Quality measures of two-stage newborn hearing screening: Systematic review with a Bayesian meta-analysis

Abstract

AbstractBackgroundNewborn Screening for hearing impairment (NHS) is a crucial public health issue worldwide. Often, a two-stage screening with two different testing approaches is used. We aimed to investigate the optimal screening algorithm, based on data from the literature published in the last 30 years. A particular focus of the study was to synthesize the existing evidence on two-stage newborn hearing screening regarding the refer rate (RFR), the percentage of children that did not pass the second test or were lost after the first test.MethodsWe searched MEDLINE and Scopus for studies on two-stage NHS using transitory evoked otoacoustic emissions (TEOAE) or automated auditory brainstem response (AABR). All studies on newborns who received their first test as an inpatient and a second test up to one month later were eligible. Random effects meta-analysis and Bayesian modeling were performed to estimate RFR as well as effects of the second test phase on the RFR. Risk of bias was assessed using QUADAS-II. The unfunded study was registered in PROSPERO (CRD42023403091).ResultsEighty-five study protocols, including over 1,12 million newborns, met the inclusion criteria. Certainty in the evidence was rated as moderate. The RFR was higher when the test method was changed than without a change of method (AABR-AABR: RFR = 1.3% (95% confidence interval (CI): 0.9, 1.8%), TEOAE-TEOAE: RFR = 2.7% (CI: 2.2, 3.2%), TEOAE-AABR: RFR = 3.9% (CI: 2.9, 5.1%), AABR-TEOAE: 5.9% (CI: 5.0, 6.9%).ConclusionsStrategies that did not involve changes to the screening method had lower RFR.