Objective: To determine the efficacy and refer rates of universal newborn infant hearing screening prior to hospital discharge using a two stage screening protocol.

Method: Over a two-year period, January 1,1995-December 31, 1996, universal newborn infant hearing screening prior to hospital discharge was performed on 28,202 infants born at one of seven regional centers participating in the NYS DOH Newborn Infant Hearing Screening Program Demonstration Project. Newborn nursery screenings were conducted by either technicians or audiologists using a two-stage procedure: TEOAE followed by ABR for infants who failed the TEOAE test at six sites, or TEOAE followed by repeat TEOAE at one center. ≤48 hour discharge for healthy babies was the standard in all study nurseries. Neonates in the NICU were screened by nurses, technicians or audiologists, using ABR as the primary testing modality.

Results: In 1995, 14,670 neonates were screened: 1414 (9.6%) referred on first stage TEOAE screening as compared to 410 (2.8%) after the second stage ABR. Among the 27,417 infants tested during 1996, 2,398 (8.8%) referred after TEOAE alone versus 859 (3.1%) after TEOAE-ABR screening. There was a statistically significant reduction in the refer rate between year 1 and 2 (p<.01, Chi square analysis with Bonferroni correction) attributable to improved proficiency among screeners. Refer rates for the initial stage TEOAE for infants born during 1996 differed for those newborns in the newborn nursery versus the group as a whole: 9.6% v. 8.4%; (p<0.001). Two stage screening eliminated this difference, 3.2% v. 2.9% (N.S.). The site using a two stage TEOAE protocol demonstrated extremely low refer rates: 4.4% and 3.0% using a single TEOAE or two stage TEOAE-TEOAE strategy respectively.

Conclusion: Use of a two stage protocol for universal hearing screening of newborns prior to nursery discharge has proved to be an effective means to reducing the refer rate.