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What is the updated USPSTF recommendation for universal newborn hearing screening?

In July 2008, the USPSTF recommended screening for hearing loss in all newborn infants.  (Grade B recommendation). The USPSTF’s recommendation for universal newborn hearing screening (UNHS) can be found at: http://www.ahrq.gov/clinic/uspstf/uspsnbhr.htm.

What was the previous USPSTF recommendation for universal newborn hearing screening?

In 2001, the USPSTF found good evidence that newborn hearing screening leads to earlier identification and treatment of infants with hearing loss. However, they concluded that there was not yet sufficient evidence to determine whether earlier treatment resulting from screening led to clinically important improvement in speech and language skills at age three years or beyond for children with hearing loss that was moderate to severe, permanent, bilateral and congenital. Therefore, the USPSTF issued an “I” recommendation for UNHS. 

Why did the USPSTF change its recommendation from an “I” recommendation (Insufficient evidence to recommend for or against screening) to a “B” recommendation?

The USPSTF updates its recommendations every five years or sooner if new evidence becomes available that could substantially change a recommendation. As new evidence became available for UNHS, the task force reviewed that evidence and changed the recommendation to reflect the improved health outcomes that had been demonstrated in good-quality studies.

What does this updated USPSTF recommendation mean for early hearing detection and intervention (EHDI)?

Universal newborn hearing screening, the first step in the EHDI process, is regarded as the standard of care in the U.S., a standard backed by other committees and policy making bodies such as the Joint Committee on Infant Hearing (JCIH), the American Academy of Pediatrics (AAP) and Healthy People 2010.  In the past, critics of UNHS had raised concern that there was not enough objective, population-based scientific evidence showing the benefits of EHDI.  However, since the USPSTF bases its recommendations on such evidence, this recent “B” recommendation could answer those concerns and help further strengthen the rationale for EHDI among a broader spectrum of pediatric clinical providers and policy makers.

What key questions did the USPSTF address when making its 2008 recommendations?

Key Question 1. Among infants identified by universal screening that would not be identified by targeted screening, does initiating treatment before 6 months of age improve language and communication outcomes?

A good-quality retrospective population-based study of children with hearing loss indicated that children whose hearing loss was detected early as a result of being born in hospitals with UNHS had better receptive language at eight years of age than those who were born in hospitals without UNHS.  There was no significant difference in expressive language or speech.

Key Question 2: Compared with targeted screening, does universal screening increase the chance that treatment will be initiated by 6 months of age for infants at average risk or for those at high risk?

A good-quality nonrandomized controlled trial of a large birth cohort indicates that infants identified with hearing loss through universal newborn screening have earlier referral, diagnosis, and treatment than those not screened. These findings are corroborated by multiple descriptive studies of ages of referral, diagnosis, and treatment.

Key Question 3: What are the adverse effects of screening and early treatment?

When a child fails a hearing screen, parent reactions may include worry, uncertainty and distress, but these resolve for most parents.  In addition, one of the treatment options families can choose, cochlear implants, has been associated with higher risks for bacterial meningitis in young children.  The cochlear implant model with the highest risk of bacterial meningitis is no longer manufactured.

What is the U.S. Preventive Services Task Force (USPSTF)?

The USPSTF is the leading independent panel of experts in prevention and primary care in the United States.  It was convened by the U.S. Public Health Service in 1984 and has been sponsored by the Agency for Healthcare Research and Quality (AHRQ) since 1998.

What is the role of the USPSTF?

The USPSTF conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. Its recommendations are a primary, national reference used by clinical care providers as they design their preventive services.

Who are the members of the U.S. Preventive Services Task Force (USPSTF)?

The USPSTF consists of non-Federal experts in primary care, epidemiology, and prevention. Throughout its existence, the task force has had at least two pediatricians, as well as other pediatric health care providers, among its members.  At the time it issued its 2008 recommendation on universal newborn hearing screening, three of its 16 members were pediatricians, and a fourth was a pediatric nurse practitioner

What are the recommendations used by the USPSTF? 

The USPSTF considers both the potential net benefit of a particular service and the degree of certainty that scientific evidence supports the conclusion.

“A” – The USPSTF recommends this service.  There is high certainty the net benefit of this service is substantial.

“B: - The USPSTF recommends this service.  There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.

“C” - The USPSTF recommends against routinely providing the service.  There may be considerations that support providing the service in an individual patient. There is moderate or high certainty that the net benefit is small.

“D” - The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.

“I” - The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.

Who uses U.S. Preventive Services Task Force (USPSTF) recommendations?

Primary care clinicians are the principal audience for USPSTF recommendations. Task Force recommendations have also influenced recommendations developed by professional societies and have figured prominently in the development of health care quality measures and national health objectives.

US Preventive Services Task Force.  Universal Screening for Hearing Loss in Newborns: US Preventive Services Task Force Recommendation Statement.  Pediatrics 2008;122;143-148.

Nelson, HD, Bougatsos, C, and Nygren, P.  Universal Newborn Hearing Screening: Systematic Review to Update the 2001 US Preventive Services Task Force Recommendation.  Pediatrics 2008;122;e266-e276.

Moyer, VA and Nelson, D.  Pediatricians and the US Preventive Services Task Force: A Natural Partnership to Enhance the Health of Children.  Pediatrics 2008;122;174-176.

Kennedy C, McCann D, Campbell MJ, Kimm L, Thornton R. Universal newborn screening for permanent childhood hearing impairment: an 8-year follow-up of a controlled trial Lancet

2005;366:660–662.

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Date: July 21, 2008
Content source: National Center on Birth Defects and Developmental Disabilities