Timing of Newborn Hearing Screening Effects on Passing Rates : A Prospective Cohort Study

Background: Newborn hearing screening using transient evoked otoacoustic emissions (TEOAEs) is essential for early detection of hearing impairment. The Joint Committee on Infant Hearing (JCIH) recommends screening near hospital discharge but does not specify an optimal timing. Objectives: To determine the optimal timing for TEOAE screening in neonates at low risk of hearing impairment and to identify perinatal factors influencing pass rates. Methods: Neonates underwent sequential TEOAE screening based on postnatal age at the time of testing: less than 24 hours, 24–36 hours, 36–48 hours, and more than 48 hours, with follow-up at one month for persistent failures. Statistical analyses included Fisher’s exact test to compare pass rates across time intervals and multivariate Cox proportional hazards regression and Laplace regression to assess factors associated with screening outcomes. Results: Among 408 neonates, the median passing age was 23.8 hours (IQR 14.3). Pass rates improved with later screening: 53.7% at less than 24 hours, 80.1% at 24–36 hours, 92.6% at 36–48 hours, and 99.3% at more than 48 hours. A significant improvement was observed only at more than 48 hours (OR: 5.26, p = 0.0153). Cesarean delivery was associated with delayed passing compared to vaginal delivery (p = 0.036). Late preterm neonates demonstrated a significantly delayed passing time of approximately 12.9 hours (p < 0.01), whereas small for gestational age (SGA) neonates passed earlier by 8.2 hours (p = 0.021). Conclusion: Screening at greater than or equal to 48 hours significantly improved pass rates. An older age at successful screening was observed among preterm neonates and those delivered by cesarean section, underscoring the need for tailored follow-up protocols. These findings highlight the importance of optimizing screening strategies to enhance early detection and intervention.