Magnitude and Factors Associated with Refer Results of Newborn Hearing Screening at Academic Tertiary Level Hospital, Addis Ababa, Ethiopia

Abstract

Background. Hearing impairment is a leading cause of disability worldwide. Early identification and early intervention of hearing loss can prevent further disability in the development of speech, language, cognition, and other developmental domains. This study aimed to determine the magnitude and factors associated with the refer results of newborn hearing screening at an academic tertiary hospital. Methods. An institution-based time series cross-sectional study was conducted with a calculated sample size of 368 newborns selected by systemic random sampling from a total of 2087 newborns born in SPHMMC during the study period. Two stage screening protocol was conducted using Transient Evoked Otoacoustic Emission (TEOAE) on the first, followed by TEOAE and Auditory Brainstem Reflex (ABR) as a second stage for newborns with refer results. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 26.0. Bivariate and multivariate analyses between dependent and independent variables were performed using binary logistic regression with a significance level of $P$ value <0.05. Result. Of the total sample size of 368 newborns, 62% (228) passed the first TEOAE and 38% (140) yielded refer results. From 121 who came for follow-up screening (6–28 days), 49.5% (60) passed the second TEOAE and 50.5% (61) had refer results. AABR screening of 61 newborns yielded pass in 11.5% (7) and refer result in 88.5% (54) newborns. Noise (AOR= 4.746, 95% CI 2.505–8.992, $P<0.001$ ), vernix caseosa (AOR= 19.745, 95% CI 9.057–43.043, $P<0.001$ ), and very low birth weight (AOR= 4.338, 95% CI 1.338–14.067, $P=0.015$ ) were found to be significantly associated with the refer rate of the first TEOAE test. Noise (AOR 39.445, 95% CI 5.974–260.467, $P<0.001$ ) and neonatal jaundice (AOR 21.633, 95% CI 1.540–303.994, $P=0.023$ ) were significantly associated with the follow-up screening refer result of TEOAE. Repeat TEOAE has decreased the refer rate from 38.0% (140/368) to 17.5% (61/349), 19 of which were lost to follow-up. AABR has decreased the overall refer rate from 17.5% to 15.5% (54/349). Conclusion. This study shows a significant number of newborns (15.5%) who need diagnostic audiologic work-up and may need intervention. Vernix caseosa and noise are avoidable factors, but newborns with jaundice and very low birth weight should be sent to ENT for screening.