Outcomes of newborn hearing screening at an academic secondary level hospital in Johannesburg, South Africa.
Jacqueline K Bezuidenhout, Katijah Khoza-Shangase, Tim De Maayer and 1 others
PMID 33567828WHAT IT FOUND
Newborn hearing screening at a South African hospital failed to meet quality benchmarks.
Nearly half of screened babies were referred for repeat testing, far above the 5% target. Most infants with refer results did not return for follow-up, and no risk factors predicted referral.
Key findings
01A high proportion of screened neonates (47%) received a 'refer' result on initial screening, significantly exceeding the recommended target of less than 5%.
02Only 35% of infants referred for repeat screening returned for follow-up, meaning the majority were lost to the system.
03There was no statistically significant association between standard hearing risk factors (such as NICU admission, family history, or ototoxic drug exposure) and the likelihood of a 'refer' screening result.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study had a very small sample size relative to the population (121 screened out of 2740 born), limiting generalizability. The 3-month data collection period was short. The setting was an academic secondary-level hospital in Johannesburg, which has better resources than many other public facilities, so findings may not apply to rural or under-resourced clinics. The high refer rate may have been inflated by technical issues (faulty equipment), environmental factors (noise), and clinical factors (vernix caseosa), rather than reflecting true hearing loss prevalence. The study could not determine the true positive rate because most referred infants did not return for follow-up, and those who did had limited diagnostic confirmation. Otoscopy and ear canal cleaning were not standardized interventions during the screening, potentially affecting DPOAE accuracy.
Declared interests
The study was part of a larger project titled 'Universal Newborn Hearing Screening in Public Healthcare in South Africa: Challenges to Implementation'. No specific commercial funding or conflicts of interest were declared in the provided text.
The easy way to misread this
Do not interpret the 47% refer rate as evidence that nearly half of the newborns in this population have hearing loss. The high rate was likely driven by technical and environmental factors such as vernix caseosa, ambient noise, and equipment issues, compounded by the lack of a two-stage screening protocol. Similarly, do not assume that a 'pass' on initial screening rules out hearing loss, as the study notes the potential for false negatives due to the single-stage approach and the inability to track long-term outcomes for those lost to follow-up.