Abstract
Background
Permanent neonatal hearing loss can significantly impact language, cognitive, and social development. Universal newborn hearing screening (UNHS) facilitates early detection and intervention, yet coverage and follow-up remain inconsistent, especially in low- and middle-income regions. Southwestern Iran, with its large birth cohort and high prevalence of consanguinity, offers a unique opportunity to evaluate the performance of the UNHS program and its associated neonatal risk factors.Objective
The primary objective of this study was to assess the overall coverage and lost-to-follow-up rates of UNHS in Khuzestan Province, Iran. The secondary objective was to evaluate the impact of established neonatal risk factors on auditory outcomes.Methods
This prospective population-based cohort study included all newborns screened in 29 referral centers in Khuzestan Province from 2019 to 2023. A two-stage screening protocol using transient evoked otoacoustic emissions (TEOAEs) and automated auditory brainstem response (AABR) was applied, with diagnostic audiology for infants referred from screening. Associations between neonatal risk factors and hearing loss were analyzed using odds ratios (ORs) with 95% confidence intervals (CIs).Results
Out of 450,542 live births, 403,833 newborns (89.96%) underwent hearing screening. A total of 7,491 infants (1.85%) were referred for diagnostic assessment, and permanent hearing loss was confirmed in 986 cases, corresponding to a prevalence of 2.44 per 1,000 live births. The prevalence was markedly higher among NICU-admitted infants compared to well-baby nursery infants (11.6 vs. 1.05 per 1,000 live births). Sensorineural hearing loss accounted for 78.49% of cases, and 59.12% were bilateral. Overall, 71.39% of affected infants had at least one recognized neonatal risk factor. In multivariable analysis, prematurity (aOR = 4.39; 95% CI: 1.38-11.81), consanguinity (aOR = 4.14; 95% CI: 1.71-6.73), neonatal hyperbilirubinemia (aOR = 3.14; 95% CI: 1.79-4.60), and family history of hearing loss (aOR = 3.29; 95% CI: 1.25-6.44) were identified as significant independent predictors.Conclusions
UNHS in southwestern Iran achieves substantial coverage and effectively identifies infants with permanent hearing loss. Targeted follow-up for high-risk populations and early intervention are critical to optimize auditory, speech, and cognitive outcomes.