Universal newborn hearing screening in the NICU: Who do we miss?

Objectives: Recognition of the developmental consequences of unidentified congenital hearing loss has prompted universal hearing screening of newborns. We sought to identify the incidence of infants discharged from the neonatal intensive care unit (NICU) without hearing screening and identify factors associated with failure to screen. Study Design: Retrospective case-control study of all infants admitted for >48 hours to a tertiary care NICU in 2005-2006 (N = 958). Methods: Statistical analysis was performed using simple and multiple logistic regression. Results: A total of 644 of 958 (67.2%) infants underwent hearing screening prior to discharge. Gestational age less than 30 weeks (OR 3.91, P<0.0001), birth weight less than 2500g (OR 4.50, P<0.0001) and discharge to an outside hospital (OR 14.09, P<0.0001) were significantly associated with failure to screen. Screening was performed in 339/379 (89%) patients discharged to home, 207/256 (81%) transferred to another hospital unit and 98/323 (30%) transferred to an outside hospital. Patients born at an outside hospital were more likely to undergo screening prior to discharge (OR=1.16, P=0.002). Screening incidence increased with longer length of stay and discharge at >50 days of age in the MLR (multiple logistic regression) (P =0.002, P <0.0001). Conclusions: Failure to perform hearing screening prior to discharge from the NICU was significantly greater for patients transferred to an outside hospital, low birth weight, gestational age < 30 weeks and born at the study hospital. These data suggest that an increased emphasis on hearing screening is needed for these high risk infants in the NICU setting.