Screening for permanent neonatal hearing loss involves conducting hearing tests on all newborns before they are discharged from the maternity ward.

The national hearing screening program was launched in November 2014. With a coverage rate of 94%, the target of 90% coverage after two years of operation was thus exceeded. Furthermore, this screening was very well received by parents as early as 2015 (refusal rate = 0.1%). In 2016, there was significant interregional variation in the program’s practical implementation (whether or not to screen for unilateral hearing loss, screening techniques, etc.). It was also found that 1.4% of newborns were suspected of having bilateral hearing loss before discharge from the maternity ward.

Usefulness of the additional screening test performed after discharge from the maternity ward

A majority of regions added an additional screening test conducted after discharge from the maternity ward as early as 2016. Indeed, amniotic fluid may sometimes remain in the child’s ear for a few days and skew the results of the screening performed in the maternity ward. The report “Universal Screening for Permanent Bilateral Neonatal Hearing Loss: Evaluation of Its Implementation After Two Years of Operation in France” shows that the rate of children suspected of having bilateral neonatal hearing loss drops from 1.4% to 0.9% after adding this test. This test would also be useful for detecting cases of hearing loss that, after discharge from the maternity ward, have progressed from unilateral to bilateral hearing loss.

Estimated prevalence of bilateral neonatal hearing loss at 0.9‰ (tone loss > 40 decibels)

The prevalence of permanent bilateral neonatal hearing loss was estimated in 2015 at 1.3‰ of newborns for mild to profound forms and at 0.9‰ for moderate to profound forms. Among the latter, 52% were moderate hearing impairments, 18% severe, and 30% profound. However, these prevalence rates must be confirmed using more comprehensive data.

Areas for improvement

The effect of the screening program on lowering the age at diagnosis or hearing aid fitting could not be assessed due to missing data for a significant number of children. Strategies must be identified to support clinicians’ commitment and motivation to submit data related to this program.

The specific case of Brittany

A study conducted specifically in Brittany at the request of the ARS reveals that in 2016, 1% of newborns were suspected of having bilateral hearing loss before leaving the maternity ward, which is lower than the national rate. The observed rate of moderate to profound bilateral hearing loss was also lower (0.6‰), which could be partly explained by the gradual ramp-up of the program in the region.

Furthermore, the Breton study shows that in 2016, children transferred to the neonatal unit were four times more likely to miss screening than children who were not transferred (1.9% vs. 0.5%). It would therefore be advisable to raise awareness among healthcare teams to ensure optimal follow-up for these children, who are ten times more at risk of hearing loss.