Not Passing Newborn Hearing Screening and Neurodevelopment at 2 Years in Infants Born Extremely Preterm.

OBJECTIVE

To evaluate the association between not passing newborn hearing screening and language, cognitive, and behavioral outcomes at 2 years' corrected age among infants born extremely preterm.

STUDY

DESIGN

Retrospective cohort study of infants born at 22-26 weeks of gestation or 401-1000 g at Neonatal Research Network centers from 2012-2021 who completed predischarge newborn hearing screening and neurodevelopmental follow-up at 22-26 months' corrected age. Mixed-effects models estimated associations between screening result and Bayley Language and Cognitive Composite scores and Child Behavior Checklist (CBCL) Total Problems T-scores, with secondary analyses of clinically relevant Bayley and CBCL thresholds after adjustment for center and clinical and sociodemographic covariates.

RESULTS

Among 4891 infants, 690 (14%) did not pass newborn hearing screening. Compared with infants who passed, those who did not pass had modestly lower Bayley language (adjusted mean difference, -2.6; 95% CI, -4.1 to -1.1) and cognitive (adjusted mean difference, -2.4; 95% CI, -3.7 to -1.1) scores. They also had higher odds of Bayley language score <85 (aOR, 1.4; 95% CI, 1.1 to 1.7) and cognitive score <85 (aOR, 1.4; 95% CI, 1.1 to 1.7), but not of scores <70. Screening result was not independently associated with CBCL Total Problems T-score or with CBCL Total Problems T-score ≥60 or ≥64, although exploratory mediation analyses suggested small indirect associations through lower Bayley scores. In a small exploratory subgroup of infants who did not pass screening but had a normal inpatient diagnostic auditory brainstem response before discharge (n = 119), adjusted Bayley language and cognitive scores were also lower than among infants who passed screening.

CONCLUSIONS

Among extremely preterm infants, not passing newborn hearing screening was associated with modestly lower language and cognitive performance at 2 years, particularly in the mild-to-moderate range, but not with early behavioral problems. These findings support prompt audiologic follow-up and developmental surveillance.