Universal newborn hearing screening follow-up in two Georgia populations: newborn, mother and system correlates.

BACKGROUND

Nearly half of babies who "fail" their newborn hearing screening do not receive appropriate follow-up. Various explanations have been suggested.

OBJECTIVE

To investigate, in two contrasting populations of newborns in Georgia, contemporaneous medical, socio-demographic and screening correlates of follow-up after newborn hearing screening. Three hypotheses were addressed: (1) follow-up correlated with particular medical, social and demographic features; (2) screening performance indicators correlated with follow-up; and (3) screening policies and procedures correlated with follow-up.

METHODS

The studied babies, born July 2001 through June 2003 at Atlanta's Piedmont Hospital and Waycross Health District, had failed screening in both ears. Each site had about 4000 births per year, and a plan for outpatient follow-up of in-patient "fail" babies.

RESULTS

At Piedmont, where Medicaid funded less than 7% of the births, 57% (130/230) had known follow-up to outpatient screening. In contrast, at Waycross, where Medicaid funded 89.6% of the births, 100% (38/38) had follow-up. The first study hypothesis was only partially supported by the data-from Piedmont, but not Waycross. White race and maternal age 30 years or older correlated with following-up: odds ratios 2.07 (95% CI 1.17, 3.68) and 1.83 (1.05, 3.17), respectively. Private health insurance and marriage trended with following-up. Follow-up rates did not correlate with the rates of screening refusal, missed screening and "fail" rates. Follow-up was unrelated to mothers witnessing the screening, receiving in-person explanations and having appointments arranged for them. The Piedmont and Waycross programs were quite different. Piedmont's began in 2001, mothers typically learned about screening when it was done and "fail" babies were reported to many public health entities. In contrast, the Waycross program was more than 20 years old, prenatal care included teaching about screening and reporting was to one public health entity.

CONCLUSIONS

Though maternal socio-demographic features (poor, non-white, young) and access problems have been considered factors for non-follow-up, this study found two program characteristics most important: the lack of prenatal education about newborn hearing screening, and the lack of functionally integrated hospital hearing information with Public Health.