International Journal of Pediatric Otorhinolaryngology 123 (2019) 110–115

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International Journal of Pediatric Otorhinolaryngology

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Newborn hearing screening at the Neonatal Intensive Care Unit and T

Auditory Brainstem Maturation in preterm infants
Andrea Ciorba∗, Stavros Hatzopoulos, Virginia Corazzi, Cristina Cogliandolo, Claudia Aimoni,
Chiara Bianchini, Francesco Stomeo, Stefano Pelucchi
ENT & Audiology Department, University Hospital of Ferrara, Via A. Moro 8, Loc Cona, Ferrara, 44124, Italy

ARTICLE INFO ABSTRACT

Keywords: Objectives: Aim of this study is to report and discuss the results of 4 years of Newborn hearing screening (NHS)
Newborn hearing screening program at the Neonatal Intensive Care Unit (NICU), particularly evaluating the clinical ABR results.
Neonatal Intensive Care Unit Methods: Retrospective study. NHS data from NICU newborns, admitted for ≥5 days, in the period from January
NICU 1st, 2013 and December 31st, 2016, were retrieved and analyzed. NHS results were classified as following: (i)
OAE
“pass” when both ears for both the a-TEOAE (automated Transient-Evoked Otoacoustic Emissions) and the a-
ABR
ABR maturation
ABR (automated Auditory Brainstem Response) protocol resulted as “pass”; (ii) “fail” when one ear, at either one
of the two performed tests resulted as “fail”; (iii) “missing” when the newborns were not tested with both
protocols. All “fail” and “missing” newborns were retested (with both tests): in the case of a second “fail” result, a
clinical ABR was performed within a period of 3 months.
Results: A total of 1191 newborns were screened. From those, 1044/1191 resulted as “pass”, 108/1191 as “fail”,
and 39/1191 as “missing”. During the re-testing of these 147 newborns, 43 were assigned as “missing”, 63 were
assigned as “pass” (showing bilaterally a wave V identifiable within 30 dB nHL) and 25 failed the retest and/or
did not present an identifiable wave V within 30 dB nHL. Among the 147 retested infants, we identified a group
of 16 subjects who resulted as NHS “refer” and who, during the audiological follow-up, showed either: (i) a
unilateral or bilateral wave V identifiable over 30 dB nHL, at the first clinical ABR assessment; or (ii) a bilateral
wave V identifiable within 30 dB nHL, in a following clinical ABR test during the first year of life. These 16
subjects were defined to have an ‘Auditory Brainstem Maturation’ issue.
Conclusions: A possible “maturation” of the ABR response (and therefore of the auditory pathway) has been
hypothesised in 16 out of 1191 infants (1.3%). A delay of the auditory pathway maturation in preterm babies
compared to term newborns has already been suggested in the literature. A possible delay of the NHS retest
could be considered, in selected cases, with significant savings in economic resources and parental anxiety.

1. Background
The incidence of congenital hearing loss rate in full-term birth is
reported to be about 0.1–0.3% [1–3]. This rate is reported to increase
up to 2–3% in newborns at the Neonatal Intensive Care Unit (NICU)
[3–7].
The Universal Newborn Hearing Screening (UNHS) is mandatory for
the early identification, diagnosis and treatment/rehabilitation of
children with moderate to profound hearing loss [8]. The screening
technology consists in the evaluation of automated Transient-Evoked
Otoacoustic Emissions (a-TEOAE) and/or automated Auditory Brain-
stem Response (a-ABR), both non-invasive and repeatable procedures
and simple to perform in neonates [1,9]. As suggested in the Position
Statement of the Joint Committee on Infant Hearing (JCIH) in 2007 [1],
all infants should be screened at no later than 1 month of age, but
different protocols are indicated for children who have an NICU ad-
mission for more than 5 days [1]. The JCIH proposed a list of risk in-
dicators associated to congenital, delayed-onset or progressive hearing
loss [1].
The systematic evaluation of these risk factors could help in the
identification of infants at risk for developing permanent hearing loss,
who should be referred to an audiological evaluation and should be
monitored [1]. Neonates exposed to JCIH risk factors are 10 times more
at risk in developing sensorineural hearing loss (SNHL), compared to
healthy infants [3–7]. The main causes of NICU admission are: pre-
maturity, which is frequently associated with low birth weight (less

∗
Corresponding author. Clinic of Audiology & ENT, University of Ferrara, Via A. Moro 8, Loc Cona, 44124, Ferrara, Italy.
E-mail address: andrea.ciorba@unife.it (A. Ciorba).

https://doi.org/10.1016/j.ijporl.2019.05.004
Received 30 January 2019; Received in revised form 31 March 2019; Accepted 4 May 2019
Available online 07 May 2019
0165-5876/ © 2019 Elsevier B.V. All rights reserved.
A. Ciorba, et al.
Fig. 1. NHS test flow chart, test-retest and clinical ABR at the NICU.
than 1500 g) [10]; severe respiratory distress at birth, with or without
need of mechanical ventilation; in utero or perinatal infections; hy-
perbilirubinemia; craniofacial anomalies or head trauma [11–14].
An improper identification and early rehabilitation of hearing loss
in infants is known to be responsible for an incomplete/delayed or
absent development of speech and language, according to the grade of
hearing loss, with negative impact on cognitive development, and with
scholastic and social-economic implications [1,15].
The neonatal hearing screening (NHS) protocol for NICU newborns
consists in performing a-TEOAE and a-ABR tests, as soon as possible,
111
International Journal of Pediatric Otorhinolaryngology 123 (2019) 110–115
preferably before discharge [1,16]. a-ABR testing is important in order
to identify hearing loss related to auditory neuropathy/dyssynchrony,
typically affecting infants in need for NICU care [1,17]. A “fail” result of
a-TEOAE and a-ABR, even in one ear, could suggest a possible hearing
loss; newborns have to be re-tested within 1 month and, if the resulting
assessment is still “fail”, should undergo a clinical ABR evaluation
within 3 months, as per the Position Statement of the Joint Committee
on Infant Hearing recommendations [1]. The importance of retesting by
a-TEOAE and a-ABR is strongly supported in the literature, as it allows
the identification of false positive cases and the reduction of candidates
A. Ciorba, et al.
for the clinical ABR assessment [12,18].
Aim of this study is to report and discuss the results of 4 years of
NHS program in NICU, particularly evaluating the clinical ABR results.
2. Subjects and methods
Retrospective study. NHS data from NICU newborns, admitted for
≥5 days, in the period from January 1st, 2013 and December 31st,
2016, were retrieved and analyzed. The collected data included in-
formation on: the gestational age at birth, the birth weight, the causes
of admission at the NICU, the age at the time of NHS, the NHS data and
the rescreening and clinical ABR testing data.
NHS was performed at the NICU, 1–2 days before discharge, by the
same audiometrist when newborns were asleep. Both ears were tested,
one at a time. The mean time required to perform both procedures (i.e.
a-TEOAE and a-ABR) was approximately 20 min. For each newborn, a
personal identification code, the causes of NICU admission and the risk
factors for hearing loss [1] were all collected and registered in a NICU
NHS database.
TEOAEs were acquired by the EchoLab device (Labat International
SRL, Italy). TEOAEs were evoked by 80 μs click stimuli following a
linear protocol (i.e. all clicks in the stimulus train were of the same
positive polarity), introducing the plug in one ear at a time. a-ABR
responses were also acquired by the EchoLab device, using the stan-
dardized electrode montage in the conventional positions (forehead,
cheek and mastoid). Click stimuli of 35 dB (nHL – normalized Hearing
Level) were delivered to the ear via inserts. Details on these procedures
can be found in a previous publication [19].
The clinical ABR data were acquired by an ICS CHAPTER device
(GN Otometrics/Mercury, Italy). Tests were performed in an acousti-
cally and electrically shielded room and the data were recorded during
a spontaneous sleep, without a need for sedation. Electrophysiological
activity was recorded ipsilaterally to the stimulated ear using silver
chloride cup electrodes, with the active and reference electrodes ap-
plied to the vertex and the mastoid, respectively. ABR recording stimuli
were given monoaurally by an earphone and consisted of 0.1 ms clicks
with alternating polarity starting from a maximum intensity of 90 dB
nHL (approximately equal to 120 dB SPL – Sound Pressure Level, re-
ferred to the psychoacoustic threshold of normal hearing subjects) [19].
The electrophysiological threshold was found and registered at the
lowest acoustic stimulus intensity able to generate twice an identifiable
wave V. Latency and interpeak values were also evaluated, in order to
evaluate the ABR data (SNHL vs. conductive hearing loss vs. auditory
neuropathy).
NHS results were classified as following: (i) “pass” when both ears
for both the a-TEOAE (automated Transient-Evoked Otoacoustic
Emissions) and the a-ABR (automated Auditory Brainstem Response)
protocol resulted as “pass”; (ii) “fail” when one ear, at either one of the
two performed tests resulted as “fail”; (iii) “missing” when the new-
borns were not tested with both protocols. Anatomical factors (i.e. ex-
ternal acoustic meatus too small in order to allow the TEOAE/ABR
Table 1
Descriptive characteristics of the sample.
Characteristics
No. of screened patients per year 2013
2014
2015
2016
General characteristics Gestational age at birth (weeks)
Birth weight (grams)
Age at NHS (days)a
“Screening age” at NHS (weeks)
a
The age of the premature babies was analyzed as a not “corrected” age.
112
International Journal of Pediatric Otorhinolaryngology 123 (2019) 110–115
probe to detect the signal) and alteration of the newborn quiet state (i.e.
awakening and cry) represented the main causes for the “missing”
cases.
All “refer” and “missing” newborns were retested (with a-TEOAE
and a-ABR) within 1 month and in the case of a second “refer” result, a
clinical ABR was performed within a period of 3 months. ABR results
were considered as “normal” when bilaterally a wave V was identifiable
within 30 dB nHL. The ABR response was evaluated according the
normal latency and interpeak values, corresponding to the age of the
patient (see also Fig. 1). When the clinical ABR showed a pathological
hearing threshold, a prompt audiological follow-up was initiated.
We named as ‘immature’, a group of infants who resulted refer at
the NHS testing and who during the audiological follow-up, showed
either (i) a unilateral or bilateral wave V identifiable over 30 dB nHL (at
the first clinical ABR); or (ii) a bilateral wave V identifiable within
30 dB nHL in a following clinical ABR test during the first year of life.
For all newborns, in order to evaluate the influence of age on the
NHS results, we defined a NHS ‘screening age’, calculated as the days
passed since birth to the time of NHS (estimated in weeks), in addition
to the gestational age. Furthermore, a ‘diagnosis age’ was calculated as
days passed since birth to the audiological diagnosis (estimated in
weeks) in addition to the gestation age.
The study was conducted in compliance with the Helsinki
Declaration (2008); the research did not affect patient care in any way,
since only patient data were retrieved and reviewed.
2.1. Statistical analysis
Descriptive statistics were used to show the distribution of variables.
Pearson's coefficient was used to evaluate the possible correlation be-
tween non-numeric variables. Non-parametric tests, such as Mann-
Whitney U Test and Kruskal-Wallis Test, were used to evaluate con-
tinuous variables between samples. Differences were considered sig-
nificant when p < 0.05 and highly significant when p < 0.01. The
SPSS Windows v 18.0 (SPSS, Inc. Chicago, Ill 60611), was used in all
calculations.
3. Results
The study sample consisted of 1191 newborns screened at the NICU.
The descriptive characteristics of the sample are presented in Table 1.
In terms of subjects, 261 were tested in 2013, 258 in 2014, 318 in 2015
and 354 in 2016, respectively. The mean age at NHS was 11.5 ± 15.3
days, while the mean ‘screening age’ at NHS was 37.8 ± 2.7 weeks.
Table 2 presents the causes of hospitalization at the NICU. The most
common cause is represented by prematurity 46.8% (557/1191 infants
had a gestational age < 37 weeks), followed by respiratory distress
(39.5%). The third most frequent cause was low weight at birth
(37,6%), were low weight is defined as birth weight < 2500 g.
In terms of NHS results, 1044 of 1191 newborns (87.7%) were
“pass”, 108/1191 (9.1%) were “fail”, while 39/1191 (3.3%) were
Patients (No. = 1191; 100%) Mean
N (%)
261 (21.9)
258 (21.7)
318 (26.7)
354 (29.7)
36.2 ± 3.2
2658.1 ± 822.3
11.5 ± 15.3
37.8 ± 2.7
A. Ciorba, et al.
Table 2
Causes of admission in NICU according to frequency (total No. of new-
borns = 1191).
Causes of admission N %
Prematurity 557
Respiratory distress 470
Low weight at birth 448
Jaundice 332
Twins 185
Perinatal suffering 142
Hypoglycaemia or gestational diabetes 111
Cerebral, vascular, cardiac or gastrointestinal malformations 86
Perinatal infections 61
Small for gestational age (SGA) 57
Genetic syndromes 17
Maternal HIV or HCV infection 7 0.6
Unknown 33
“missing”. The data are summarized in Fig. 1.
For the “pass” newborns the mean gestational age, at birth, was
36.4 ± 2.9 weeks and for the refer newborns 34.7 ± 4.1 weeks. The
latter was significantly lower (p < 0.01) compared to mean value of
the “pass” sample. For the “pass” newborns the mean birth weight was
2697.6 ± 795.7 g, which was found statistically different (p < 0.01)
from the “refer” mean value of 2297.8 ± 910.6 g. The mean ‘screening
age’ of the “pass” sample was 37.9 ± 2.7 weeks, which was found
statistically different (p < 0.01, at the Mann-Whitney U Test) than the
37.1 ± 3.0 weeks value of the “refer” sample. The data are summar-
ized in Table 3.
A total of 147 infants (108 “refer” and 39 “missing”) were referred
for retesting. Of these, 43/147 infants (29.3%) were “missing”, as they
did not attend the retest appointment. 13/147 infants (8.8%) presented
a “pass” during the retest, while 91/147 (61.9%) presented a second
refer. These 91 infants were evaluated by a clinical ABR and 50/91
(54.9%) showed a wave V bilaterally identifiable within 30 dB nHL,
during the first clinical ABR evaluation. 25/91 (27.5%) infants did not
present an identifiable wave V within 30 dB nHL during the first or the
following clinical ABR, even only in one ear. 16/91 cases (17.6%)
presented a ‘maturated’ ABR consisting of: (i) a unilateral or bilateral
wave V identifiable over 30 dB nHL during the first clinical ABR; and
(ii) a bilateral wave V identifiable within 30 dB nHL (having a latency
and interpeak values within the normal range, according to the age of
the patient) at the following clinical ABR tests, performed during the
first year of life.
Overall 63/1191 (5.3%) infants became “pass” at retest or during
the first clinical ABR. A total of 25/1191 infants (2.1%) were identified
with a hearing deficit, confirmed by the clinical ABR and by the
audiological follow-up. Among these infants affected by hearing loss, no
significant relations were found between the gestational age at birth
(34.8 ± 4.6 weeks on average) or the NHS “screening age”
(37.8 ± 2.1 weeks on average) and the hearing impairment condition
(“fail” result at the rescreening or hearing loss at the clinical ABR),
except for the birth weight (2178.1 ± 877.0 g on average): the birth
weight represented an independent risk factor for the hearing impair-
ment condition, as the it was significantly lower (p = 0.037) in the
retested “fail” infants, compared to the “pass” infants
(2675.3 ± 809.7 g on average).
For the group of infants identified as normally hearing (1123), a
Table 3
Differences among gestational age at birth, birth weight and NHS ‘screening age’, between NHS “pass” and “refer” newborns (No. of screened newborns = 1191).
PASS at NHS (n = 1044, 87.7%)
Mean gestational age at birth (weeks) 36.4 ± 2.9
Mean birth weight (grams) 2697.6 ± 795.7
Mean “screening age” at NHS (weeks) 37.9 ± 2.7
International Journal of Pediatric Otorhinolaryngology 123 (2019) 110–115
significant relation was found between the retest “pass” result and the
gestational age at birth (p < 0.01), the birth weight (p < 0.01) and
the “screening age” at NHS (p = 0.001). The significant relation be-
tween the retest “pass” result and the “diagnosis age” (p < 0.01),
suggests that it might be necessary to follow the NHS “refer” newborns
46.8 over time.
39.5
With the Kruskal-Wallis test, we evaluated a possible significant
37.6
27.9 relation between the following variables 1) gestational age at birth, 2)
15.5 birth weight and 3) “screening age” at NHS, and the retest result (in-
11.9 dependently if it is “fail” or “pass”). It has been noticed that gestational
9.3
age at birth and NHS “screening age” did not have a significant influ-
7.2
5.1
ence on retest results (p = 0.114 and p = 0.109 respectively). In the
4.8 present study, gestational age at birth did not represent an independent
1.4 risk factor for retest results; only birth weight (which was significantly
lower in hearing impaired children compared to normally hearing in-
2.8
fants) had a significant influence on the retest result (p = 0.013).
In terms of rehabilitation, 2/25 (8%) infants received a bilateral
cochlear implant; 10/25 (40%) infants, received hearing aids due to
bilateral hearing loss. 6/25 infants (24%) who showed a unilateral
SNHL and 7/25 (28%) who presented conductive hearing loss, were
strictly followed-up, as no intervention strategies were applicable (see
also Fig. 1).
Table 4 lists the risk factors for the cases presenting a confirmed
hearing loss, categorized according to JCIH [1]. All infants shared the
same risk factor, represented by the admission in NICU for more than 5
days. Two cases were exposed to ototoxic drugs and 2 cases presented a
family history of hearing diseases. Only 1 infant was affected by a
congenital CMV infection.
4. Discussion
To date, several NHS protocols (using a-TEOAE, a-ABR and ABR) for
well-babies have been proposed [20–24], while, according to the JCIH
protocols [1], hearing screening for NICU infants should be performed
by both aOAE and aABR.
It is well known that NHS cannot detect some forms of hearing loss,
in particular those with a delayed onset, nor mild or isolated frequency
losses [1]. Also, NHS does not provide a definition of hearing loss in
terms of severity. When indicated, in order to obtain a reliable hearing
threshold estimation, a clinical ABR allows an objective evaluation at 2
and 4 kHz.
The present study shows the results of the NHS performed on
newborns, admitted for more than 5 days at NICU: this condition re-
presents a well-known risk factor for sensorineural hearing loss [1]. In
the present cohort, the main causes of NICU admission were re-
presented by prematurity and low weight at birth (about 47% of the
sample was preterm and about 38% had a birth weight < 2500 g)
often associated to respiratory distress (about 40% of the sample) and,
in 185 newborns out of 1191 (about 16% of the sample), due to a twin
birth (Table 2). About 5% of the sample had perinatal infections and
was exposed to ototoxic drugs.
At the audiological follow-up of the NICU babies, it was possible to
identify 25 out of 1191 children affected by hearing loss. The incidence
of hearing loss was found to be 2.1%, a percentage consistent with the
literature data [3–7].
Considering our data, it is possible to suggest that a low birth weight
could be related to a higher risk to develop hearing loss, while a full-
FAIL at NHS (n = 108, 9.1%) p value
34.7 ± 4.1 < 0.01*
2297.8 ± 910.6 < 0.01*
37.1 ± 3.0 0.007*
113
A. Ciorba, et al.
Table 4
Risk factors for permanent hearing loss according to JCIH (2007) [1] in the group of children with confirmed hearing loss (No. = 28).
Risk indicators associated with permanent congenital, delayed-onset, or progressive hearing loss in childhood
2. Family history of permanent childhood hearing loss
3. Neonatal intensive care more than 5 days or any of the following regardless of length of stay: ECMO, assisted ventilation, exposure to ototoxic medication or loop
diuretic and hyperbilirubinemia that requires exchange transfusion
4. In utero infection, such as CMV, herpes, rubella, syphilis and toxoplasmosis
5. Craniofacial anomalies, including those that involve the pinna, ear canal, ear tags, ear pits, and temporal bone anomalies
7. Syndromes associated with hearing loss or progressive or late-onset hearing loss, such as neurofibromatosis, osteopetrosis, and Usher syndrome; other frequently
identified syndromes include Waardenburg, Alport, Pendred, and Jervell and Lange-Nielson
9. Culture-positive postnatal infections associated with sensorineural hearing loss, including confirmed bacterial and viral (especially herpes viruses and varicella)
meningitis
term delivery could be more probably related to a “pass” result at NHS
(36.4 ± 2.9 on average in NHS “pass” population). Furthermore, in-
fants who failed the NHS had a gestational age at birth significantly
lower than “pass” newborns (see Table 3). It was possible to observe an
evident difference in the gestational age at birth, between the group of
the “refer” babies at NHS who subsequently passed the NHS retest or
showed a bilateral wave V within 30 dB nHL at first clinical ABR and
the group of “pass” babies at NHS: respectively 33.9 ± 4.1 weeks (with
a range between 23.0 and 40.0 weeks) vs. 36.4 ± 2.9 weeks (with a
range between 25.4 and 41.9 weeks).
An even more significant difference was noticed evaluating birth
weight: both NHS “refer” to “refer” (2311.0 ± 816.5) and NHS “refer”
to “pass” newborns (2206.2 ± 941.9), showed a lower birth weight
compared to NHS “pass” newborns (2697.6 ± 795.7). Only 3.6% (43/
1191) of infants did not attend the retest or the follow-up appointment,
even if this percentage of drop-out newborns is smaller compared to
literature data [25].
A possible “maturation” of the ABR response (and therefore of the
auditory pathway) has been hypothesised for 16 of 1191 infants (1.3%).
A delay of the auditory pathway maturation in preterm compared to
term newborns has already been suggested in the literature, since the
central nervous system of preterm babies is still ‘immature’, as pre-
viously reported [26,27]. Authors described hearing level improving
over time in preterm newborns who failed NHS [28]; Hof et al. [29],
reported a potential maturation of the auditory system up to 80 weeks
gestational age in preterm infants with a gestational age at birth less
than 28 weeks. As previously reported, the brainstem auditory system
achieves a complete maturation at around 6 months of gestational age,
while the auditory cortex between 6 and 12 years of life [30]. There-
fore, the physiological maturation of the auditory system continues
after term birth; as supposed by Pasman [27], a hypothetical matura-
tion delay in preterm infants may involve (i) the myelinization process
(both in cochlear nerve and in the central auditory system) and (ii) the
auditory pathway development [29]. Selective damages of cochlear
nuclei, superior olives and inferior colliculi in case of exposition to
anoxic-ischemic accidents, hypotension, hypoglycaemia have also been
advocated [27]. It is likely that, a combination of these mechanisms
could possibly delay the maturation of the auditory pathway, in pre-
term babies. Other possible explanations of the auditory pathway
‘maturation’ have been advocated in literature: considering the esti-
mation of the gestational age during pregnancy with an inaccuracy of
about 2 weeks, there could be a real possibility to misinterpret the la-
tency and interpeak values of clinical ABRs [31].
Table 5
Comparison between ‘pass’ (at NHS, at retest and at clinical ABR) and ‘maturated’ infants.
Every PASS (n = 1107, 92.9%)
Mean gestational age at birth (weeks) 36.3 ± 3.0
Mean birth weight (grams) 2675.3 ± 809.7
Mean “screening age” at NHS (weeks) 37.8 ± 2.7
Mean “diagnosis age” (weeks) 38.4 ± 3.9
114
International Journal of Pediatric Otorhinolaryngology 123 (2019) 110–115
N %
2 7.1
28 100
1 3.6
1 3.6
4 14.3
2 7.1
As showed in Table 5, infants of the studied cohort that showed an
‘Auditory Brainstem Maturation’, resulted slightly more premature on
average than the “pass” newborns. At the non-parametric test, the
difference of gestational age at birth between the two groups resulted
highly significant (p = 0.002), as for birth weight (p < 0.01), which
was significantly lower in “maturated” infants (see also Table 6). The
“age at diagnosis” for infants with ‘Auditory Brainstem Maturation’
resulted 61.3 weeks on average, which is about 7 months since birth.
This possible “maturative” trend of some preterm infants could
suggest the possibility of evaluating carefully the NHS planning in se-
lected cases, reducing the number of the audiological controls/retest, in
selected cases, with implications on the economic resources and for the
parental psychological consequences (such as anxiety, confusion and
frustration). A possible reference is represented by United Kingdom
guidelines [32]: in case of presence of risk factors for hearing loss, a
single audiological evaluation between 9 and 12 months is re-
commended (excluded family history and infections which follow a
closer follow-up).
In conclusion, in the present sample, a significant percentage (1.3%)
of infants who failed the NHS were found to be normally hearing during
the audiological follow-up, after a mean period of about 7 months since
birth, following a hypothetical “maturation” trend. Considering that
these infants were on average preterm and characterized by a low
weight at birth, the “normalization” of hearing threshold during this 7-
months period, could be related to a possible “maturation” of the au-
ditory system. A possible postposition of NHS retest could be con-
sidered, in selected cases, with significant savings in economic re-
sources and parental anxiety.
Funding
This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors.
Declarations of interest
None.
Acknowledgments
Authors wish to thank Monica Rosignoli for her precious help with
the statistical analysis.
“Maturated” (n = 16, 1.3%) p value
31.7 ± 5.5 0.002*
1847.5 ± 1015.8 < 0.01*
37.1 ± 2.9 0.107
61.3 ± 18.4 < 0.01*
A. Ciorba, et al.
Table 6
Comparison between ‘pass’ at retest or at clinical ABR and ‘maturated’ infants.
PASS at retest or at clinical ABR (n = 63, 5.3%)
Mean gestational age at birth (weeks) 34.4 ± 3.9
Mean birth weight (gr) 2302.7 ± 948.4
Mean “screening age” at NHS (weeks) 36.7 ± 3.6
Mean “diagnosis age” (weeks) 45.7 ± 9.1
Appendix A. Supplementary data
Supplementary data to this article can be found online at https://
doi.org/10.1016/j.ijporl.2019.05.004.
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