Identification of oral clefts as a risk factor for hearing loss during newborn hearing screening

Objective: This study assessed whether children with oral clefts are appropriately classified as at-risk for hearing loss at the time of newborn hearing screening and describes their screening and diagnostic results. Design: Birth certificates were used to identify children with cleft lip and palate or isolated cleft palate born in Washington State from 2008–2013. These were cross-referenced with the state’s Early Hearing Detection, Diagnosis and Intervention (EHDDI) database. Multivariate logistic regression was used to examine associations. Results: Birth records identified 235 children with cleft lip and palate and 116 with isolated cleft palate. Six children were listed as having both diagnoses. Only 138 (39%) of these children were designated as having a craniofacial anomaly in the EHDDI database. Children who were misclassified were less likely to have referred on initial hearing screening, OR 0.3, 95% CI [0.2, 0.5]. Misclassification of risk factor status was also associated with delayed hearing screening past 30 days of age or unknown age at screening, OR 4.4, 95% CI [1.5, 13.3], p = 0.008. Of 50 children with diagnostic results; 25 (50%) had hearing loss: 18 conductive, 2 mixed, and 5 unspecified. Conclusion: A majority of children with oral clefts were misclassified regarding risk factor for hearing loss in the EHDDI database