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Summary of Systematic Review

Universal Newborn Hearing Screening: Systematic Review to Update the 2001 US Preventive Services Task Force Recommendation
Nelson, H. D., Bougatsos, C., et al. (2008).
Pediatrics, 122(1), e266-276.

This review meets the criteria for a high-quality evidence-based systematic review.

Indicators of Review Quality:

The review states a clearly focused question or aim Yes
Criteria for inclusion of studies are provided Yes
Search strategy is described in sufficient detail for replication No
Included studies are assessed for study quality Yes
Quality assessments are reproducible Yes*
Characteristics of the included studies are provided Yes

*For more information about quality assessment, see the current methods of the U.S. Preventive Services Task Force http://www.ahrq.gov/clinic/ajpmsuppl/harris1.htm

Description:
This is an updated systematic review of controlled trials and observational studies addressing outcomes of infants screened for hearing loss by 6 months of age.

Question(s)/Aim(s) Addressed:

  1. Among infants identified by universal screening who would not be identified by targeted screening, does initiating treatment before 6 months of age improve language and communication outcomes?

  2. Compared with targeted screening, does universal screening increase the chance that treatment will be initiated by 6 months of age for infants at average risk or for those at high risk?

  3. What are the adverse effects of screening and early treatment?

Population:
Infants.

Intervention/Assessment:
Universal newborn hearing screening (UNHS).

Number of Studies Included:
20

Years Included:
Through November 2007

Conclusions:

Permanent Childhood Hearing Loss

  • Screening/Assessment

    • Screening

      • General Findings

        • “Results of this review indicate that infants identified with PCHL [permanent childhood hearing loss] through UNHS [universal newborn hearing screening] have significantly earlier referral, diagnosis, and treatment than those identified in other ways.” (p. 274).

        • Children who underwent UNHS had better scores than those who did not on receptive language but not on expressive language or speech.

        • Patient Perspective: "Studies of adverse effects of screening indicate that usual parental reactions to an initial nonpass include worry, questioning, and distress. Negative emotions resolve for most parents when a diagnostic test is provided with a normal result" (p. 274).

  • Treatment

    • Cochlear Implants

      • Contraindications/Risks

        • "Cochlear implants have been associated with higher risks for bacterial meningitis in young children” (p. 266). Implants with positioners showed the highest risk for infection. These were voluntarily recalled in the United States in 2002.

      • General Findings

        • Patient Perspectives: "Families were anxious about possible device failure and maintenance of the equipment and acknowledged that their children needed more support from the family after the implantation. Most parents reported benefits of implantation, including improved communication, self-confidence, well-being, and social relationships" (p. 273).

        • "Parents of 123 children with hearing loss (average: 38 months of age) were asked about their stress and quality of life related to 3 types of treatments. All had cochlear implants, hearing aids, or switched treatments (hearing aid first then cochlear implants). Parents of children with switched treatments had significantly reduced quality of life and increased stress, whereas parents of children using only cochlear implants had improved quality of life and normal stress" (p. 273).

    • Hearing Aids

      • General Findings

        • "Parents of 123 children with hearing loss (average: 38 months of age) were asked about their stress and quality of life related to 3 types of treatments. All had cochlear implants, hearing aids, or switched treatments (hearing aid first then cochlear implants). Parents of children with switched treatments had significantly reduced quality of life and increased stress, whereas parents of children using only cochlear implants had improved quality of life and normal stress" (p. 273).

Sponsoring Body:
Agency for Healthcare Research and Quality

Keywords:
Hearing Loss, Deafness, Early Hearing Detection and Intervention

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