Not passing newborn hearing screening and neurodevelopment at 2 years in infants born extremely preterm

Abstract

OBJECTIVE: To evaluate the association between not passing newborn hearing screening and language, cognitive, and behavioral outcomes at 2 years' corrected age among infants born extremely preterm.

STUDY DESIGN: Retrospective cohort study of infants born at 22-26 weeks' gestation or 401-1,000 g at Neonatal Research Network centers from 2012-2021 who completed predischarge newborn hearing screening and neurodevelopmental follow-up at 22-26 months' corrected age. Mixed-effects models estimated associations between screening result and Bayley Language and Cognitive Composite scores and Child Behavior Checklist (CBCL) Total Problems T-scores, with secondary analyses of clinically relevant Bayley and CBCL thresholds after adjustment for center and clinical and sociodemographic covariates.

RESULTS: Among 4,891 infants, 690 (14%) did not pass newborn hearing screening. Compared with infants who passed, those who did not pass had modestly lower Bayley language (adjusted mean difference [AMD], -2.6; 95% CI, -4.1 to -1.1) and cognitive (AMD, -2.4; 95% CI, -3.7 to -1.1) scores. They also had higher odds of Bayley language score <85 (adjusted odds ratio [aOR], 1.4; 95% CI, 1.1 to 1.7) and cognitive score <85 (aOR, 1.4; 95% CI, 1.1 to 1.7), but not of scores <70. Screening result was not independently associated with CBCL Total Problems T-score or with CBCL Total Problems T-score ≥60 or ≥64, although exploratory mediation analyses suggested small indirect associations through lower Bayley scores. In a small exploratory subgroup of infants who did not pass screening but had a normal inpatient diagnostic auditory brainstem response before discharge (n=119), adjusted Bayley language and cognitive scores were also lower than among infants who passed screening.

CONCLUSIONS: Among extremely preterm infants, not passing newborn hearing screening was associated with modestly lower language and cognitive performance at 2 years, particularly in the mild-to-moderate range, but not with early behavioral problems. These findings support prompt audiologic follow-up and developmental surveillance.