512 - Association of Newborn Hearing Screening Failure and Sociodemographic Factors with Language and Behavioral Outcomes in Extremely Preterm Children: A Neonatal Research Network Study

Katsuaki Kojima, Cincinnati Children's Hospital, Montgomery, OH, United States; Carla Bann, RTI International, Apex, NC, United States; Chelsea Blankenship, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Cathy Grisby, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Susan R. Hintz, Stanford University School of Medicine, Palo Alto, CA, United States; Betty R. Vohr, Women & Infants Hospital/ Brown Medical School, Providence, RI, United States; Sara DeMauro, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Jean R. Lowe, University of New Mexico School of Medicine, Albuquerque NM, NM, United States; Kathryn Gustafson, Duke University School of Medicine, Durham, NC, United States; Stephanie L. Merhar, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; NICHD Neonatal Research Network, National Institute of Child Health and Human Development, Bethesda, MD, United States

Background: Studies have separately linked preterm birth with hearing loss, language difficulties, and behavioral issues. However, the complex interplay between these conditions and their associated clinical and sociodemographic factors remains poorly understood.

Objective: To identify factors associated with failed newborn hearing screens and assess relationships between hearing screen failure, clinical and sociodemographic variables, and language and behavioral outcomes at 2 years in extremely preterm children.

Design/Methods: We included children born between 22 0/7 and 26 6/7 weeks gestation from 2012 to 2021 without congenital anomalies and followed to 2 years corrected age in the NICHD Neonatal Research Network. Clinical and sociodemographic factors, language development scores, and behavioral scores were compared based on newborn hearing screening results using chi-square tests and t-tests. Linear mixed-effect regression models were used to assess associations between language and behavioral scores and hearing screening results while controlling for clinical and sociodemographic factors.

Results: Of the 4,143 infants included, 552 (13%) failed the newborn hearing screen. Bivariate analyses showed associations between newborn hearing screen failure and several clinical factors (Table 1). After controlling for clinical and sociodemographic factors, infants who failed the newborn hearing screen had lower Bayley Language Composite scores compared to those who passed (adjusted mean difference -1.83, p = .035; Table 2). The Child Behavior Checklist Total Problems score did not differ based on hearing screen status (p = .786). Path analysis showed an association between language and behavioral outcomes (Figure 1). Language outcomes were associated with clinical and sociodemographic factors, whereas behavioral outcomes were associated with sociodemographic factors, including public insurance, non-English household status, maternal education, sex, and race. Newborn hearing screening status was not included in the path model due to the lack of association.

Conclusion(s): Newborn hearing screening failure was associated with poorer language outcomes, but not behavioral outcomes, at 2 years corrected age in extremely preterm infants. Sociodemographic factors were associated with both language and behavioral outcomes. These findings underscore the critical importance of considering sociodemographic factors in addition to providing timely diagnostic and therapeutic follow-up for infants who fail newborn hearing screens.

Table 1. Prenatal, Neonatal, and Sociodemographic Characteristics by Hearing Screening Results


Table 2. Linear Regression Models of the Relationship of Newborn Hearing Screening Results with Child Behavior Checklist Total Problems and Bayley III/IV Language Composite Scores


Figure 1. Pathway Analysis of Clinical, Socioeconomic, and Demographic Factors Associated with Language Development and Behavioral Problems in Preterm Infants
This diagram illustrates associations between clinical (yellow), socioeconomic (green), and demographic (blue) factors and two outcome measures: the Bayley III/IV Language Composite Score and the Child Behavior Checklist Total Problems Score. Arrows indicate the direction of each relationship.