Following the introduction of the Newborn Hearing Screening Programme (NHSP), guidelines were issued for the ongoing audiological surveillance of infants, in May 2003 and revised in June 2005.
Our questionnaire survey was conducted in November 2006. 100 neonatal units, level 2 and above, across the UK were identified from the Directory of Clinical Care 2006. The response rate was 68%.
86% (59) units used gentamicin with penicillin (80%), cefotaxime (7.3%) or amoxicillin (7.3%) as first line antibiotics.
1 unit (1.4%) undertook therapeutic drug monitoring (TDM) after every dose of gentamicin, 75% (51) units measured the gentamicin levels pre and post, with the 3rd dose. TDM with the 3rd dose, which was the most common practice, is in keeping with the British National Formulary for children.
Referral of those babies receiving aminoglycosides for audiological surveillance varied from unit to unit. The majority (50%) referred those babies whose drug levels had risen above the therapeutic range, 25% (17) referred all babies who received aminoglycoside, and 23.5% (16) referred none.
49 (72%) were unaware of any guidelines post NHSP, and 15 (22%) were aware of some local guidelines.
Such wide variability in clinical practice raises questions about the effectiveness of the distribution process of the guidelines. The current guidelines recommend that where the levels have risen outside the therapeutic range the baby should be referred for audiological assessment, irrespective of the screen outcome.
We hope that the reporting of our findings will help paediatricians become aware of this important recommendation and change their practice.