Infant, Maternal, and Hospital Factors' Role in Loss to Follow-up After Failed Newborn Hearing Screening

Acad Pediatr. 2018 Mar;18(2):188-195. doi: 10.1016/j.acap.2017.05.005. Epub 2017 May 23.


Objective: Completion of newborn hearing screening (NBHS) is recommended by 1 month old. Delays and loss to follow-up and documentation (LTF/LTD) after failed NBHS are common. Committees of experts have established hospital guidelines to reduce LTF/LTD. We aimed to identify maternal and infant factors associated with LTF/LTD and determine if adherence to hospital guidelines is associated with timely completion of follow-up screening.

Methods: We conducted a retrospective study of all infants born in Colorado hospitals who failed the newborn admission hearing screening from 2007 to 2012 and a cross-sectional survey of NBHS coordinators at Colorado birthing hospitals. Neonatal intensive care unit infants were excluded. Outcomes included documented completion of the follow-up NBHS and completion by 1 month. Data sources comprised the electronic birth record, infant hearing integrated data system, and NBHS coordinator survey. Data were analyzed by logistic regression.

Results: A total of 13,904 newborns did not pass the newborn admission hearing screening from 2007 to 2012, and 11,422 (82%) had documentation of a completed follow-up screening. A total of 10,558 (76%) completed follow-up screening by 1 month. All 53 NBHS coordinators completed the survey. Maternal age, education, smoking, and birth country; and payer, race, birth order, and population density were associated with completion of follow-up hearing screening. Maternal education, payer, population density, birth weight, and cleft lip were associated with completion by 1 month of age. Only birth in a facility that charges a rescreening fee was associated with completion of follow-up screening.

Conclusions: Low-income, rural, and minority infants are at risk for LTF. Further studies are needed to determine if adherence to guidelines can overcome barriers to follow-up.

Keywords: early hearing detection and intervention (EHDI); hearing loss; loss to follow-up and documentation; newborn hearing screening.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aftercare / statistics & numerical data*
  • Ambulatory Care / statistics & numerical data
  • Birth Order*
  • Cohort Studies
  • Colorado / epidemiology
  • Cross-Sectional Studies
  • Educational Status
  • Emigration and Immigration / statistics & numerical data
  • Ethnic Groups / statistics & numerical data
  • Female
  • Guideline Adherence / statistics & numerical data
  • Hearing Loss / diagnosis*
  • Hearing Tests / statistics & numerical data*
  • Hospitals / statistics & numerical data
  • Humans
  • Income / statistics & numerical data
  • Infant, Newborn
  • Insurance, Health
  • Logistic Models
  • Lost to Follow-Up*
  • Male
  • Maternal Age
  • Medicaid
  • Minority Groups / statistics & numerical data
  • Neonatal Screening*
  • Population Density*
  • Poverty / statistics & numerical data
  • Practice Guidelines as Topic
  • Retrospective Studies
  • Rural Population / statistics & numerical data
  • Smoking / epidemiology
  • United States
  • Urban Population / statistics & numerical data
  • Young Adult