Challenges of implementing universal newborn hearing screening at a tertiary care centre from India

Objectives: To report experience of implementing universal newborn hearing screening (UNHS) in a tertiary care neonatal unit, identify risk factors associated with failed two-step automated acoustic brainstem response (AABR) screen and evaluate cost of AABR. Methods: This was a prospective study of UNHS outcomes of all live births with two step AABR using BERAphone MB11®. Outcome measures were screening coverage, refer, pass and lost to follow up rates and cost of AABR using micro-costing method. To identify risk factors for failed screening, authors performed multivariate logistic regression with failed two-step AABR screen as dependent variable and baseline risk factors significant on univariate analysis as predictors. Results: Screening coverage was moderate (84 %), with 2265 of total 2700 eligible infants screened with initial AABR (mean gestation 37.2 ± 2.3 wk; birth weight 2694 ± 588 g; 305 received nursery care). A total of 273 of 2265 infants were “refer” on first screen. Second screen was done on 233, of which 58 were “refer”. Of these, 35 underwent conventional ABR, of which 5 were diagnosed to have hearing impairment. Only 2 could get hearing aid. Overall, a total of 2197 (81.4 %) infants passed, 496 (18.4 %; excluding 2 deaths) were lost to follow up at various stages, and 5 (0.2 %) were diagnosed with hearing impairment, all of whom were high risk. Average cost of AABR was INR 276 per test. No factor emerged as significant on multivariate analysis. Conclusions: UNHS is feasible to implement, but significant lost to follow up and non-linkage with appropriate rehabilitation services limit its utility. Cost effectiveness of UNHS compared to high risk based screening needs to be determined