19th ANNUAL EARLY HEARING DETECTION & INTERVENTION MEETING
March 8-10, 2020 • Kansas City, MO
3/10/2020 | 1:45 PM - 2:15 PM | What can EHDI data tell us about false positive newborn hearing screening results and possible strategies to reduce their occurrence | Chouteau B
What can EHDI data tell us about false positive newborn hearing screening results and possible strategies to reduce their occurrence
Universal Newborn Hearing Screening (NHS) has been widely adopted as an alternative to universal diagnostic testing given the inadequacy of the high risk register (HRR), which misses half the cases. However, diagnostic testing reveals normal hearing in most NHS refers. The high false-positive rate is concerning because unnecessary testing consumes resources, and a child’s not passing NHS may cause parents anxiety—usually needlessly. The inadequacy of the HRR as a risk indicator results from incomplete knowledge of hearing-loss etiology. This study used EHDI data to refine the HRR toward combining it with NHS results to develop a referral protocol with higher predictive value, and a lower false positive rate, than NHS results alone. In Massachusetts, where NHS non-passes are re-screened in the hospital, 7,505 (1.8%) of 429,412 screened babies born between 2012 and 2017 did not pass NHS. Among the almost 90% that completed follow-up, only 1,042 (16%) were diagnosed with hearing loss—the other 84% having screened falsely positive. Logistic regression identified several independent hearing-loss predictors among maternal and child characteristics available to Massachusetts EHDI through audiologist reporting and birth certificate data, including some that have not previously been cited, and excluding some that have. Risk-factor presence interacted statistically with NHS results—suggesting that the effect of not passing NHS on hearing-loss risk was increased significantly by the presence of an identified risk factor. Specifically, 14% of babies who did not pass NHS but had no risk factors received a hearing-loss diagnosis, as compared to 36% of babies who did not pass and also had a risk factor. Referring for diagnostic testing only those NHS non-passes who also had risk factors would have low sensitivity for hearing loss. However, the low hearing-loss risk observed among the 90% of NHS non-passes who lacked risk factors might justify a different protocol for such children.
- Increase understanding of key attributes of a screening test
- Increase understanding of the adverse consequences of false positive and false negative screening results
- Increase understanding of the strengths and weaknesses of newborn hearing screening in terms of the key attributes of a screening test
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Presenters/Authors
Martha Morris
(), Massachusetts Department of Public Health, martha.morris@massmail.state.ma.us;
Since 2014, Dr. Morris has served as the epidemiologist for the Massachusetts Department of Public Health Universal Newborn Hearing Screening Program. She is also the Principal Investigator of a Centers for Disease Control and Prevention Cooperative Agreement. She holds a PhD in epidemiology and biostatistics from the University of Massachusetts at Amherst and has worked as an epidemiologist for more than 30 years. She recently returned to the Massachusetts Department of Public Health, where her career began, from Tufts University, where her research focused on nutrition and aging.
ASHA DISCLOSURE:
Financial -
No relevant financial relationship exist.
Nonfinancial -
No relevant nonfinancial relationship exist.