Feasibility of otoacoustic emission detection followed by ABR as a universal neonatal screening test for hearing impairment.

The feasibility of attempting a two-stage universal screening test for auditory impairment was assessed at a large district maternity hospital. The first stage was measurement of otoacoustic emissions using the Programmable Otoacoustic Emission Measurement System. Those failing the first stage proceeded to automated analysis of auditory brainsteam responses. A single tester working for 6 h on 6 days per week attempted to test all babies born between the hours of midday and midnight for 2 weeks and then all babies born between midnight and midday for a further 2 weeks. Of 217 babies born during the study periods, one infant died and three were still receiving intensive care at the end of the study. Of the remaining 213 infants, auditory testing was undertaken in 201 infants (94%). Eight infants (4%) who failed the first stage of the screening test did not undergo the second stage. Of those 193 infants completing the screen, one (0.5%) failed the screen unilaterally. There were no bilateral failures. Three testers, working two and a half whole-time equivalents, should be adequate to achieve a coverage of 90% and a specificity of 99% for this screen in this clinical setting.