A study to decrease the false–positive referralrateinnewbornhearingscreening

Objectives The false-positive referral rate after newborn hearing screening (NHS) is more than eight times as that for the case of congenital metabolic diseases in Japan. We designed a system to decrease the high-false positive referral rate after NHS. Subjects and Methods The audiological records of 1,849 neonates delivered at the Toranomon Hospital over a 5-year period (2006～2010) were analyzed retrospectively. The neonates received NHS by automated auditory brainstem response (AABR) evaluation during their hospital stay. Results The records of 25 neonates showed “refer” at the initial screening, however, in 19 of these cases, “refer” changed to “pass” at the second or final screening at the routine checkup performed 1 month later. The remaining 6 were confirmed to have moderate to profound deafness by evaluation of the ASSR. Namely, the false-positive referral rate decreased from 76% to 0%. The causes of the false-positive referrals were thought to be external and middle ear pathologies or retarded central nervous system maturation. Conclusion. Our proposed auditory care system for neonates is as follows; only neonates who do not pass the final NHS performed at the 1-month checkup of neonates should be referred to audiological centers for further evaluation by auditory brainstem response (ABR) or auditory steady state response (ASSR). This system would minimize the false-positive referral rate and also the rate of unnecessary ABR or ASSR examinations. In addition, it would also reduce the adverse effects like worry or distress in the parents. This modification of the universal NHS system seems possible to establish in countries, which have a public periodic checkup system for neonates and nursing mothers.