Manz Kirsi, Nennstiel Uta, Marzi Carola, Mansmann Ulrich, Brockow Inken
Faculty of Medicine, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), LMU Munich, Munich, Germany.
Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School (MHH), Hannover, Germany.
Front Public Health. 2025 Apr 16;13:1566478. doi: 10.3389/fpubh.2025.1566478. eCollection 2025.
Newborn screening for hearing impairment (NHS) is a crucial public health issue worldwide. Often, a two-stage screening with two different testing approaches is used. We aimed to investigate the optimal screening algorithm, based on data from the literature published in the last 30 years. A particular focus of the study was to synthesize the existing evidence on two-stage newborn hearing screening regarding the refer rate (RFR), the percentage of children that did not pass the second test or were lost after the first test.
We searched MEDLINE and Scopus for studies on two-stage NHS using transient evoked otoacoustic emissions (TEOAE) or automated auditory brainstem response (AABR). All studies on newborns who received their first test as an inpatient and a second test up to 1 month later were eligible. Random effects meta-analysis was performed to estimate RFR. Risk of bias was assessed using QUADAS-II. The unfunded study was registered in PROSPERO (CRD42023403091, available at https://www.crd.york.ac.uk/PROSPERO/view/CRD42023403091).
Eighty-five study protocols, including over 1,120,000 newborns, met the inclusion criteria. Certainty in the evidence was rated as moderate.
Strategies that did not involve changes to the screening method had a lower RFR. AABR-AABR: RFR = 1.3% [95% confidence interval (CI): 0.9, 1.8%], TEOAE-TEOAE: RFR = 2.7% (CI: 2.2, 3.2%), TEOAE-AABR: RFR = 3.9% (CI: 2.9, 5.1%), AABR-TEOAE: 5.9% (CI: 5.0, 6.9%). Consequently, where feasible, changing the screening method at the second screening should be avoided in order to minimize the number of follow-up examinations.
新生儿听力障碍筛查（NHS）是全球重要的公共卫生问题。通常采用两种不同检测方法进行两阶段筛查。我们旨在根据过去30年发表的文献数据，研究最佳筛查算法。该研究的一个特别重点是综合现有关于两阶段新生儿听力筛查的证据，涉及转诊率（RFR），即未通过第二次测试或在第一次测试后失访的儿童百分比。
我们在MEDLINE和Scopus数据库中检索了使用瞬态诱发耳声发射（TEOAE）或自动听性脑干反应（AABR）进行两阶段NHS的研究。所有首次作为住院患者接受测试且在1个月内接受第二次测试的新生儿研究均符合条件。采用随机效应荟萃分析来估计RFR。使用QUADAS-II评估偏倚风险。该无资金支持的研究已在PROSPERO注册（CRD42023403091，可在https://www.crd.york.ac.uk/PROSPERO/view/CRD42023403091获取）。
85项研究方案，包括超过1120000名新生儿，符合纳入标准。证据的确定性被评为中等。
不涉及筛查方法改变的策略具有较低的RFR。AABR - AABR：RFR = 1.3% [95%置信区间（CI）：0.9，1.8%]，TEOAE - TEOAE：RFR = 2.7%（CI：2.2，3.2%），TEOAE - AABR：RFR = 3.9%（CI：2.9，5.1%），AABR - TEOAE：5.9%（CI：5.0，6.9%）。因此，在可行的情况下，应避免在第二次筛查时改变筛查方法，以尽量减少后续检查的数量。
