Hearing assessment after referral in universal newborn hearing screening

Analysis of the medical records of 51 infants referred by maternity hospitals where UNHS was performed and were referred to a Hearing Health Center, between January and June 2021. Infants who completed hearing assessment, who never attended the appointments, or were lost during the diagnostic process were identified. Attempts were made to contact infants' guardians in order to understand the reason for missing the appointments.

Results

The attendance to the diagnosis was 75%. Fifty percent of the infants completed hearing assessment as recommended, up to 3 months of life. The attempt to contact parents who missed the appointments was successful, and the most frequent reasons are: the infant was ill on the day of scheduled appointment, distance from home to the hearing health center, parents’ working hours.

Conclusion

For the diagnostic stage, the attendance rate and the age for completing hearing assessment were below the recommended. The active search for telephone contact and use of phone messaging application was important to reduce evasion by seventy-six percent. Tools that optimize the diagnostic process with less infants missing still must be studied.

Keywords:
Hearing; Screening; Diagnosis; Loss to follow-up; Hearing loss; Newborn

Variables studied	Data analysis
UNHS dates (test and retest)	Age of infants at UNHS stages, arrival, and completion of diagnosis
Date of referral to diagnosis
Completion date
Presence of loss or hearing within the normal range, type, degree, and laterality of hearing alterations	Audiological result
Attendance/absences	Qualitative description of subjects who evaded and the form of contact used in the search
Infant identification
Telephones
Report from parents/guardians via phone/WhatsApp	Identification of reasons for evasions
Audiological result	Relationship with the types of hearing loss and the age of the infant after the diagnosis
Diagnosis completion date
RIHL	Relationship of presence and amount of RIHL with completion of diagnosis
Diagnosis completion date

RIHL	n	%
Heredity	3	5,9%
Consanguinity	1	2,0%
Use of ototoxic medication	8	15,7%
NICU stay > five days	11	21,6%
Use of mechanical ventilation	7	13,7%
Hyperbilirubinemia	3	5,9%
Severe perinatal anoxia	3	5,9%
Ventricular hemorrhage	1	2,0%
Birth weight < 1500g	4	7,8%
Congenital infections	1	2,0%
Craniofacial/ear anomalies	6	11,8%
Signs associated with the syndrome	3	5,9%
Total	51	100%

Infant age	n	Average	SD	Minimum	Median	Maximum
Referral to diagnosis	51	57	59	9	37	390
Conclusion of the diagnosis	24	99	56	30	91	213

RIHL of infants with diagnosed hearing loss	n	%
Stay in the NICU for more than five days	7	24,14%
Use of ototoxic medication	5	17,24%
Craniofacial/ear malformation	3	10,34%
Use of mechanical ventilation	3	10,34%
Severe perinatal anoxia	2	6,90%
Hyperbilirubinemia	2	6,90%
Family history of hearing loss	2	6,90%
Weight less than 1500g	2	6,90%
Ventricular hemorrhage	1	3,45%
Consanguinity	1	3,45%
Signs associated with the syndrome	1	3,45%
Total	29	100%

REASONS FOR EVASION SAID BY THE RESPONSIBLE
	n	%
infant was ill/hospitalized	4	21%
lives far away	3	16%
father was working and could not take	2	11%
underwent/will undergo audiological assessment in another service (public or private)	2	11%
was traveling	2	11%
death	1	5%
father didn't have a car to take	1	5%
didn't know the address of the center	1	5%
returned to work after maternity leave ended	1	5%
could not attend and did not want to explain why	1	5%
didn't have money for transport	1	5%
Total	19	100%

Academia Brasileira de Audiologia Rua Itapeva, 202, conjunto 61, CEP 01332-000, Tel.: (11) 3253-8711, Fax: (11) 3253-8473 - São Paulo - SP - Brazil
E-mail: revista@audiologiabrasil.org.br

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[1] Conflict of interests: No.