This statement endorses the implementation of universal newborn hearing screening. In addition, the statement reviews the primary objectives, important components, and recommended screening parameters that characterize an effective universal newborn hearing screening program.

Newborn and Infant Hearing Loss: Detection and Intervention

Objectives In this monograph we examine the added value of new psychometric methods (Rasch measurement and Item Response Theory) over traditional psychometric approaches by comparing and contrasting their psychometric evaluations of existing sets of rating scale data. We have concentrated on Rasch measurement rather than Item Response Theory because we believe that it is the more advantageous method for health measurement from a conceptual, theoretical and practical perspective. Our intention is to provide an authoritative document that describes the principles of Rasch measurement and the practice of Rasch analysis in a clear, detailed, non-technical form that is accurate and accessible to clinicians and researchers in health measurement. Review methods A comparison was undertaken of traditional and new psychometric methods in five large sets of rating scale data: (1) evaluation of the Rivermead Mobility Index (RMI) in data from 666 participants in the Cannabis in Multiple Sclerosis (CAMS) study; (2) evaluation of the Multiple Sclerosis Impact Scale (MSIS-29) in data from 1725 people with multiple sclerosis; (3) evaluation of test-retest reliability of MSIS-29 in data from 150 people with multiple sclerosis; (4) examination of the use of Rasch analysis to equate scales purporting to measure the same health construct in 585 people with multiple sclerosis; and (5) comparison of relative responsiveness of the Barthel Index and Functional Independence Measure in data from 1400 people undergoing neurorehabilitation. Results Both Rasch measurement and Item Response Theory are conceptually and theoretically superior to traditional psychometric methods. Findings from each of the five studies show that Rasch analysis is empirically superior to traditional psychometric methods for evaluating rating scales, developing rating scales, analysing rating scale data, understanding and measuring stability and change, and understanding the health constructs we seek to quantify. Conclusions There is considerable added value in using Rasch analysis rather than traditional psychometric methods in health measurement. Future research directions include the need to reproduce our findings in a range of clinical populations, detailed head-to-head comparisons of Rasch analysis and Item Response Theory, and the application of Rasch analysis to clinical practice.

https://njl-admin.nihr.ac.uk/document/download/2001725

Improving the evaluation of therapeutic interventions in multiple sclerosis: the role of new psychometric methods.

Objective: To estimate the prevalence of confirmed permanent childhood hearing impairment and its profile across age and degree of impairment in the United Kingdom. Design: Retrospective total ascertainment through sources in the health and education sectors by postal questionnaire. Setting: Hospital based otology and audiology departments, community health clinics, education services for hearing impaired children. Participants: Children born from 1980 to 1995, resident in United Kingdom in 1998, with permanent childhood hearing impairment (hearing level in the better ear >40 dB averaged over 0.5, 1, 2, and 4 kHz). Main outcome measures: Numbers of cases with date of birth and severity of impairment converted to prevalences for each annual birth cohort (cases/1000 live births) and adjusted for underascertainment. Results: 26 000 notifications ascertained 17 160 individual children. Prevalence rose from 0.91 (95% confidence interval 0.85 to 0.98) for 3 year olds to 1.65 (1.62 to 1.68) for children aged 9-16 years. Adjustment for underascertainment increased estimates to 1.07 (1.03 to 1.12) and 2.05 (2.02 to 2.08). Comparison with previous studies showed that prevalence increases with age, rather than declining with year of birth. Conclusions: Prevalence of confirmed permanent childhood hearing impairment increases until the age of 9 years to a level higher than previously estimated. Relative to current yields of universal neonatal hearing screening in the United Kingdom, which are close to 1/1000 live births, 50-90% more children are diagnosed with permanent childhood hearing impairment by the age of 9 years. Paediatric audiology services must have the capacity to achieve early identification and confirmation of these additional cases. What is already known on this topic The prevalence of confirmed permanent childhood hearing impairment (>40 dB HL) in the United Kingdom has been estimated to rise with age to 1.33/1000 live births among children aged 5 years and older It has been predicted that only an additional 16% of children will remain to be detected in the postnatal years, given current yields from universal neonatal hearing screening What this study adds The prevalence of confirmed permanent childhood hearing impairment (>40 dB HL) in the United Kingdom has risen with age to at least 1.65/1000 live births (and may be as high as 2.05/1000 live births) among children 9 years of age and older If the current yield from screening is sustained, then an additional 50-90% of children will remain to be detected in the postnatal years

https://www.bmj.com/content/bmj/323/7312/536.full.pdf

Prevalence of permanent childhood hearing impairment in the United Kingdom and implications for universal neonatal hearing screening: questionnaire based ascertainment study.

Maturational Constraints on Language Learning

ContextEach year, approximately 5000 infants are born in the United States
with moderate-to-profound, bilateral permanent hearing loss (PHL). Universal
newborn hearing screening (UNHS) has been proposed as a means to speed diagnosis
and treatment and thereby improve language outcomes in these children.ObjectivesTo identify strengths, weaknesses, and gaps in the evidence supporting
UNHS and to compare the additional benefits and harms of UNHS with those of
selective screening of high-risk newborns.Data SourcesWe searched the MEDLINE, CINAHL, and PsychINFO databases for relevant
articles published from 1994 to August 2001, using terms for hearing disorders,
infants or newborns, screening, and relevant treatments. We contacted experts
and reviewed reference lists to identify additional articles, including those
published before 1994.Study SelectionWe included controlled and observational studies of (1) the accuracy,
yield, and harms of screening using otoacoustic emissions (OAEs), auditory
brainstem response (ABR), or both in the general newborn population and (2)
the effects of screening or early identification and treatment on language
outcomes. Of an original 340 articles identified, 19 articles, including 1
controlled trial, met these inclusion criteria.Data ExtractionData on population, test performance, outcomes, and methodological quality
were extracted by 2 authors (D.C.T., H.M.) using prespecified criteria developed
by the US Preventive Services Task Force. We queried authors when information
needed to assess study quality was missing.Data SynthesisGood-quality studies show that from 2041 to 2794 low-risk and 86 to
208 high-risk newborns were screened to find 1 case of moderate-to-profound
PHL. The best estimate of positive predictive value was 6.7%. Six percent
to 15% of infants who are missed by the screening tests are subsequently diagnosed
with bilateral PHL. In a trial of UNHS vs clinical screening at age 8 months,
UNHS increased the proportion of infants with moderate-to-severe hearing loss
diagnosed by age 10 months (57% vs 14%) but did not reduce the rate of diagnosis
after age 18 months. No good-quality controlled study has compared UNHS with
selective screening of high-risk newborns. In fair- to poor-quality cohort
studies, intervention before age 6 months was associated with improved language
and communication skills by ages 2 to 5 years. These studies had unclear criteria
for selecting subjects, and none compared an inception cohort of low-risk
newborns identified by screening with those identified in usual care, making
it impossible to exclude selection bias as an explanation for the results.
In a mathematical model based on the literature review, we estimated that
extending screening to low-risk infants would detect 1 additional case before
age 10 months for every 1441 low-risk infants screened, and result in treatment
before 10 months of 1 additional case for every 2401 low-risk infants screened.
With UNHS, 254 newborns would be referred for audiological evaluation because
of false-positive second-stage screening test results vs 48 for selective
screening.ConclusionsModern screening tests for hearing impairment can improve identification
of newborns with PHL, but the efficacy of UNHS to improve long-term language
outcomes remains uncertain.

Universal newborn hearing screening: summary of evidence

Background This review was commissioned because of the increasing doubt about the ability of existing screening programmes (mainly the health visitor distraction test (HVDT) at 7-8 months) to identify children with congenital hearing impairment, and technological advances which have made neonatal hearing screening an alternative option. Objectives To review the available literature on the screening of permanent childhood hearing impairment. To provide commissioners and providers of health care with information about how to deliver a more uniform service, better outcomes, and more cost-effective screening. To identify areas for further research and service development. How the research was conducted The research involved a review of the available published and unpublished literature, and a comprehensive survey of current pre-school hearing screening provision in the UK coupled with a health economics study of hearing screening costs. The research also included a number of focus groups and visits to key centres in the UK and North America. Research findings EPIDEMIOLOGY OF PERMANENT CHILDHOOD HEARING IMPAIRMENT: There are approximately 840 children a year born in the UK with significant permanent hearing impairment likely to affect their own and their family's quality of life. Present services will miss about 400 of these children by 1 1/2 years of age, and about 200 of these children by 3 1/2 years of age. Such late identification of hearing impairment greatly reduces the responsiveness of the services for individual children. Evidence for improved outcomes with earlier identification Hearing-impaired children identified late are at risk of substantial delay in their acquisition of language and communication skills, with consequent longer-term risk to education achievement, mental health and quality of life. Theoretical arguments on neural development support the limited evidence here for the increased benefit for child and family associated with very early identification. In general, parents and professionals want very early identification, which, if implemented properly, does not cause undue anxiety. Current uk practice The survey of current practice indicated a major problem with poor information systems. This problem was further highlighted as a major concern by the multi-disciplinary focus groups. Practice varies. There are two District-wide programmes in which all newborn babies are neonatally screened, a large number of ad hoc programmes for neonatal screening of 'at-risk' babies, a variety of early surveillance programmes, and widespread use of the HVDT. Intervention and habilitation for the majority of those screened neonatally is routinely undertaken within 6 months of birth. For those screened only by the health visitor, identification was on average at about 26 months of age with intervention at about 32 months on average. (ABSTRACT TRUNCATED)

https://njl-admin.nihr.ac.uk/document/download/2004155

T Ramkalawan

Papers

A critical review of the role of neonatal hearing screening in the detection of congenital hearing impairment