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Prevention

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Evidence is inconclusive on the long-term benefits of newborn hearing screening

The U.S. Preventive Services Task Force (USPSTF) has determined 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 an extensive review of the evidence conducted by the Evidence-based Practice Center (EPC) at Oregon Health & Science University. The EPC is supported by the Agency for Healthcare Research and Quality (290-97-0018).

The review examined two key issues: one, the effectiveness and success of existing universal screening programs; and two, the evidence that earlier detection and treatment of hearing problems in children result in 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 evidence was inconclusive about whether earlier treatment as a result of screening leads to long-term improvements in language skills.

The USPSTF process requires good evidence that a service produces significant improvements in important clinical outcomes, and that these benefits outweigh any harms, before the Task Force recommends a service for routine use. They defined routine screening to include universal screening and screening in high-risk infants. The USPSTF noted that although early identification and intervention might be of value to some parents, these benefits need to be weighed against the frequent false-positive results that arise from universal screening.

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.

Newborn hearing screening is the fifth recommendation released by the USPSTF; the first four recommendations concerned screening for chlamydia, high blood cholesterol and other lipid abnormalities, skin cancer, and bacterial vaginosis. 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. The Task Force grades the strength of evidence from "A" (strongly recommends) to "D" (recommends against).

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.

Editor's Note: An article summarizing the evidence on universal newborn hearing screening, authored by Diane C. Thompson, M.S., Heather McPhillips, M.D., M.P.H., Robert L. Davis, M.D., M.P.H., and others, appears in the October 24/31, 2001, Journal of the American Medical Association 286(16), pp. 2000-2010.

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