PP1104 - Inpatient Audiologic Services Facilitate Early Hearing Detection in the NICU

Abstract:
Infants needing NICU intervention have protracted timelines for diagnosis after referral on newborn hearing screening despite being at higher risk for congenital hearing loss. This retrospective study evaluates factors associated with diagnostic completion for NICU infants served in two different NICU settings—those completing only screenings versus those that provide additional diagnostic services during admission. Analysis revealed diagnosis by 3 months corrected age is feasible in this medically complex population but occurs at a lower rate when compared to the non-NICU population. In-NICU diagnostic testing during admission reduces the likelihood of LTFU and facilitates early hearing detection in this population.

Summary:

Introduction:
Although the national benchmark for Early Hearing Detection and Intervention (EHDI) is to complete screening by 1 month, diagnosis by 3 months, and enrollment into early intervention by 6 months, multiple barriers exist that hinder families effectively moving through the EHDI process. One such barrier is the medical status of the infant, as it has been shown that infants needing neonatal intensive care unit (NICU) intervention have protracted timelines to diagnosis after a referral on newborn hearing screening despite being at higher risk for congenital hearing loss. This retrospective study evaluates factors associated with diagnostic completion for NICU infants after a referral on newborn hearing screening.

Results:
Between 2018 and 2021, 368 infants with NICU history were referred to our center for diagnostic testing due to referral on the newborn hearing screening; 96.4% completed diagnostic evaluation resulting in a 5.4% loss-to-follow-up (LTFU) rate. This LTFU rate was similar to that found in infants with no NICU history at our center. Infants received neonatal care either in our Downtown Campus NICU (D-NICU) that provides both screening and diagnostic services through our Inpatient Audiology team (n = 178, 48.4%) or at community NICUs (C-NICU) at various birth hospitals that only provide screening services (n = 190, 51.6%). Median gestational age for infants evaluated were 37 and 36 weeks, respectively, for the D-NICU and C-NICU, with an overall range of 22 to 40 weeks for both groups. Corrected age was used to calculate descriptive statistics and average corrected age at diagnosis was 82.7 and 77.2 days for the D-NICU and C-NICU, respectively. Overall, 57.9% of NICU babies were diagnosed by 3 months corrected age with no significant difference between NICU groups; however, this is in contrast to 87% of infants without NICU history completing diagnosis by 3 months of age at the same center. In addition to the 20 infants who were completely LTFU for diagnostic assessment, 38 infants had protracted diagnostic processes or were lost after one diagnostic evaluation (i.e., did not return for recommended follow-up testing). Analysis of these data revealed that the D-NICU had a 14% LTFU rate while the C-NICU group had a 17.4% LTFU rate.

Conclusions:
Analysis of infants with NICU history revealed that diagnosis by 3 months corrected age is feasible in this medically complex population but occurs at a lower rate when compared to the non-NICU population. Level of in-NICU audiologic care (screening only or screening and diagnostic services provided) did not significantly impact corrected age at diagnosis. Loss-to-follow-up was higher for C-NICUs when compared to the D-NICU. The ability to provide in-NICU diagnostic testing during admission likely accounts for this difference and facilitates early hearing detection in this population. Limitations of this study include potentially over-estimating LTFU for infants who may have received services outside of our hospital system and an inability to understand how individual medical complexity may impact timing of service provision in this population.