title: Population Outcomes of Three Approaches to Detection of Congenital Hearing Loss.
abstract: BACKGROUND
  Universal newborn hearing screening was implemented worldwide largely on modeled, not measured, long-term benefits. Comparative quantification of population benefits would justify its high cost.
  
  
  METHODS
  Natural experiment comparing 3 population approaches to detecting bilateral congenital hearing loss (>25 dB, better ear) in Australian states with similar demographics and services: (1) universal newborn hearing screening, New South Wales 2003-2005, n = 69; (2) Risk factor screening (neonatal intensive care screening + universal risk factor referral), Victoria 2003-2005, n = 65; and (3) largely opportunistic detection, Victoria 1991-1993, n = 86. Children in (1) and (2) were followed at age 5 to 6 years and in (3) at 7 to 8 years. Outcomes were compared between states using adjusted linear regression.
  
  
  RESULTS
  Children were diagnosed younger with universal than risk factor screening (adjusted mean difference -8.0 months, 95% confidence interval -12.3 to -3.7). For children without intellectual disability, moving from opportunistic to risk factor to universal screening incrementally improved age of diagnosis (22.5 vs 16.2 vs 8.1 months, P < .001), receptive (81.8 vs 83.0 vs 88.9, P = .05) and expressive (74.9 vs 80.7 vs 89.3, P < .001) language and receptive vocabulary (79.4 vs 83.8 vs 91.5, P < .001); these nonetheless remained well short of cognition (mean 103.4, SD 15.2). Behavior and health-related quality of life were unaffected.
  
  
  CONCLUSIONS
  With new randomized trials unlikely, this may represent the most definitive population-based evidence supporting universal newborn hearing screening. Although outperforming risk factor screening, school entry language still lagged cognitive abilities by nearly a SD. Prompt intervention and efficacy research are needed for children to reach their potential.
authors.affiliation: Murdoch Childrens Research Institute, Parkville, Australia; Royal Children's Hospital, Parkville, Australia; The University of Melbourne, Parkville, Australia; melissa.wake@rch.org.au.
authors.forename: Melissa
authors.initials: M
authors.lastname: Wake
authors.affiliation: National Acoustic Laboratories, Australian Hearing, North Ryde, Australia; The HEARing Cooperative Research Centre, The University of Melbourne, Parkville, Australia;
authors.forename: Teresa Y C
authors.initials: TY
authors.lastname: Ching
authors.affiliation: Murdoch Childrens Research Institute, Parkville, Australia;
authors.forename: Karen
authors.initials: K
authors.lastname: Wirth
authors.affiliation: Murdoch Childrens Research Institute, Parkville, Australia; Royal Children's Hospital, Parkville, Australia;
authors.forename: Zeffie
authors.initials: Z
authors.lastname: Poulakis
authors.affiliation: Murdoch Childrens Research Institute, Parkville, Australia; Royal Children's Hospital, Parkville, Australia; The University of Melbourne, Parkville, Australia;
authors.forename: Fiona K
authors.initials: FK
authors.lastname: Mensah
authors.affiliation: Deakin Health Economics, Deakin University, Burwood, Australia; and.
authors.forename: Lisa
authors.initials: L
authors.lastname: Gold
authors.affiliation: Australian Hearing, Box Hill, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: King
authors.affiliation: Murdoch Childrens Research Institute, Parkville, Australia;
authors.forename: Hannah E
authors.initials: HE
authors.lastname: Bryson
authors.affiliation: Murdoch Childrens Research Institute, Parkville, Australia; Royal Children's Hospital, Parkville, Australia; The University of Melbourne, Parkville, Australia;
authors.forename: Sheena
authors.initials: S
authors.lastname: Reilly
authors.affiliation: The University of Melbourne, Parkville, Australia;
authors.forename: Field
authors.initials: F
authors.lastname: Rickards
mesh_terms: D001315:Australia; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D006311:Hearing Disorders / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening / Q000191:economics / Q000379:methods*; D018570:Risk Assessment; D012307:Risk Factors