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Candidate's Thesis: Universal Newborn Hearing Screening in an Inner‐City, Managed Care Environment
Author(s) -
Isaacson Glenn
Publication year - 2000
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1097/00005537-200006000-00002
Subject(s) - habilitation , medicine , psychological intervention , hearing loss , health care , intervention (counseling) , pediatrics , audiology , family medicine , nursing , philosophy , humanities , economics , economic growth
Abstract Objectives/Hypothesis Universal neonatal hearing screening (UNHS) programs aim to identify and treat educationally significant hearing loss in the first months of life. Several states have mandated UNHS for all newborns. Such programs have been successful in small, homogeneous populations. As larger states attempt to implement such programs, important obstacles have arisen, particularly in sparsely populated rural environments and in the inner city, where poverty, unstable living situations, and inadequate access to health care make follow‐up of infants failing initial testing difficult. Study Design We performed a prospective longitudinal study e‐amining the effects of increasingly comple‐ and e‐pensive interventions designed to ensure that children failing initial hearing screening returned for complete evaluation and habilitation. Methods A UNHS program based on transient evoked otoacoustic emissions testing was implemented at Temple University Hospital, with 2,000 births per year. At 6 months into the program, efficacy was assessed and modifications in follow‐up methodology were made in an attempt to improved rate of return of infants failing newborn screening. The effect of these interventions was reassessed 6 months later. Results In its first 12 months, the Temple University Infant and Young Child Hearing Intervention Initiative successfully screened 95% (2,031) of all newborns using transient evoked otoacoustic emissions. Collecting a complete database profile for each newborn, establishing rapport with the family, and offering immediate follow‐up appointments yielded a 61% return rate after discharge. The addition of a dedicated project secretary, free day‐care for siblings, and cab vouchers for transportation and the elimination of a requirement for health maintenance organization referrals increased follow‐up yield to 75%. Conclusion Given adequate resources and planning, UNHS can be successful, even in economically depressed environments.