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Press Release Date: October 23, 2001
The U.S. Preventive Services Task Force (USPSTF) today announced that the available scientific evidence is insufficient to recommend for or against routine screening of newborns for hearing loss. The USPSTF, a panel of independent, private-sector experts in prevention and primary care, reached its conclusion based on a report by the Evidence-based Practice Center (EPC) at Oregon Health & Science University, which is supported by the Agency for Healthcare Research and Quality (AHRQ).
The USPSTF review examined two key questions: 1) the effectiveness and success of existing universal screening programs, and 2) the evidence that children who are detected and treated earlier have better speech and language outcomes. The USPSTF found good evidence that universal screening leads to earlier identification and treatment of infants with hearing loss. However, the USPSTF found that the evidence to determine whether earlier treatment resulting from screening leads to long-term improvements in language skills was not conclusive.
The USPSTF process requires good evidence that a service produces significant improvements in important clinical outcomes, and that these benefits outweigh any harms, before it recommends it for routine use. The Task Force defined routine screening to include universal screening and screening in high-risk infants. The USPSTF noted that, while early identification and intervention might itself be of value to some parents, these benefits need to be weighed against the frequent false-positive results that arise from universal screening.
"The USPSTF has identified important gaps in our knowledge of the impact of screening and how we can help children with hearing loss improve their language skills," said Lisa A. Simpson M.B., B.Ch., F.A.A.P., AHRQ deputy director. "AHRQ is committed to working with the child health research community to fill these knowledge gaps and those in other critically important children's health care issues."
Newborn hearing screening is the fifth recommendation released by the USPSTF. Working with the Oregon Health & Science University EPC, the Task Force conducts rigorous, impartial assessments of scientific evidence for a broad range of preventive services. It grades the strength of evidence from "A" (strongly recommends) to "D" (recommends against). For routine newborn hearing screening, the USPSTF issued an "I" recommendation. An "I" recommendation, in which the USPSTF finds insufficient evidence to recommend for or against a particular intervention, means that the evidence that the service is effective is lacking, of poor quality, or conflicting, and the balance of harms and benefits cannot be determined.
Specific to newborn hearing screening, the USPSTF found:
- Research indicates that universal newborn hearing screening leads to earlier detection and to earlier treatment of hearing loss. On average, hearing loss is detected and treated 6-9 months earlier.
- Studies that reviewed the association between early intervention and better language at 2 to 4 years had serious methodological limitations.
- The yield of screening is substantially higher in high-risk populations (children in the neonatal intensive care unit and those with other risk factors for hearing loss) because of the higher prevalence of potential hearing problems.
"Universal newborn hearing screening programs in more than 30 states provide an excellent opportunity to collect additional data that may help us determine the impact of screening on important clinical outcomes," said USPSTF chairman Alfred O. Berg, M.D., M.P.H., Chair of the Department of Family Medicine, University of Washington, Seattle.
The newborn hearing screening recommendation can be found on the AHRQ Web site. Previous USPSTF recommendations, summaries of the evidence, easy-to-read fact sheets explaining the recommendations, and related materials are available from the AHRQ Publications Clearinghouse via E-mail at: AHRQPubs@ahrq.hhs.gov and through the National Guideline Clearinghouse™ at http://www.guideline.gov. AHRQ is planning to compile all of the USPSTF chapters and evidence summaries in a semiannual notebook that will include a cumulative index.
To help clinicians apply Task Force recommendations in practice and to help patients understand which clinical preventive services they should expect clinicians to provide, AHRQ sponsors the Put Prevention Into Practice (PPIP) program. Information about the PPIP program and products is available on the AHRQ Web site at http://www.ahrq.gov/clinic/prevenix.htm.
Editor's Note: An article based on the report of the evidence on universal newborn hearing screening produced by the Oregon Health & Science University Evidence-based Practice Center will be published in the October 24, 2001, issue of the Journal of the American Medical Association.
For more information, please contact AHRQ Public Affairs, (301) 427-1364.