Objective: To evaluate the benefits and harms of universal newborn hearing screening programmes in the detection of hearing impairment.
Methods: In the absence of randomised trials evaluating whole screening programmes, we divided the objective into three systematic reviews of non-randomised controlled studies of screening versus no screening, therapeutic effect of early versus later treatment, and diagnostic accuracy of screening tests.
We searched eleven bibliographic databases, contacted authors, and checked references of included trials and reviews, and we sent enquiries to hospitals and manufacturers.
Results: Seventeen studies (screening: 2, treatment: 6, and diagnostic: 9) were included.
All studies apart from one treatment study showed major quality deficits. The studies comparing screening versus no screening showed an improvement of speech development of children in the screening group compared to the group without screening. Early treatment of hearing impairment was associated with better language development in comparison to children with later treatment. Eight diagnostic studies comparing otoacoustic emissions with auditory brainstem response show sensitivities (and specificities) between 50% (49.1%) and 100% (97.2%). Only one study evaluated these tests in a two-stage screening procedure and reported a sensitivity of. 91.7% (95% CI, 74.2% to 97.7%) and a specificity of 98.5% (95% CI, 98.3% to 98.7%).
Conclusions: There is a lack of high-quality evidence regarding all elements of newborn hearing screening. Early identification and early treatment of children with hearing impairments may be associated with advantages in the language development. Other patient-relevant parameters, such as social aspects, quality of life, and educational development, have not been adequately investigated.