Maternal Factors Predicting Follow-up in a Statewide Early Hearing Detection and Intervention Program

Background and Purpose:  Hearing loss in neonates is 1.7 per 1000 births, and states’ Early Hearing Detection and Intervention programs (EHDI) have been established to identify and address infant hearing loss. Although compliance with initial screenings offered at birth is high, follow-up rates in the screening, diagnosis and treatment process drops off significantly (Centers for Disease Control and Prevention, 2017). While the problem of loss to follow-up (LTF) has been studied extensively, high LTF rates continue to be pervasive.

Previous research has looked at constellations of factors related to LTF, but more attention to maternal factors is warranted as mothers are often decision-makers regarding their children’s healthcare. Previous research has demonstrated a link between parental educational attainment and pediatric well-visit compliance (Goedkin et al., 2014). LTF from general pediatric visits has been associated with maternal perceptions of child health, race, and general busy-ness (Gross & Howard, 2001; Samuels et al., 2015). Kim and colleagues (2018) found that maternal age was associated with follow-up compliance in very low birthweight infants. To examine this more closely in EHDI programs, the current research addresses the following question: “What maternal factors are predictive of LTF at the point of rescreening in a statewide EHDI program?”

Methods: Data for this study were obtained from a northeastern state's Department of Health. All 197,814 babies born between June 2015 and June 2017 who had completed a hearing screening prior to hospital discharge were considered for inclusion. During that time, 4,141 babies were referred for additional hearing screenings as they had not passed their initial hospital screening. Binary logistic regression was utilized to develop a model predicting LTF based on maternal factors.

Results: Of the babies referred for additional hearing screening, 3,707 (89.52%) returned at least once while 434 were LTF (10.48%). Of those who were referred, 1,636 (39.51%) failed the initial screening in both ears while the remainder (n=2,505; 60.49%) failed unilaterally.

The best fitting model predicting LTF found the following factors increased the odds of being LTF: additional live births for each mother (OR=1.29; p=0.00), mothers being Black (OR=1.59; p=0.00), and maternal obesity (OR=1.57; p=0.01). Maternal factors that reduced the odds of being LTF were being a WIC recipient (OR=0.62; p=0.00), mothers having a Master’s degree or higher (OR=0.52; p=0.00), maternal age (OR=0.93; p=0.00), and mothers being Hispanic (OR=0.71; p=0.01).

Conclusions and Implications:  To the best of our knowledge, this research is the first population-based study studying the relationship between maternal factors and follow-up for congenital pediatric hearing loss. Findings indicate that for mothers who are Black, who have had prior live births, have education levels lower than a Master’s degree, and those with obesity are at an increased risk for being LTF at the point of rescreening. Therefore, it would be helpful to develop a method to identify mothers and babies in these high risk groups and target them for intervention. Further research is needed to understand the protective factors associated with receiving WIC and being Hispanic, which may aid in intervention development.