Frontiers in public health · 2026
Nonlinear associations of birth weight and gestational age with initial newborn hearing screening referral in a large Chinese neonatal cohort.
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Yang Xiaozhe, Li Yue, Wen Cheng, Cheng Xiaohua, Xie Jinge, Ruan Yu, Wang Chuan, Zhang Wei, Cui Qingjia, Yu Yiding, Deng Lin, Gao Shan, Qi Beier, En Hui, Liu Hui, Fu Xinxing, Huang Lihui, Han Demin
Аннотация
BACKGROUND: The potential risk factors for concurrent newborn hearing screening and genetic screening remain unclear, posing challenges to the prevention of hearing loss. Although gestational age and birth weight are known to influence hearing development, their associations with newborn hearing screening referral remain controversial due to limited large-scale validation.
METHODS: This retrospective population-based cohort study included 76,460 newborns who underwent concurrent newborn and genetic screening. Restricted cubic splines and piecewise linear models were used to identify threshold effects in the associations of birth weight and gestational age with initial hearing screening referral, second hearing screening outcomes, and genetic screening results. Sensitivity analyses were conducted by including sex and Apgar scores.
RESULTS: We identified non-linear, U-shaped associations between birth weight, gestational age and the odds of referral at initial hearing screening. A birth weight of 3,297 g and gestational age of 39.19 weeks were key change points. Infants above or below these points had increased odds of referral at initial hearing screening. Neither second hearing nor genetic screening results showed significant associations with both factors. Sex-stratified analysis showed male infants had higher odds of referral at initial hearing screening, with similar non-linear patterns observed for gestational age. Adjusting for Apgar scores confirmed these results, with the thresholds at a birth weight of 3,297 g and gestational age of 39.27 weeks.
CONCLUSION: Birth weight and gestational age were associated with initial hearing screening referral only. The lowest referral odds occurred around 3.3 kg and 39 weeks of gestation, which may help identify newborns who require closer follow-up after initial screening.
METHODS: This retrospective population-based cohort study included 76,460 newborns who underwent concurrent newborn and genetic screening. Restricted cubic splines and piecewise linear models were used to identify threshold effects in the associations of birth weight and gestational age with initial hearing screening referral, second hearing screening outcomes, and genetic screening results. Sensitivity analyses were conducted by including sex and Apgar scores.
RESULTS: We identified non-linear, U-shaped associations between birth weight, gestational age and the odds of referral at initial hearing screening. A birth weight of 3,297 g and gestational age of 39.19 weeks were key change points. Infants above or below these points had increased odds of referral at initial hearing screening. Neither second hearing nor genetic screening results showed significant associations with both factors. Sex-stratified analysis showed male infants had higher odds of referral at initial hearing screening, with similar non-linear patterns observed for gestational age. Adjusting for Apgar scores confirmed these results, with the thresholds at a birth weight of 3,297 g and gestational age of 39.27 weeks.
CONCLUSION: Birth weight and gestational age were associated with initial hearing screening referral only. The lowest referral odds occurred around 3.3 kg and 39 weeks of gestation, which may help identify newborns who require closer follow-up after initial screening.