Universal newborn hearing screening in the Lazio region, Italy

Background: The introduction of Universal Newborn Hearing Screening (UNHS) programs has drastically contributed to the early diagnosis of hearing loss in children, allowing prompt intervention with significant results on speech and language development in affected children. UNHS in the Lazio region has been initially deliberated in 2012; however, the program has been performed on a universal basis only from 2015. The aim of this retrospective study is to present and discuss the preliminary results of the UNHS program in the Lazio region for the year 2016, highlighting the strengths and weaknesses of the program. Methods: Data from screening facilities in the Lazio region for year 2016 were retrospectively analyzed. Data for Level I centers were supplied by the Lazio regional offices; data for Level II and III centers were provided by units that participated to the study. Results: During 2016, a total of 44,805 babies were born in the Lazio region. First stage screening was performed on 41,821 children in 37 different birth centers, with a coverage rate of 93.3%. Of these, 38.977 (93.2%) obtained a "pass" response; children with a "refer" result in at least one ear were 2844 (6.8%). Data from Level II facilities are incomplete due to missing reporting, one of the key issues in Lazio UNHS. Third stage evaluation was performed on 365 children in the three level III centers of the region, allowing identification of 70 children with unilateral (40%) or bilateral (60%) hearing loss, with a prevalence of 1.6/1000. Conclusions: The analysis of 2016 UNHS in the Lazio region allowed identification of several strengths and weaknesses of the initial phase of the program. The strengths include a correct spread and monitoring of UNHS among Level I facilities, with an adequate coverage rate, and the proper execution of audiological monitoring and diagnosis among Level III facilities. Weakness, instead, mainly consisted in lack of an efficient and automated central process for collecting, monitoring and reporting of data and information

Modifications of auditory brainstem responses (ABR): observations in full-term and pre-term newborns

Objective: In this study, we have evaluated by means of auditory brainstem responses (ABR), in a population derived from a newborn hearing screening protocol, some aspects of maturation of the auditory pathways in the first months after birth, and the possible repercussions on early treatment. Materials and methods: In this retrospective study newborns were recruited through our hearing screening program, and an ABR evaluation was performed on 339 newborns, that had risk factors or had failed the screening, or both. Such population was divided in two groups for statistical analysis purposes: full-term and pre-term. The initial ABR was pathological in 70 infants. Results: We observed an improvement over time of the estimated hearing threshold in follow-up ABRs in 43 newborns (26 in the full-term group, mean improvement 27.9 dB SPL, and 17 in the pre-term group, mean improvement 34.6 dB SPL); such an improvement might be related to a maturation of the auditory pathways that was not complete at birth. Conclusions: The auditory system might not be completely developed at birth, and might require some months to complete; hence any early clinical approach should consider the possibility of an overtreatment, and any therapeutic strategy should only be considered once the diagnosis is certain and definitive