2023 Early Hearing Detection & Intervention Conference
March 5-7, 2023 • Cincinnati, OH
Neurodevelopmental risk factors and false positive ABR-based newborn hearing screening results
Newborn hearing screening programs facilitate the detection of hearing loss and access to time-sensitive interventions. However, there is speculation that auditory brainstem response (ABR)-based, hearing screening referrals in absence of diagnosed hearing loss may reflect risk for neurodevelopmental disorders. We aim to investigate whether three highly replicable risk factors for neurodevelopmental disorders (male sex, preterm delivery, familial risk) are associated with false positive ABR-based findings at initial screening.
We linked birth certificate and Early Hearing Detection and Intervention data maintained by the Michigan Department of Health and Human Services. Singleton births (2004-2019) with available ABR-based hearing screening data were eligible for analysis (n=1,318,632). We then excluded children with conductive, sensorineural, or mixed hearing loss to yield our analytic sample (n=1,313,880). False positive findings included newborns with “refer” results (either ear) at the initial screen. We obtained sex and preterm delivery (early: <34 weeks; late: 34-36 weeks) information from birth certificates. To examine familial risk, we limited the sample to infants who had one other sibling in the dataset born to the same mother (n=482,934).
Approximately 4% of newborns obtained “refer” results in the absence of diagnosed hearing loss. Males were more likely to obtain these false positive findings (OR=1.2, 95%CI: 1.1,1.3), along with children born early and late preterm (OR=1.6, 95%CI: 1.5,1.7; OR=1.6, 95%CI: 1.5,1.7, respectively). In addition, infants with refer results were more likely to have an older sibling with a refer result, even though neither were diagnosed with hearing loss (OR=2.4, 95%CI: 2.3,2.9). Findings persisted following adjustment for socio-demographics, congenital anomalies, and age at screening.
Well-known and highly replicated risk factors for neurodevelopmental disorders were associated with false positive, ABR-based newborn hearing screening results. Future research is needed to examine whether false positive findings reflect subclinical hearing loss and/or whether they are associated with neurodevelopmental disorder diagnoses themselves.
- Identify three risk factors for neurodevelopmental disorders.
- Define "false positive" as it pertains to this study.
- State whether the high-replicated neurodevelopmental disorder risk factors studied were found to be associated with false-positive ABR-based newborn hearing screens.
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Presenter: Nicole Talge
Dr. Talge investigates the perinatal pathways that contribute to risk for neurodevelopmental disorders, with a focus on identifying biological or socio-demographic factors that explain heterogeneity in these associations. The goal of these efforts is to help tailor developmental surveillance efforts and identify at-risk subgroups of children who could benefit from increased access to early interventions. Dr. Talge also serves as a Member-at-Large (2017-2021) for the Society for Pediatric and Perinatal Epidemiologic Research.
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Michelle Garcia is a licensed audiologist. She obtained her doctorate of audiology from the Pennsylvania College of Optometry and has experience as a clinical audiologist and expertise in newborn hearing screening as follow-up consultant for the Michigan EHDI program. Dr. Garcia has coordinated meetings for hearing screening, presented at educational conferences and in-service trainings, edited program materials and publications, and developed and maintained contacts with partner organizations and agencies.
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Research Director, MSU Department of Epidemiology and Biostatistics, College of Human Medicine
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Joseph Gardiner is the founder of the Division of Biostatistics in the Department of Epidemiology in the College of Human Medicine. He has been at the university since 1978 and is Professor of Statistics and Probability in the College of Natural Science. Dr. Gardiner has collaborated extensively with epidemiologists and medical researchers at MSU, and with health services researchers outside the university. Since 1991, Dr. Gardiner has had a pivotal role in over 22 epidemiologic/clinical studies, many of these supported by NIH, and as principal biostatistician or collaborator in 12 additional NIH-funded projects. His recent and current research addresses statistical issues in cost-effectiveness analysis which grew from a comprehensive study of cost-effectiveness in heart disease and evaluation of the cost-effectiveness of the implantable cardioverter defibrillator (ICD). His current research “Statistical Innovations in Health Services Research” builds upon this early work. It addresses the development of models that reflect the experience of patients in sustained and changing states of health, and methods for analyzing jointly both cost and effectiveness measures using multivariate methods from survival analyses.
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