# Maternal and Neonatal Vulnerabilities Associated with Abnormal Outcomes in Newborn Hearing Screening: A Focus on Adolescent Mothers

## TL;DR

Newborns of adolescent mothers have a slightly higher risk of abnormal hearing screening results due to combined maternal and neonatal risk factors.

## Contribution

The study identifies specific maternal and neonatal vulnerabilities linked to abnormal hearing screening outcomes in infants of adolescent mothers.

## Key findings

- The REFER rate was slightly higher in newborns of adolescent mothers (5.3%) compared to those of adult mothers (4.8%).
- Maternal anemia, limited prenatal care, and neonatal prematurity were more common in infants with persistent REFER results.
- Strengthening prenatal care and audiological follow-up may improve early detection of hearing loss in this population.

## Abstract

Universal newborn hearing screening is essential for early identification of sensorineural hearing loss. Infants born to adolescent mothers may be more vulnerable to abnormal screening outcomes due to biological, socio-economic, and obstetrical risk factors frequently associated with adolescent pregnancy. This study evaluates hearing screening outcomes in newborns of adolescent mothers and examines whether maternal and neonatal vulnerabilities contribute to abnormal (REFER) results. A retrospective observational study was conducted over four years (January 2021–January 2025) at the “Sf. Ap. Andrei” County Emergency Clinical Hospital, Galați, Romania. The study included 187 newborns of adolescent mothers (≤18 years) and 3203 newborns of mothers aged >19 years. All infants underwent transient evoked otoacoustic emission (TEOAE) testing within 48–72 h after birth, according to institutional protocol. PASS/REFER outcomes were recorded, and retesting was performed when indicated. Although otological conditions such as middle ear dysfunction may influence OAE responses, routine otoscopic examination and clinical assessment were performed prior to testing. Automated auditory brainstem response (AABR) testing was not routinely applied due to equipment availability and local screening practices. The final REFER rate was slightly higher in the adolescent group (5.3%) compared with the adult group (4.8%). Maternal age alone was not directly associated with abnormal outcomes; however, maternal anemia, limited prenatal care, rural residence, prematurity, and low birth weight were more frequently observed among cases with persistent REFER results. Infants born to adolescent mothers show a modestly increased likelihood of abnormal hearing screening outcomes, primarily related to cumulative maternal and neonatal vulnerabilities. Strengthening prenatal care and targeted audiological follow-up may improve early detection of sensorineural hearing loss in this population.