Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Interdisciplinary approach to design, performance, and quality management in a multicenter newborn hearing screening project

Discussion of the results of newborn hearing screening in Hamburg (Part II)

  • 250 Accesses

  • 13 Citations

Abstract

Previously presented results of the newborn hearing screening in Hamburg and the perspectives are subsequently discussed. Minimum standards referring a participation of 95% of the neonates and a fail rate of less than 4% hearing-impaired children at the primary screening are fulfilled in Hamburg. Systematic screening of newborn hearing by an interdisciplinary approach provides early identification and intervention for children with permanent unilateral and bilateral hearing loss. But a newborn hearing screening on a voluntary basis alone cannot be maintained in the long run. Further, an anonymous data collection is not sufficient in regard to an uninterrupted tracking of conspicuous and unscreened neonates. A lost-to-follow-up rate of 31.3% at primary screening in Hamburg is much too high and emphasizes the need for a public health approach to a population-based newborn hearing screening with an elaborate and name-based tracking system. The legislation and implementation of a nationwide newborn hearing screening program in Germany and the association of German newborn hearing screening centers are highlighting long efforts of hearing professionals. But the implementation of a newborn hearing screening only makes sense if there exists an efficient tracking system. Sad to say, we are still a long way from the implementation of such a tracking system.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3

References

  1. 1.

    Hörzentrum der Charité-Universitätsmedizin Berlin “Wir sehen, ob Ihr Baby hören kann”. http://www.charite.de/hoerzentrum/

  2. 2.

    Rohlfs AK, Wiesner T, Drews H et al Interdisciplinary approach to design, performance and quality management in a multicentre newborn hearing screening project. Introduction, methods and results of the newborn hearing screening in Hamburg

  3. 3.

    Anonymous (1995) Joint Committee on Infant Hearing 1994 Position Statement. American Academy of Pediatrics Joint Committee on Infant Hearing. Pediatr 95:152–156

  4. 4.

    Bamford J, Uus K, Davis A (2005) Screening for hearing loss in childhood: issues, evidence and current approaches in the UK. J Med Screen 12:119–124

  5. 5.

    Bess FH, Dodd-Murphy J, Parker RA (1998) Children with minimal sensorineural hearing loss: prevalence, educational performance, and functional status. Ear Hear 19:339–354

  6. 6.

    Bess FH, Tharpe AM (1986) Case history data on unilaterally hearing-impaired children. Ear Hear 7:14–19

  7. 7.

    Bess FH, Tharpe AM (1986) An introduction to unilateral sensorineural hearing loss in children. Ear Hear 7:3–13

  8. 8.

    Bess FH, Tharpe AM, Gibler AM (1986) Auditory performance of children with unilateral sensorineural hearing impairment. Ear Hear 7:20–26

  9. 9.

    Böttcher P, Gramß M, Euler HA et al (2009) Cost analysis of a universal newborn hearing screening for clinics using the State of Hesse as an example. HNO 57:21–28

  10. 10.

    Böttcher P, Neumann K, Madzinski C (2008) Retrospektive Untersuchung von “lost to follow-up—Fällen” beim qualitätskontrollierten Neugeborenen-Hörscreening in Hessen. www.uzh.ch/orl/dga2008/DGA_2008_Programm.pdf

  11. 11.

    Böttcher P, Neumann K, Weiner W (2007) Qualitätsgesichertes Neugeborenenhörscreening in Hessen. Was sind die künftigen Anforderungen an ein generelles Neugeborenen-Hörscreening-Programm? http://hoerscreening.de/download/NHS_2007_Abstractband.pdf

  12. 12.

    Bretschneider J, Maier H, Hess M et al (2001) Use and results of universal newborn hearing screening with ALGO portable device. Laryngorhinootol 80(7):357–364

  13. 13.

    Buser K, Sinn D (2007) Neugeborenen-Hörscreening—Effektivitätsuntersuchungen der Frühdiagnose kindlicher Hörstörungen bei Schulkindern. http://hoerscreening.de/download/NHS_2007_Abstractband.pdf

  14. 14.

    Cao-Nguyen MH, Kos MI, Guyot JP (2007) Benefits and costs of universal hearing screening programme. Int J Pediatr Otorhinolaryngol 71(10):1591–1595

  15. 15.

    International Working Group on Childhood Hearing—IGCH (2004). Survey on early hearing detection and intervention programs: year 2003. http://childhearingroup.isib.cnr.it/surveys.html

  16. 16.

    Clarke P, Iqbal M, Mitchell S (2003) A comparison of transient-evoked otoacoustic emissions and automated auditory brainstem responses for pre-discharge neonatal hearing screening. Int J Audiol 42:443–447

  17. 17.

    Dalzell L, Orlando M, MacDonald M et al (2000) The New York State universal newborn hearing screening demonstration project: ages of hearing loss identification, hearing aid fitting, and enrollment in early intervention. Ear Hear 21:118–130

  18. 18.

    Dalzell LE, Orlando MS, Seeger C (1996) 3-Stage newborn hearing screening reduces failures at discharge. Poster at American Academy of Audiology, Salt Lake City

  19. 19.

    Davis A, Hind S (2003) The newborn hearing screening programme in England. Int J Pediatr Otorhinolaryngol 67(Suppl 1):S193–S196

  20. 20.

    Delb W, Merkel D, Pilorget K et al (2004) Effectiveness of a TEOAE-based screening program. Can a patient-tracking system effectively be organized using modern information technology and central data management? Eur Arch Otorhinolaryngol 261:191–196

  21. 21.

    Dettman SJ, Pinder D, Briggs RJ et al (2007) Communication development in children who receive the cochlear implant younger than 12 months: risks versus benefits. Ear Hear 28(2 Suppl):11S–18S

  22. 22.

    Deutsches Konsensuspapier zu Neugeborenenhörscreening-Programmen 3.0 (2001) http://www.neugeborenenhoerscreening.de/download/Konsens3_0.pdf

  23. 23.

    Erenberg A, Lemons J, Sia C et al (1999) Newborn and infant hearing loss: detection and intervention. American Academy of Pediatrics. Task Force on Newborn and Infant Hearing, 1998–1999. Pediatr 103:527–530

  24. 24.

    Finckh-Krämer U, Spormann-Lagodzinski M, Gross M (2000) German registry for hearing loss in children: results after 4 years. Int J Pediatr Otorhinolaryngol 56:113–127

  25. 25.

    Finckh-Krämer U, Spormann-Lagodzinski M, Nubel K et al (1998) Is diagnosis of persistent pediatric hearing loss still made too late? HNO 46:598–602

  26. 26.

    Fortnum H, Davis A (1997) Epidemiology of permanent childhood hearing impairment in Trent Region, 1985–1993. Br J Audiol 31:409–446

  27. 27.

    Foulon I, Naessens A, Foulon W et al (2008) A 10-year prospective study of sensorineural hearing loss in children with congenital cytomegalovirus infection. J Pediatr 153(1):84–88

  28. 28.

    Fowler KB, Boppana SB (2006) Congenital cytomegalovirus infection and hearing deficit. J Clin Virol 35:226–231

  29. 29.

    Fowler KB, McCollister FP, Dahle AJ et al (1997) Progressive and fluctuating sensorineural hearing loss in children with asymptomatic congenital cytomegalovirus infection. J Pediatr 130:624–630

  30. 30.

    Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (2006) Früherkennungsuntersuchung von Hörstörungen bei Neugeborenen. Vorbericht S05-01. http://www.iqwig.de/download/S05-01_Vorbericht_Bewertung_des_Nutzens_und_der_medizinischen_Notwendigkeit_der_Frueherkennungsuntersuchung_von_Hoerstoerungen_bei_Neugeborenen.pdf

  31. 31.

    Govaerts PJ (2006) Universal newborn hearing screening in Belgium. http://www.oae.it/guest_editorials/2006/06_08_2006.htm

  32. 32.

    Govaerts PJ, Yperman M, De Ceulaer G et al (2001) A two-stage bipodal screening model for universal neonatal hearing screening. Otol Neurotol 22:850–854

  33. 33.

    Gross M, Finckh-Krämer U, Spormann-Lagodzinski M (2000) Congenital hearing disorders in children. 1: Acquired hearing disorders. HNO 48:879–886

  34. 34.

    Hall JW 3rd, Smith SD, Popelka GR (2004) Newborn hearing screening with combined otoacoustic emissions and auditory brainstem responses. J Am Acad Audiol 15:414–425

  35. 35.

    Harrison M, Roush J (1996) Age of suspicion, identification, and intervention for infants and young children with hearing loss: a national study. Ear Hear 17:55–62

  36. 36.

    Heinemann M, Bohnert A (2000) Hearing screening in newborn infants. Comparative studies and cost analysis with different instruments. Laryngorhinootol 79(8):453–458

  37. 37.

    Hergils L (2007) Analysis of measurements from the first Swedish universal neonatal hearing screening program. Int J Audiol 46:680–685

  38. 38.

    Hyde M (2004) Family anxiety and universal newborn hearing screening (UNHS): a review of current evidence. http://childhearingroup.isib.cnr.it/docs/unhs_and_family_anxiety.pdf

  39. 39.

    Iwasaki S, Hayashi Y, Seki A et al (2003) A model of two-stage newborn hearing screening with automated auditory brainstem response. Int J Pediatr Otorhinolaryngol 67:1099–1104

  40. 40.

    Johnson JL, Kuntz NL, Sia CC et al (1997) Newborn hearing screening in Hawaii. Hawaii Med J 56:352–355

  41. 41.

    Joint Committee on Infant Hearing, American Academy of Audiology, American Academy of Pediatrics et al (2000) Year 2000 position statement: principles and guidelines for early hearing detection and intervention programs. Joint Committee on Infant Hearing, American Academy of Audiology, American Academy of Pediatrics, American Speech-Language-Hearing Association, and Directors of Speech and Hearing Programs in State Health and Welfare Agencies. Pediatr 106:798–817

  42. 42.

    Kiese-Himmel C, Kruse E (2001) Unilateral hearing loss in childhood. An empirical analysis comparing bilateral hearing loss. Laryngorhinootol 80:18–22

  43. 43.

    Kropf F, Nawka T, Gaede G (2007) Nachverfolgung von Kindern mit auffälligen Befunden im Hörscreening. http://hoerscreening.de/download/NHS_2007_Abstractband.pdf

  44. 44.

    Kunze S, Schnell-Inderst P, Hessel F et al (2004) Hörscreening für Neugeborene. Ein Health Technology Assessment der medizinischen Effektivität und der ökonomischen Effizienz. DAHTA/DIMDI: HTA 12. http://gripsdb.dimdi.de/de/hta/hta_berichte/hta063_bericht_de.pdf

  45. 45.

    Lesinski-Schiedat A, Illg A, Warnecke A et al (2006) Paediatric cochlear implantation in the first year of life: preliminary results. HNO 54:565–572

  46. 46.

    Lin HC, Shu MT, Lee KS et al (2005) Comparison of hearing screening programs between one step with transient evoked otoacoustic emissions (TEOAE) and two steps with TEOAE and automated auditory brainstem response. Laryngoscope 115:1957–1962

  47. 47.

    Magnuson M, Hergils L (1999) The parents’ view on hearing screening in newborns. Feelings, thoughts and opinions on otoacoustic emissions screening. Scand Audiol 28:47–56

  48. 48.

    Maxon AB, White KR, Behrens TR et al (1995) Referral rates and cost efficiency in a universal newborn hearing screening program using transient evoked otoacoustic emissions. J Am Acad Audiol 6:271–277

  49. 49.

    Mehl AL, Thomson V (2002) The Colorado newborn hearing screening project, 1992–1999: on the threshold of effective population-based universal newborn hearing screening. Pediatr 109:E7

  50. 50.

    Meier S, Narabayashi O, Probst R et al (2004) Comparison of currently available devices designed for newborn hearing screening using automated auditory brainstem and/or otoacoustic emission measurements. Int J Pediatr Otorhinolaryngol 68:927–934

  51. 51.

    Mezzano P, Serra G, Calevo MG (2009) Cost analysis of an Italian neonatal hearing screening programme. J Matern Fetal Neonatal Med 22(9):806–811

  52. 52.

    Nennstiel-Ratzel U, Arenz S, von Kries R et al (2007) The model project “newborn auditory screening” in the Upper Palatinate: high process and result quality of an interdisciplinary concept. HNO 55:128–134

  53. 53.

    Nennstiel-Ratzel U, Arenz S, Wildner M et al (2004) New challenges to the Screening Center in the Bavarian State office for Health Care and Safe Quality of Foods. Gesundheitswes 66 (Suppl 1):S8–S12

  54. 54.

    Nennstiel-Ratzel U, von Kries R, Wildner M et al (2007) Erfahrungen und Ergebnisse im Modellprojekt Neugeborenen-Hörscreening in der Oberpfalz und Oberfranken. http://hoerscreening.de/download/NHS_2007_Abstractband.pdf

  55. 55.

    Neumann K, Gross M, Böttcher P et al (2006) Effectiveness and efficiency of a universal newborn hearing screening in Germany. Folia Phoniatr Logop 58:440–455

  56. 56.

    Neumann K, Gross M, Böttcher P et al (2007) Effektivität und Effizienz eines universellen Neugeborenen-Hörscreenings in Hessen und Deutschland. http://hoerscreening.de/download/NHS_2007_Abstractband.pdf

  57. 57.

    Deutsche Gesellschaft für Phoniatrie und Pädaudiologie (2001) Phoniatrisch-pädaudiologischer Konsensus zu einem universellen Neugeborenen Hörscreening in Deutschland. Phoniatr Pädaudiol Mitt, 11

  58. 58.

    Deutsche Gesellschaft für Phoniatrie und Pädaudiologie (2007) Konsenspapier der DGPP zur Hörgeräteversorgung bei Kindern, Vers. 3.0. http://www.dgpp.de/Profi/index_Profi.htm

  59. 59.

    Rasinski C, Vorwerk W, Neumann K et al (2007) Probleme bei der Einführung des Neugeborenen-Hörscreenings in Sachsen-Anhalt. http://hoerscreening.de/download/NHS_2007_Abstractband.pdf

  60. 60.

    Rauterberg EW, Böttcher P, Luetkens C et al (2007) Qualitätskontrolliertes Hörscreening: eine neue Aufgabe des Screening-Zentrums Hessen. http://hoerscreening.de/download/NHS_2007_Abstractband.pdf

  61. 61.

    Schönweiler R, Katalinic A, Tyen U et al (2007) Universelles Neugeborenenhörscreening Schleswig-Holstein (UNHS-SH): Trackingergebnisse, laufende Qualitätssicherung und gezielte Intervention durch einen Mobilen Dienst. http://hoerscreening.de/download/NHS_2007_Abstractband.pdf

  62. 62.

    Shehata-Dieler W, Cebulla M, Keim R et al (2007) ABR-basierendes Hörscreening bei Neugeborenen: Eine effektive Methode zur Optimierung der Frühdiagnose und Behandlung von Hörstörungen im Kindesalter. http://hoerscreening.de/download/NHS_2007_Abstractband.pdf

  63. 63.

    Stolle S, Reuter G, Lenarz T (2007) Status Quo des Neugeborenen-Hörscreening in Niedersachsen. http://hoerscreening.de/download/NHS_2007_Abstractband.pdf

  64. 64.

    Szyfter W, Wróbel M, Radziszewska-Konopka M et al (2008) Polish universal neonatal hearing screening program-4-year experience (2003–2006). Int J Pediatr Otorhinolaryngol 72:1783–1787

  65. 65.

    Tait M, De Raeve L, Nikolopoulos TP (2007) Deaf children with cochlear implants before the age of 1 year: comparison of preverbal communication with normally hearing children. Int J Pediatr Otorhinolaryngol 71:1605–1611

  66. 66.

    Tharpe AM, Sladen DP, Dodd-Murphy J et al (2009) Minimal hearing loss in children: minimal but not inconsequential. Semin Hear 30:080–093

  67. 67.

    Thompson DC, McPhillips H, Davis RL et al (2001) Universal newborn hearing screening: summary of evidence. J Am Med Assoc 286:2000–2010

  68. 68.

    Uilenburg N, Kauffman-de Boer M, van der Ploeg K et al (2009) An implementation study of neonatal hearing screening in the Netherlands. Int J Audiol 48:108–116

  69. 69.

    Uus K, Bamford J (2006) Effectiveness of population-based newborn hearing screening in England: ages of interventions and profile of cases. Pediatr 117:e887–e893

  70. 70.

    Vohr BR, Carty LM, Moore PE et al (1998) The Rhode Island Hearing Assessment Program: experience with statewide hearing screening (1993–1996). J Pediatr 133:353–357

  71. 71.

    Vohr BR, Oh W, Stewart EJ et al (2001) Comparison of costs and referral rates of 3 universal newborn hearing screening protocols. J Pediatr 139:238–244

  72. 72.

    Vohr B, Simon P, McDermott C et al (2002) Early hearing screening, detection and intervention (EHDI) in Rhode Island. Med Health R I 85:369–372

  73. 73.

    Watkin PM, Baldwin M (1999) Confirmation of deafness in infancy. Arch Dis Child 81:380–389

  74. 74.

    Watkin PM, Baldwin M, Dixon R et al (1998) Maternal anxiety and attitudes to universal neonatal hearing screening. Br J Audiol 32:27–37

  75. 75.

    Weichbold V, Nekahm-Heis D, Welzl-Müller K (2005) Evaluation of the Austrian Newborn Hearing Screening Program. Wien Klin Wochenschr 117:641–646

  76. 76.

    Weichbold V, Welzl-Müller K (2000) Neonatal hearing screening—maternal attitudes and anxiety. HNO 48:606–612

  77. 77.

    Welzl-Müller K, Nekahm-Heis D, Weichbold V (2004) Verbesserung der Früherfassung durch Neugeborenen-Hörscreening? http://www.neugeborenenhoerscreening.de/download/NHS_2004_Abstractband.pdf

  78. 78.

    White KR (1996) Universal newborn hearing screening using transient evoked otoacoustic emissions: past, present, and future. Sem Hear 17:171–183

  79. 79.

    Yoshinaga-Itano C (2004) Levels of evidence: universal newborn hearing screening (UNHS) and early hearing detection and intervention systems (EHDI). J Commun Disord 37:451–465

Download references

Acknowledgments

The project received partial funding from the Ministry for Social and Family Affairs and the Ministry of Environment and Health in the first 2 years; the subsequent financing of the part-time jobs was supplied by funds donated to the “Hamburg working group for hearing screening of newborns registered association” (Hamburger Arbeitskreis für Hörscreening bei Neugeborenen, eingetragener Verein” (H.A.H.N. e.V.)). From August 2008 to January 2009, financing was supplied by the Social and Health Authority of Hamburg. None of the sponsors was involved in the study design, collection, analysis, and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.

Training support was received from H.A.H.N. e.V. The authors are grateful to the staff and management of the participating hospitals, pediatricians, and pediatric audiologists without whom this project would have been unsuccessful. We thank each professional who identified children for screening.

We thank Professor Dr. med. Antoinette am Zehnhoff-Dinnesen, director of the Department of Phoniatrics and Pediatric Audiology, University of Münster, Germany, and Professor Dr. Katrin Neumann, director of the Department of Phoniatrics and Pediatric Audiology, University of Frankfurt, Germany as the main initiators of the new association of German NHS centers.

We thank Dr. Axel von der Wense, chairman of the HAHN eV and Kai Uus (MD, Ph.D.), program director of Audiology (School of Psychological Sciences, University of Manchester, UK) for their valuable comments. We thank Peter Boettcher, project manager of the newborn hearing screening in Hessen, Germany, Dr. Kurt Buser, Department of Epidemiology and Social Medicine, Hannover Medical University, Dr. Uta Nennstiel-Ratzel and Dr. Inken Brockow, Screening Center in the Bavarian State Office for Health Care and Safe Quality of Foods, and PD Dr. Wafaa Shehata-Dieler, Department of Otolaryngology-Head and Neck Surgery, University of Würzburg, Germany, for the sharing of further data from their newborn hearing screenings. We thank Professor Reinhard G. Matschke (Hannover, Germany) for support and advice. We thank PD Dr. Mark Praetorius, Department of Otolaryngology, University of Heidelberg, Heidelberg, Germany for information about the new association of German NHS centers including program, initiatives, and targets. We thank Dr. Gabriella Tognola, Istituto di Igegneria Biomedica CNR, Milano, Italy for providing the European screening data (2003) for our discussion.

Conflict of interest

None of the sponsors was involved in the study design, collection, analysis, and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication. Neither the authors nor their departments have received any financial support from any industry or other external source related to the material discussed in this manuscript.

Disclosure of financial interest

The responsible author and coauthors have never received any financial support belonging to the presented investigation.

Author information

Correspondence to Anna-Katharina Rohlfs.

Additional information

M. Hess and T. Wiesner are representatives of all members of the “Hamburg working group for hearing screening of newborns registered association” (Hamburger Arbeitskreis für Hörscreening bei Neugeborenen, eingetragener Verein” (H.A.H.N. e.V.)).

Statement of the authors

All authors certify that the work has not been published previously and that all authors agreed to the content of the manuscript (see copyright release and author agreement).

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Rohlfs, A., Wiesner, T., Drews, H. et al. Interdisciplinary approach to design, performance, and quality management in a multicenter newborn hearing screening project. Eur J Pediatr 169, 1453–1463 (2010). https://doi.org/10.1007/s00431-010-1229-0

Download citation

Keywords

  • Interdisciplinary approach
  • Multicenter newborn hearing screening
  • Screening and fail rate
  • Lost to follow-up
  • Diagnosis and therapeutic intervention of hearing loss
  • Unilateral and bilateral hearing loss