@up.ac.za.
De Wet
de W
Swanepoel
Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa; Osborne College of Audiology, Salus University, Elkins Park, PA, USA.
James W
JW
Hall
D000367:Age Factors; D003906:Developing Countries; D016057:Evoked Potentials, Auditory, Brain Stem / Q000502:physiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D017084:Otoacoustic Emissions, Spontaneous; D010351:Patient Discharge; D012017:Referral and Consultation; D013019:South Africa
Age at screen; Automated auditory brainstem response; Developing countries; Early intervention; Newborn hearing screening; Otoacoustic emissions