title: Newborn hearing screening at a community-based obstetric unit: Screening and diagnostic outcomes.
abstract: OBJECTIVE
  Postnatal visits at community-based midwife obstetric units (MOUs) have been proposed as an alternative primary healthcare screening platform in South Africa. This study evaluated the outcomes of distortion product otoacoustic emissions (DPOAEs) and automated auditory brainstem response (AABR) screening conducted by a dedicated non-professional screener at a community-based MOU in the Western Cape, South Africa.
  
  
  METHODS
  Universal newborn hearing screening (UNHS) at a community-based MOU was evaluated over a 16-month period. A dedicated non-professional screener was trained to follow a two-stage screening protocol targeting bilateral hearing loss. A two group comparative design was used alternating AABR (Maico MB11 BERAphone™()) and DPOAE (Bio-logic AuDX I) technology on a daily basis. Infants referring the initial screen received a follow-up appointment in two days' time and were rescreened with the same technology used at their first screen. Those referring the second stage were booked for diagnostic assessments.
  
  
  RESULTS
  7452 infants were screened including 47.9% (n=3573) with DPOAE and 52.1% (n=3879) with AABR technology. Mean age at first stage screen was 6.1 days. The initial bilateral referral rate was significantly lower for AABR (4.6%) compared to DPOAE (7.0%) and dropped to 0.3% and 0.7% respectively following the second stage screenings. First rescreen and initial diagnostic follow-up rates of 90% and 92.3% were obtained for the DPOAE group and 86.6% and 90% for the AABR group. Follow-up rates showed no significant difference between technology groups. Diagnostic assessment revealed a higher prevalence rate for bilateral SNHL among the AABR group (1/1000) compared to the DPOAE group (0.3/1000). Screening technology had no significant influence on daily screening capacity (23 AABR/day; 24 DPOAE/day).
  
  
  CONCLUSIONS
  Postnatal visits at community-based MOUs create a useful platform for hearing screening and follow-up. AABR technology with negligible disposable costs provides opportunity for AABR screening to be utilised in community-based programmes. AABR screening offers lower initial referral rates and a higher true positive rate compared to DPOAE.
authors.affiliation: Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa.
authors.forename: Tersia
authors.initials: T
authors.lastname: de Kock
authors.affiliation: Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa; Ear Sciences Centre, School of Surgery, The University of Western Australia, Australia; Ear Science Institute Australia, Subiaco, Western Australia, Australia. Electronic address: dewet.swanepoel@up.ac.za.
authors.forename: DeWet
authors.initials: D
authors.lastname: Swanepoel
authors.affiliation: Osborne College of Audiology, Salus University, Elkins Park, PA, USA; Department of Communication Sciences and Disorders, University of Hawaii, Honolulu, HI, USA; Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa. Electronic address: jwhall3phd@gmail.com.
authors.forename: James W
authors.initials: JW
authors.lastname: Hall
mesh_terms: D001300:Audiometry, Evoked Response; D003151:Community Health Centers; D016057:Evoked Potentials, Auditory, Brain Stem; D005260:Female; D005500:Follow-Up Studies; D006312:Hearing Loss, Bilateral / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008430:Maternal-Child Health Centers; D015997:Neonatal Screening / Q000379:methods* / Q000458:organization & administration; D017084:Otoacoustic Emissions, Spontaneous; D011181:Postnatal Care / Q000379:methods* / Q000458:organization & administration; D012017:Referral and Consultation; D013019:South Africa
keywords: Automated auditory brainstem response; Community-based newborn hearing screening; Dedicated screener; Developing countries; Distortion product otoacoustic emissions; Midwife obstetric units