Peer-reviewed article
Pediatric hearing loss in the universal newborn hearing screening era: etiologies, risk indicators, and clinical phenotypes.
Ziyuan Zhao, Yaxuan Wang, Hua Qiu, Xiaofang Sui, Yiying Zhang ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This review examines hearing loss in children and how it is identified through universal newborn hearing screening programs. It discusses the main causes of hearing loss, including genetic factors, infections, and complications during pregnancy or birth. The review notes that some types of hearing loss can develop after birth and may be missed by initial screening. It emphasizes the need for better follow-up care to catch hearing problems that appear later in childhood.
Key points
- Universal newborn hearing screening has improved early detection of congenital hearing loss but cannot identify all cases, including mild, unilateral, delayed-onset, progressive, and certain neural forms of hearing loss
- Major causes include genetic factors, cytomegalovirus infection, nutritional or metabolic problems, and neonatal intensive care unit-related risks such as prematurity, high bilirubin levels, oxygen deprivation, infection, and ototoxic medications
- Hearing loss can emerge after birth, meaning normal newborn screening results do not rule out future auditory problems
- Different risk factors have different clinical implications—some directly cause hearing loss while others increase vulnerability to delayed or progressive hearing dysfunction
- Distinguishing between causes, risk indicators, and clinical features could improve identification of children needing ongoing monitoring after screening
Limitations
This is a literature review that consolidates existing evidence rather than presenting original research data, so it cannot provide quantitative outcomes or direct evidence of screening effectiveness. The document does not specify which countries or populations are covered by the evidence reviewed.
Abstract
Childhood hearing loss poses significant developmental and public health challenges, impacting language acquisition, cognitive development, social participation, and educational outcomes. Universal newborn hearing screening (UNHS) has notably enhanced the early identification of congenital hearing loss, yet limitations persist. Mild, unilateral, delayed-onset, progressive, and certain neural forms of hearing loss may remain undetected during a single neonatal screening session. This review consolidates current evidence regarding the etiologies, risk indicators, and clinical features of pediatric hearing loss in the context of UNHS. Essential areas of focus encompass genetic causes and pharmacogenetic susceptibility, congenital cytomegalovirus infection, intrauterine nutritional and metabolic conditions, environmental and lifestyle exposures, alongside perinatal or neonatal intensive care unit-related risks such as prematurity, hyperbilirubinemia, hypoxia, infection, and exposure to ototoxic medications. These factors exhibit varied clinical implications: some serve as direct causes of hearing loss, while others signify heightened vulnerability to delayed-onset or progressive auditory dysfunction. The evidence highlights a developmental perspective on pediatric hearing loss, indicating that auditory risks may emerge postnatally and cannot be ruled out based solely on normal newborn screening results. Distinguishing between etiology, risk indicators, and clinical phenotype may enhance the identification of children requiring intensified post-screening monitoring. Future research should aim to refine causal evidence, genotype-phenotype correlations, and viable strategies for risk-based follow-up.