Newborn and infant hearing screening outcomes at a tertiary paediatric hospital in the Western Cape, South Africa

Abstract

Background: Despite national guidelines, newborn and infant hearing screening (NIHS) is not universally implemented in South Africa, with scarce data on programme outcomes within the public health sector.
Objectives: To describe NIHS outcomes and implementation patterns at a tertiary paediatric hospital in the Western Cape.
Method: A retrospective record review of the audiology database and hospital records was conducted at Red Cross War Memorial Children’s Hospital between August 2019 and August 2024. Of 7871 children under 6 years, 511 (6.5%) documented NIHS results and were included. Descriptive statistics summarised demographics, risk factors, referral sources, screening methods, and diagnostic outcomes.
Results: Neurological (41.1%) and infectious (25.2%) risk factors related to hearing loss were most prevalent. The mean age of initial screening was 16.3 months, and the mean age of diagnosis was 15.6 months, which is earlier than prior South African reports but substantially later than 1-3-6 benchmark and 2-4-8 benchmark. Most referrals originated from tertiary facilities (60.7%) versus primary healthcare centres (10%). Initial screening (68.7%) employed otoacoustic emissions (45.2% referral rate). Repeat screening, predominantly with automated auditory brainstem response (AABR) (59.9%), reduced referrals to 1.1%. Diagnostic testing (n = 110) showed 40% normal hearing, 20% conductive losses, and a predominance of mild to moderate degrees of hearing loss.
Conclusion: Hearing screening in this tertiary setting remains delayed, resource-dependent, and disproportionately tertiary-centred.
Contribution: This study’s results highlight the need to expand primary-level hearing screening, increase AABR use, and adopt standardised protocols to improve timely detection and intervention of hearing loss in South Africa.