title: Newborn hearing screening programme in Belgium: a consensus recommendation on risk factors.
abstract: BACKGROUND
  Understanding the risk factors for hearing loss is essential for designing the Belgian newborn hearing screening programme. Accordingly, they needed to be updated in accordance with current scientific knowledge. This study aimed to update the recommendations for the clinical management and follow-up of newborns with neonatal risk factors of hearing loss for the newborn screening programme in Belgium.
  
  
  METHODS
  A literature review was performed, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system assessment method was used to determine the level of evidence quality and strength of the recommendation for each risk factor. The state of scientific knowledge, levels of evidence quality, and graded recommendations were subsequently assessed using a three-round Delphi consensus process (two online questionnaires and one face-to-face meeting).
  
  
  RESULTS
  Congenital infections (i.e., cytomegalovirus, toxoplasmosis, and syphilis), a family history of hearing loss, consanguinity in (grand)parents, malformation syndromes, and foetal alcohol syndrome presented a 'high' level of evidence quality as neonatal risk factors for hearing loss. Because of the sensitivity of auditory function to bilirubin toxicity, hyperbilirubinaemia was assessed at a 'moderate' level of evidence quality. In contrast, a very low birth weight, low Apgar score, and hospitalisation in the neonatal intensive care unit ranged from 'very low' to 'low' levels, and ototoxic drugs were evidenced as 'very low'. Possible explanations for these 'very low' and 'low' levels include the improved management of these health conditions or treatments, and methodological weaknesses such as confounding effects, which make it difficult to conclude on individual risk factors. In the recommendation statements, the experts emphasised avoiding unidentified neonatal hearing loss and opted to include risk factors for hearing loss even in cases with weak evidence. The panel also highlighted the cumulative effect of risk factors for hearing loss.
  
  
  CONCLUSIONS
  We revised the recommendations for the clinical management and follow-up of newborns exhibiting neonatal risk factors for hearing loss on the basis of the aforementioned evidence-based approach and clinical experience from experts. The next step is the implementation of these findings in the Belgian screening programme.
authors.affiliation: Research Center Epidemiology, Biostatistics and Clinical Research, Université libre de Bruxelles (ULB), School of Public Health, Route de Lennik 808, Brussels, 1070, Belgium. benevos@ulb.ac.be.|Research Center Health Policy and Systems - International Health, Université libre de Bruxelles (ULB), School of Public Health, Route de Lennik 808, Brussels, 1070, Belgium. benevos@ulb.ac.be.|Centre d'Epidémiologie Périnatale (CEpiP), Route de Lennik 808, Brussels, 1070, Belgium. benevos@ulb.ac.be.
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Vos
authors.affiliation: Research Center Epidemiology, Biostatistics and Clinical Research, Université libre de Bruxelles (ULB), School of Public Health, Route de Lennik 808, Brussels, 1070, Belgium. chsenter@ulb.ac.be.
authors.forename: Christelle
authors.initials: C
authors.lastname: Senterre
authors.affiliation: Research Center Health Policy and Systems - International Health, Université libre de Bruxelles (ULB), School of Public Health, Route de Lennik 808, Brussels, 1070, Belgium. rlagass@ulb.ac.be.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Lagasse
authors.affiliation: Research Center Epidemiology, Biostatistics and Clinical Research, Université libre de Bruxelles (ULB), School of Public Health, Route de Lennik 808, Brussels, 1070, Belgium. aleveque@ulb.ac.be.|Research Center Health Policy and Systems - International Health, Université libre de Bruxelles (ULB), School of Public Health, Route de Lennik 808, Brussels, 1070, Belgium. aleveque@ulb.ac.be.|Centre d'Epidémiologie Périnatale (CEpiP), Route de Lennik 808, Brussels, 1070, Belgium. aleveque@ulb.ac.be.
authors.forename: Alain
authors.initials: A
authors.lastname: Levêque
mesh_terms: D001530:Belgium / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D034381:Hearing Loss / Q000175:diagnosis* / Q000453:epidemiology; D006320:Hearing Tests / Q000592:standards; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening / Q000379:methods* / Q000592:standards; D015995:Prevalence; D015397:Program Evaluation / Q000379:methods*; D012307:Risk Factors