# Timing of Newborn Hearing Screening Effects on Passing Rates: A Prospective Cohort Study

## TL;DR

This study finds that waiting until after 48 hours improves newborn hearing screening success rates, reducing false positives and the need for follow-ups.

## Contribution

The study identifies optimal timing for newborn hearing screening and factors influencing pass rates, offering actionable insights for clinical protocols.

## Key findings

- Pass rates significantly improved when screening occurred after 48 hours (99.3%) compared to earlier times.
- Cesarean delivery and late preterm birth were associated with delayed screening success.
- Optimizing screening timing can reduce false positives and improve clinical efficiency.

## Abstract

Newborn hearing screening using transient evoked otoacoustic emissions (TEOAEs) is essential for early detection of hearing impairment. The Joint Committee on Infant Hearing recommends screening near hospital discharge but does not specify an optimal timing. To determine the optimal timing for TEOAE screening in neonates at low risk of hearing impairment and to identify perinatal factors influencing pass rates.

Neonates underwent sequential TEOAE screening based on postnatal age at the time of testing: less than 24, 24 to 36, 36 to 48, and more than 48 hours, with follow-up at 1 month for persistent failures. Statistical analyses included Fisher's exact test to compare pass rates across time intervals and multivariate Cox's proportional hazards regression and Laplace regression to assess factors associated with screening outcomes.

Among 408 neonates, the median passing age was 23.8 hours (interquartile range: 14.3). Pass rates improved with later screening: 53.7% at less than 24 hours, 80.1% at 24 to 36 hours, 92.6% at 36 to 48 hours, and 99.3% at more than 48 hours. A significant improvement was observed only at more than 48 hours (odds ratio: 5.26;
p
 = 0.0153). Cesarean delivery was associated with delayed passing compared with vaginal delivery (
p
 = 0.036). Late preterm neonates demonstrated a significantly delayed passing time of approximately 12.9 hours (
p
 < 0.01), whereas small for gestational age neonates passed earlier by 8.2 hours (
p
 = 0.021).

Screening at greater than or equal to 48 hours significantly improved pass rates. An older age at successful screening was observed among preterm neonates and those delivered by cesarean section, underscoring the need for tailored follow-up protocols. These findings highlight the importance of optimizing screening strategies to enhance early detection and intervention.

The ideal timing for newborn hearing screening remains unclear, affecting accuracy and follow-up rates.

Early TEOAE screening may lead to high false positives due to residual ear fluid, increasing unnecessary follow-ups.

Optimizing timing of the hearing screening window can enhance accuracy, reduce false positives, and improve clinical efficiency.