Inconsistency in Universal Newborn Hearing Screening Programmes: a Systematic Review

Transcription

1 Inconsistency in Universal Newborn Hearing Screening Programmes: a Systematic Review Pierpaolo Mincarone National Research Council Institute for Research on Population and Social Policies Evidence, Governance, Performance EBHC Conference 1 st November 013

2 Background HL, most frequent permanent congenital defect (Fujikawa et al. 000) conductive / sensorineural Risk factors for HL (most recent def.: JCIH, 007) Prevalence of HL in newborns: 5% at risk (Norton et al. 000) % (Mehl et al. 00) Tests: T / aabr No newborn screening diagnosis at 14M (Erenberg et al. 1999) impaired language and learning (Rach et al. 1988) & increased behaviour problems, decreased pychosocial wellbeing, and poor adaptive skills (Davis et al. 1999)

3 Background US National Institutes for Health (NIH, 1993), American Academy of Pediatrics (AAP) (Erenberg et al. 1999), Joint Committee on Infant Hearing (JCIH, 1994) recommended universal screening and detection of newborns with hearing loss 3M, and intervention 6M The AAP and JCIH recommendations (most recent: JCIH, 007) Universal Newborn Hearing Screening (UNHS) programmes worldwide and include indicators and benchmarks for process quality assessment

4 Aims State of Art: children with HL identified through UNHS obtained better language outcomes at school age than those not screened (Nelson et al. 008) had significantly earlier referral, diagnosis and treatment than those not screened (Wolff et al. 010) AIM: to evaluate published UNHS programmes using the AAP and JCIH benchmarks

5 Methods Systematic search Exclusion Criteria: UNHS programmes. nonenglish, no protocol description, equivocal assignment of results to the protocols, no false positive Data Extracted: study design, duration, starting year participants (#neonates, #screened, #at higher risk, risk assess.) protocol (tests, audible threshold, uni vs. bilateral HL, timing, environmental test conditions, personnel) quality indicators

6 Methods Quality indicators and benchmarks (1/) Followup rate 95% UNHS Program Scr <disc + Scr + >disc Diagn 1 % newborns compleeting screening 1M 95% F+ Recruitment and Adherence T+

7 Methods Quality indicators and benchmarks (/) % Ref. at discharge 50% () 4% (ABR) UNHS Program % Ref. def. aud. eval. <4% Resource Consumption Falsepositive rate 3% Scr <disc Diagn Scr >disc Clinical Effectiveness % def. aud. eval. 3M 90% 3 F+ 7 HL Prevalence 5% (Risk) % (All) 4 T+

8 Results Benchmark not achieved; Benchmark achieved Measured prevalence above literature data Measured prevalence under literature data Source Bevilacqua M, 010 Watkin P, 1996 Aidan D, 1999 Habib H, 005 Lin H, 007 Korres S, 008 Tatli MM, 007 Kennedy C, 005 Wessex, 1998 Lin H, 007 Test [Type; N.] 3 34 Both Both Audiol. Risk Assess. JCIH 007 JCIH 1990 JCIH 1994 Specifically reported NIH, 1994 HL Extent Recruit. and Adherence Performance Indicators Clinical Effectiv. Resource Cons. 40dB HL 40dB HL bilateral 40dB HL 6dB HL (NICU) 40dB HL 40dB HL bilateral

9 Results Benchmark not achieved; Benchmark achieved Measured prevalence above literature data Measured prevalence under literature data Source Calevo M, 007 De Capua, 007 BarskyFirkser L, 1997 Mason JA, 1998 Mason JA, 1998 Test [Type; N.] Both 4 Both 3 ABR 1 ABR 1 ABR Audiol. Risk Assess. JCIH 1994 JCIH, 000 JCIH 1994 ASHA 1988; ASHA 1989 ASHA 1988; ASHA 1989 HL Extent 40db HL Recruit. and Adherence Performance Indicators Clinical Effectiv. 30dB nhl WBB: 35dB HL NICU: 40dB HL bilateral 35dB nhl bilateral 35dB nhl bilateral Resource Cons. (NICU) (NICU) (all) (NICU) (all) Lin H, 007 Tsuchiya H, 006 Clemens CJ, 000 ABR ABR ABR 3 Admission to NICU 35dB HL 35dB nhl

10 Limits Quality indicators and benchmarks established and updated by the AAP and JCIH since February 1999 while most of the studies initiated or concluded recruitment prior to that date we tested feasibility of performing standardised evaluations of UNHS programmes Articles only in English 9 / 14 studies in our review from nonenglishspeaking countries

11 Bottom line Our systematic review substantial variability, incomplete reporting and performance gaps, in the scientific literature published to date Need to optimise reporting of screening protocols and process performance Future research: assessment of longterm outcomes of neonates with negative screening tests (false negative) causes for and interventions to reduce lost to followup standardisation of recommended quality indicators

12 Bottom Line This research was possible also thanks to Carlo Giacomo LEO Saverio SABINA Daniele COSTANTINI John B WONG Giuseppe LATINI Pierpaolo Mincarone pierpaolo.mincarone@irpps.cnr.it