Newborn hearing screening: When should it be performed for the first time?

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Ferhat ASLAN, Sercan CIKRIKCI, Mukadder TAFLI, Secaattin GULSEN This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8138968/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Aim The aim of this study is to examine the effect of the time interval between birth and the first hearing screening test on screening results, to determine the most appropriate screening time between birth and discharge, and to reduce parental anxiety and costs. Methods Our study included all newborns screened with the ABR device between October 20, 2023, and March 31, 2024, as part of the newborn hearing screening program at the audiology clinic. Only those who passed bilaterally were given a “Pass” result. Those who remained unilateral or bilateral were given a “Fail” result and were referred. Results The study included 1,838 participants, 50.1% of whom were female and 49.9% male. It was determined that 1,131 participants passed bilaterally, 707 remained bilateral, 1,268 passed on the right, and 1,222 passed on the left. When the groups were compared within themselves and in pairs, the success rate of the screening test performed on the 5th day and thereafter was higher, and there was a statistically significant difference. Conclusion According to our study, the likelihood of bilateral passing increases as the day of the test increases, especially after the third day. newborn newborn hearing screening test screening ABR 1. Introduction Hearing loss can be defined as a condition that hinders a person's development, adaptation, and, in particular, communication skills. Global reports on hearing loss indicate that the prevalence of moderate to severe bilateral hearing loss (> 40 dB) in healthy newborn populations is 1–3 per 1,000 live births. This rate is reported to be higher in intensive care populations [ 1 , 2 ]. Exposure to spoken language during early childhood is of vital importance. Therefore, children with undiagnosed hearing loss, including mild and unilateral deficits, may experience significant delays in speech development. This condition can lead to psychological and mental behavioral disorders that may affect children's social and academic skills. Universal newborn hearing screening (UNHS) is a strategy for detecting congenital deafness and hearing loss. Newborn hearing screening has become a standard of care in many countries around the world. The primary goal of UNHS is to identify children with any type and degree of hearing loss, whether bilateral or unilateral, and to maximize their language proficiency and literacy development by lowering their age at diagnosis for early hearing enhancement [ 3 ]. The aim of our study is to examine the effect of the time between birth and the first hearing screening test on screening results in healthy newborns, to determine the optimal screening time between birth and discharge, and to reduce parental anxiety and costs. 2. Materials and Methods 2.1. Patient selection & Study desing Our study consists of newborns (n = 1838) evaluated within the scope of the Newborn Hearing Screening Program at the Audiology Clinic of the Department of Otorhinolaryngology at Gaziantep City Hospital. Data were obtained from newborns between October 20, 2023, and March 31, 2024. Newborn hearing screenings were conducted in a well-ventilated room measuring 8–10 m2, designed exclusively for newborn hearing screenings, with ambient noise levels not exceeding 30 dBA. To ensure the reliability of the results, the hearing screenings were performed while the babies were asleep or in a clean, well-fed, gas-free, quiet, and calm state in their cribs or in their parents' arms. The hearing screenings were performed using Maico Diagnostics ABR Test System MB11 BERAphone (Berlin, Germany) automatic screening devices. In automatic ABR measurement, the device delivers a 35 dB nHL narrowband click stimulus and checks whether wave V is generated. The areas where the electrodes are placed—the baby's forehead, cheekbone, and mastoid regions—were cleaned with conductive gel, and after disposable electrodes were placed, measurements were taken using the appropriate probe tip. An automatic “PASS” result from the device was accepted as the pass criterion. If either ear fails the screening test in any protocol worldwide, the infant is classified as a “fail.” Similarly, if both ears pass the screening test, the infant is classified as a “pass” [ 4 ]. The study data was collected using hospital records and the Ministry of Health's National Hearing Screening Program, and consists of newborns screened at our hospital. The study utilized information on newborns from the hospital's software system, including discharge summaries and birth reports. Those screened within the first 24 hours after birth were assigned to Group 1, those screened between 24 and 48 hours were classified as Group 2, those screened between 48 and 72 hours were classified as Group 3, those screened between 72 and 96 hours were classified as Group 4, and those screened after 96 hours were classified as Group 5. Approval for this study was obtained from the Non-Interventional Research Ethics Committee of Gaziantep City Hospital on June 26, 2024, with decision number 26/2024. 2.2. Statistical Analysis The data obtained from the study were evaluated using the Statistical Package for Social Science (SPSS) 21.0 (IBM corp.) program. The Kolmogorov-Smirnov test was performed to assess the suitability of the normal distribution. Descriptive statistics are given as numbers and percentages. To assess statistical significance, the Kruskal-Wallis test was used to evaluate the relationship between the numerical values of the independent variable and the dependent variable in more than two groups. After the Kruskal-Wallis test, pairwise comparisons were made between the multiple groups. 3. Results The study included 1,838 participants, 50.1% of whom were female infants and 49.9% were male. Of the newborns, 974 were delivered vaginally and 884 were delivered by cesarean section. It was observed that 1131% of participants had bilateral passage, 707% remained bilateral, 1268% had right-sided passage, and 1222% had left-sided passage. The rate of bilateral passage was found to be higher than the rate of remaining bilateral in those with normal delivery compared to those with cesarean delivery. Participants were divided into 5 groups based on the time of testing, and the relationship between gender, type of delivery, and test results among the groups is shown in Table 1 . Table 1 Patient demographic data Groups DATA Group 1 Group 2 Group 3 Group 4 Group 5 Gender Female 56 352 74 71 375 Male 56 353 77 63 361 Type of delivery Vaginal delivery 64 373 80 70 366 Caesarean section 48 331 71 64 370 Right ear Pass 70 470 95 92 544 Fail 42 235 56 42 192 Left ear Pass 65 465 88 94 513 Fail 47 240 63 40 223 Two ears Pass 58 422 83 86 482 Fail 54 283 68 48 254 Total 112 705 151 134 736 According to the results of the screening test, there was a significant difference between the groups. (Table 2 ) Table 2 Statistical analysis of groups Hypothesis Test Sig. Right Ear Results Independent-Samples Kruskal-Wallis Test .005 Left Ear Results Independent-Samples Kruskal-Wallis Test .013 Two Ears Results Independent-Samples Kruskal-Wallis Test .010 The significance level is,05. When the groups were compared within themselves and in pairs, the success rate of the screening test performed on day 5 and thereafter was higher, and there was a statistically significant difference. (Table 3 ) Table 3 Comparison of pairs of groups Grups Test Statistic Std. Error Std. Test Statistic Sig. 1–3 -5,693 54,120 -,105 .916 1–2 -75,707 44,206 -1,713 .087 1–5 -110,120 44,079 -2,498 .012 1–4 -114,610 55,555 -2,063 .039 3 − 2 70,014 38,821 1,804 .071 3–5 -104,427 38,676 -2,700 .007 3–4 -108,917 51,373 -2,120 .034 2–5 -34,413 22,827 -1,508 .132 2–4 -38,903 40,798 -,954 .340 5 − 4 4,490 40,660 ,110 .912 Asymptotic significances (2-sided tests) are displayed. The significance level is,05. 4. Discussion With early diagnosis and appropriate intervention, congenital hearing loss or hearing impairment can have a positive impact on speech, language acquisition, psychosocial, academic, and cognitive skill development. With appropriate intervention, they can achieve language development similar to their peers [ 3 ]. For this reason, it is essential that every baby born in our country undergoes an initial hearing screening test within 72 hours of birth as part of the screening program. However, in cases where babies are discharged before 72 hours, screening tests should be performed at the moment the babies leave the healthcare facility in order to reach as many babies as possible. All screening tests for newborn babies should be repeated within the first month, diagnostic tests should be completed within the first three months, and device fitting and rehabilitation should begin by the sixth month [ 4 ]. The false positive rate increases due to reasons such as cerumen or wax in the baby's external ear canal, acoustic and biological noise caused by the baby's crying or movement during the test, a noisy screening environment, errors made by the person performing the screening, and the screening center's excessive workload. This situation causes financial strain (travel expenses, etc.), job loss, and stress for families, as well as increasing the workload at referral centers. To prevent this, it is recommended that the screening environment be kept quiet, that the test be performed while the baby is quiet and still, that the newborn hearing screening be performed by an audiologist, and that the YDİT (Newborn Hearing Screening) protocol prepared by the Ministry of Health be implemented in its entirety. For an effective and efficient protocol, it has been reported that at least 95% of newborns should complete their initial screening within one month, and the pass rate for the initial test should be higher than 96% [ 5 ]. Early diagnosis of hearing loss in newborns is essential. If not diagnosed, the baby's speech and language development will be impaired. Hearing loss is one of the most common congenital disorders, affecting 0.1–0.3% of babies. Therefore, early diagnosis of newborns allows babies to be treated. Babies diagnosed with hearing loss should begin treatment within the first 6 months. These diagnoses, which have a margin of error, can result in a positive test result even when there is no hearing loss, a concept known as false positivity. A false positivity rate of up to 4% is considered acceptable [ 6 ]. In a prospective study evaluating a 6-month period, Hrnčić et al. reported that early discharge had a negative impact on screening results. They found that the rate of remaining from the first screening was 19.1%, the lowest referral rate was 13.3% in the group screened 48 hours later, and the highest referral rate was 30% in the group screened within the first 24 hours [ 7 ]. In a study by Şahin et al., an investigation of the screening results of 2,423 newborns showed that the first 24 hours were not suitable for screening, and the lowest referral rate was achieved in screening results performed after 72 hours. It was also observed that the ABR test was negatively affected when applied immediately after birth. In this study, the highest referral rate of 65.3% was found in those screened within the first 24 hours [ 8 ]. Another study reported that delaying the first hearing screening test to 48 hours after birth in newborns delivered by cesarean section reduced the failure rate of the first screening. The retention rate for those screened between 12 and 48 hours (48%) was six times lower than that for those screened between 48 and 132 hours (8.3%), and it was found that the failure rate in the first screening decreased with increasing age (elapsed hours) [ 9 ]. The UNHS's cost-benefit analysis shows that it is a valuable investment for society, as its benefits significantly outweigh the disadvantages and costs associated with the screening program. Early diagnosis saves on the costs of intensive speech and language intervention and special education services [ 10 – 12 ]. Keren and colleagues concluded in their studies that early diagnosis and intervention for hearing impairment leads to better language skills, lower education costs, and increased lifetime productivity, and that universal newborn hearing screening is much more cost-effective than no screening or selective screening [ 13 ]. Schroeder and colleagues found that the average annual social cost for children with hearing loss was three times higher than that for normal-hearing children aged 7–9 years. The severity of hearing loss was a significant predictor of social costs, including special education services, accommodations needed by medically disabled children, and lost productivity of parents. They estimated that UNHS could significantly reduce these costs and showed that the best estimate of annual cost savings during middle childhood was 21% of the UNHS newborn cost for each child diagnosed with hearing loss [ 14 ]. The final but no less important point to note is that mild hearing loss between 20 and 35 dB is often missed in hearing screening, regardless of the protocol used. However, such hearing loss is unlikely to have a significant impact on the child's well-being [ 15 ]. 5. Conclucion Before the first screening, newborns' head, neck, and ears should be thoroughly cleaned, and the external auditory canal should be examined and the condition of the middle ear assessed. In our retrospective study evaluating healthy newborns without risk factors who underwent initial screening with ABR regarding the timing of the test, the likelihood of bilateral pass rates increased as the day of the test increased. Declarations Author Contributions : Concept – F.A., S.G., S.Ç.; Design – S.G.,; Supervision – S.G., S.Ç.; Resources – F.A., S.Ç.; Materials – S.G.; Data Collection and/or Processing – F.A.,M.T., S.Ç.; Analysis and/or Interpretation – F.A., S.G.; Literature Search – S.G., S.Ç.; Writing Manuscript – F.A., S.G., S.Ç.; Critical Review – S.Ç. Funding source: No funding was received for this research Conflict of interest: The author declares that he has no conflict of interest Compliance with Ethical Standards Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. The study protocol was approved by Clinical Research Ethics Committee in 26 June 2024 with decision number 26/2024 Availability of Data and Materials: The data that support the findings of this study are available on request from the corresponding author. References Erenberg A, Lemons J, Sia C, Trunkel D, Ziring P. Newborn and infant hearing loss: detection and intervention. American Academy of Pediatrics. Task Force on Newborn and Infant Hearing, 1998–1999. Pediatrics 1999;103:527–530. https://doi.org/10.1542/peds.103.2.527 . Mehl AL, Thomson V. Newborn hearing screening: the great omission. Pediatrics 1998;101:E4. https://doi.org/10.1542/peds.101.1.e4 . American Academy of Pediatrics, Joint Committee on Infant Hearing. Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics, 2007;120(4), 898–921. https://doi.org/10.1542/peds.2007-2333 Kemaloğlu YK. Yenidoğan İşitme Taramaları. E. Belgin ve A. S. Şahlı (Ed.), Güneş Tıp Kitapevleri. Temel Odyoloji, Ankara 2015, ss. 191–217. Korres SG, Balatsouras DG, Gkoritsa E, Eliopoulos P, Rallis E, Ferekidis E. Success rate of newborn and follow-up screening of hearing using otoacoustic emissions. Int J Pediatr Otorhinolaryngol. 2006;70(6):1039–1043. https://doi.org/10.1016/j.ijporl.2005.10.018 . Aydemir C, Zinciroğlu A. Yenidoğan bebeklerde işitme tarama testleri. Sürekli Tıp Eğitimi Dergisi, 2004;13(11):419–421. Hrnčić N, Hatibović H, Goga A, Hodžić Đ. Does an early discharge of a newborn influence the success of the newborn hearing screening in developing countries? A hospital based study. Med Glas (Zenica). Published online August 1, 2019. https://doi.org/10.17392/988-19 Merve Nur Şahin. Comprasion of first hearing screening results in newborns according to testing time. Master’s Thesis, Nevşehir, 2022 Smolkin T, Mick O, Dabbah M, et al. Birth by cesarean delivery and failure on first otoacoustic emissions hearing test. Pediatrics. 2012;130(1):e95-e100. https://doi.org/10.1542/peds.2011-3179 . Thompson DC, McPhillips H, Davis RL, Lieu TL, Homer CJ, Helfand M. Universal newborn hearing screening: summary of evidence. JAMA. 2001;286(16):2000–2010. https://doi.org/10.1001/jama.286.16.2000 Akinpelu OV, Peleva E, Funnell WR, Daniel SJ. Otoacoustic emissions in newborn hearing screening: a systematic review of the effects of different protocols on test outcomes. Int J Pediatr Otorhinolaryngol. 2014;78(5):711–717. https://doi.org/10.1016/j.ijporl.2014.01.021 Yoshinaga-Itano C.. Levels of evidence: universal newborn hearing screening (UNHS) and early hearing detection and intervention systems (EHDI). Journal of communication disorders, 2004; 37(5), 451–465. https://doi.org/10.1016/j.jcomdis.2004.04.008 Keren R, Helfand M, Homer C, McPhillips H, Lieu TA. Projected cost-effectiveness of statewide universal newborn hearing screening. Pediatrics. 2002;110(5):855–864. https://doi.org/10.1542/peds.110.5.855 Schroeder L, Petrou S, Kennedy C, et al. The economic costs of congenital bilateral permanent childhood hearing impairment. Pediatrics. 2006;117(4):1101–1112. https://doi.org/10.1542/peds.2005-1335 Papacharalampous GX, Nikolopoulos TP, Davilis DI, Xenellis IE, Korres SG. Universal newborn hearing screening, a revolutionary diagnosis of deafness: real benefits and limitations. Eur Arch Otorhinolaryngol. 2011;268(10):1399–1406. https://doi.org/10.1007/s00405-011-1672-1 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 06 Jan, 2026 Reviews received at journal 29 Dec, 2025 Reviewers agreed at journal 17 Dec, 2025 Reviewers agreed at journal 14 Dec, 2025 Reviewers invited by journal 12 Dec, 2025 Editor assigned by journal 18 Nov, 2025 Submission checks completed at journal 18 Nov, 2025 First submitted to journal 17 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Introduction","content":"\u003cp\u003eHearing loss can be defined as a condition that hinders a person's development, adaptation, and, in particular, communication skills. Global reports on hearing loss indicate that the prevalence of moderate to severe bilateral hearing loss (\u0026gt;\u0026thinsp;40 dB) in healthy newborn populations is 1\u0026ndash;3 per 1,000 live births. This rate is reported to be higher in intensive care populations [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Exposure to spoken language during early childhood is of vital importance. Therefore, children with undiagnosed hearing loss, including mild and unilateral deficits, may experience significant delays in speech development. This condition can lead to psychological and mental behavioral disorders that may affect children's social and academic skills.\u003c/p\u003e \u003cp\u003eUniversal newborn hearing screening (UNHS) is a strategy for detecting congenital deafness and hearing loss. Newborn hearing screening has become a standard of care in many countries around the world. The primary goal of UNHS is to identify children with any type and degree of hearing loss, whether bilateral or unilateral, and to maximize their language proficiency and literacy development by lowering their age at diagnosis for early hearing enhancement [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe aim of our study is to examine the effect of the time between birth and the first hearing screening test on screening results in healthy newborns, to determine the optimal screening time between birth and discharge, and to reduce parental anxiety and costs.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Patient selection \u0026amp; Study desing\u003c/h2\u003e \u003cp\u003eOur study consists of newborns (n\u0026thinsp;=\u0026thinsp;1838) evaluated within the scope of the Newborn Hearing Screening Program at the Audiology Clinic of the Department of Otorhinolaryngology at Gaziantep City Hospital. Data were obtained from newborns between October 20, 2023, and March 31, 2024.\u003c/p\u003e \u003cp\u003eNewborn hearing screenings were conducted in a well-ventilated room measuring 8\u0026ndash;10 m2, designed exclusively for newborn hearing screenings, with ambient noise levels not exceeding 30 dBA. To ensure the reliability of the results, the hearing screenings were performed while the babies were asleep or in a clean, well-fed, gas-free, quiet, and calm state in their cribs or in their parents' arms. The hearing screenings were performed using Maico Diagnostics ABR Test System MB11 BERAphone (Berlin, Germany) automatic screening devices. In automatic ABR measurement, the device delivers a 35 dB nHL narrowband click stimulus and checks whether wave V is generated. The areas where the electrodes are placed\u0026mdash;the baby's forehead, cheekbone, and mastoid regions\u0026mdash;were cleaned with conductive gel, and after disposable electrodes were placed, measurements were taken using the appropriate probe tip. An automatic \u0026ldquo;PASS\u0026rdquo; result from the device was accepted as the pass criterion.\u003c/p\u003e \u003cp\u003eIf either ear fails the screening test in any protocol worldwide, the infant is classified as a \u0026ldquo;fail.\u0026rdquo; Similarly, if both ears pass the screening test, the infant is classified as a \u0026ldquo;pass\u0026rdquo; [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The study data was collected using hospital records and the Ministry of Health's National Hearing Screening Program, and consists of newborns screened at our hospital. The study utilized information on newborns from the hospital's software system, including discharge summaries and birth reports. Those screened within the first 24 hours after birth were assigned to Group 1, those screened between 24 and 48 hours were classified as Group 2, those screened between 48 and 72 hours were classified as Group 3, those screened between 72 and 96 hours were classified as Group 4, and those screened after 96 hours were classified as Group 5.\u003c/p\u003e \u003cp\u003e Approval for this study was obtained from the Non-Interventional Research Ethics Committee of Gaziantep City Hospital on June 26, 2024, with decision number 26/2024.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Statistical Analysis\u003c/h2\u003e \u003cp\u003eThe data obtained from the study were evaluated using the Statistical Package for Social Science (SPSS) 21.0 (IBM corp.) program. The Kolmogorov-Smirnov test was performed to assess the suitability of the normal distribution. Descriptive statistics are given as numbers and percentages. To assess statistical significance, the Kruskal-Wallis test was used to evaluate the relationship between the numerical values of the independent variable and the dependent variable in more than two groups. After the Kruskal-Wallis test, pairwise comparisons were made between the multiple groups.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eThe study included 1,838 participants, 50.1% of whom were female infants and 49.9% were male. Of the newborns, 974 were delivered vaginally and 884 were delivered by cesarean section. It was observed that 1131% of participants had bilateral passage, 707% remained bilateral, 1268% had right-sided passage, and 1222% had left-sided passage. The rate of bilateral passage was found to be higher than the rate of remaining bilateral in those with normal delivery compared to those with cesarean delivery.\u003c/p\u003e \u003cp\u003eParticipants were divided into 5 groups based on the time of testing, and the relationship between gender, type of delivery, and test results among the groups is shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient demographic data\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDATA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGroup 3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGroup 4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGroup 5\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e352\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e375\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e353\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e361\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eVaginal delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e366\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eCaesarean section\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e331\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e370\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRight ear\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePass\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e470\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e544\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFail\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e192\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLeft ear\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePass\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e465\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e513\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFail\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e223\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTwo ears\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePass\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e422\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e482\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFail\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e283\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e254\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e705\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e736\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAccording to the results of the screening test, there was a significant difference between the groups. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStatistical analysis of groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypothesis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight Ear Results\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndependent-Samples Kruskal-Wallis Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft Ear Results\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndependent-Samples Kruskal-Wallis Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTwo Ears Results\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndependent-Samples Kruskal-Wallis Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eThe significance level is,05.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eWhen the groups were compared within themselves and in pairs, the success rate of the screening test performed on day 5 and thereafter was higher, and there was a statistically significant difference. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of pairs of groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTest Statistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStd. Error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStd. Test Statistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1\u0026ndash;3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-5,693\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54,120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-,105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.916\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1\u0026ndash;2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-75,707\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44,206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1,713\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.087\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1\u0026ndash;5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-110,120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44,079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2,498\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.012\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1\u0026ndash;4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-114,610\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55,555\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2,063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.039\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3\u0026thinsp;\u0026minus;\u0026thinsp;2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70,014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38,821\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,804\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.071\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3\u0026ndash;5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-104,427\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38,676\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2,700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3\u0026ndash;4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-108,917\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51,373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2,120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.034\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2\u0026ndash;5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-34,413\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22,827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1,508\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.132\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2\u0026ndash;4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-38,903\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40,798\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-,954\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.340\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5\u0026thinsp;\u0026minus;\u0026thinsp;4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,490\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40,660\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e,110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.912\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eAsymptotic significances (2-sided tests) are displayed. The significance level is,05.\u003c/em\u003e \u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eWith early diagnosis and appropriate intervention, congenital hearing loss or hearing impairment can have a positive impact on speech, language acquisition, psychosocial, academic, and cognitive skill development. With appropriate intervention, they can achieve language development similar to their peers [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. For this reason, it is essential that every baby born in our country undergoes an initial hearing screening test within 72 hours of birth as part of the screening program. However, in cases where babies are discharged before 72 hours, screening tests should be performed at the moment the babies leave the healthcare facility in order to reach as many babies as possible. All screening tests for newborn babies should be repeated within the first month, diagnostic tests should be completed within the first three months, and device fitting and rehabilitation should begin by the sixth month [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe false positive rate increases due to reasons such as cerumen or wax in the baby's external ear canal, acoustic and biological noise caused by the baby's crying or movement during the test, a noisy screening environment, errors made by the person performing the screening, and the screening center's excessive workload. This situation causes financial strain (travel expenses, etc.), job loss, and stress for families, as well as increasing the workload at referral centers. To prevent this, it is recommended that the screening environment be kept quiet, that the test be performed while the baby is quiet and still, that the newborn hearing screening be performed by an audiologist, and that the YDİT (Newborn Hearing Screening) protocol prepared by the Ministry of Health be implemented in its entirety. For an effective and efficient protocol, it has been reported that at least 95% of newborns should complete their initial screening within one month, and the pass rate for the initial test should be higher than 96% [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEarly diagnosis of hearing loss in newborns is essential. If not diagnosed, the baby's speech and language development will be impaired. Hearing loss is one of the most common congenital disorders, affecting 0.1\u0026ndash;0.3% of babies. Therefore, early diagnosis of newborns allows babies to be treated. Babies diagnosed with hearing loss should begin treatment within the first 6 months. These diagnoses, which have a margin of error, can result in a positive test result even when there is no hearing loss, a concept known as false positivity. A false positivity rate of up to 4% is considered acceptable [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn a prospective study evaluating a 6-month period, Hrnčić et al. reported that early discharge had a negative impact on screening results. They found that the rate of remaining from the first screening was 19.1%, the lowest referral rate was 13.3% in the group screened 48 hours later, and the highest referral rate was 30% in the group screened within the first 24 hours [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In a study by Şahin et al., an investigation of the screening results of 2,423 newborns showed that the first 24 hours were not suitable for screening, and the lowest referral rate was achieved in screening results performed after 72 hours. It was also observed that the ABR test was negatively affected when applied immediately after birth. In this study, the highest referral rate of 65.3% was found in those screened within the first 24 hours [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Another study reported that delaying the first hearing screening test to 48 hours after birth in newborns delivered by cesarean section reduced the failure rate of the first screening. The retention rate for those screened between 12 and 48 hours (48%) was six times lower than that for those screened between 48 and 132 hours (8.3%), and it was found that the failure rate in the first screening decreased with increasing age (elapsed hours) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe UNHS's cost-benefit analysis shows that it is a valuable investment for society, as its benefits significantly outweigh the disadvantages and costs associated with the screening program. Early diagnosis saves on the costs of intensive speech and language intervention and special education services [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eKeren and colleagues concluded in their studies that early diagnosis and intervention for hearing impairment leads to better language skills, lower education costs, and increased lifetime productivity, and that universal newborn hearing screening is much more cost-effective than no screening or selective screening [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSchroeder and colleagues found that the average annual social cost for children with hearing loss was three times higher than that for normal-hearing children aged 7\u0026ndash;9 years. The severity of hearing loss was a significant predictor of social costs, including special education services, accommodations needed by medically disabled children, and lost productivity of parents. They estimated that UNHS could significantly reduce these costs and showed that the best estimate of annual cost savings during middle childhood was 21% of the UNHS newborn cost for each child diagnosed with hearing loss [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The final but no less important point to note is that mild hearing loss between 20 and 35 dB is often missed in hearing screening, regardless of the protocol used. However, such hearing loss is unlikely to have a significant impact on the child's well-being [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e"},{"header":"5. Conclucion","content":"\u003cp\u003eBefore the first screening, newborns' head, neck, and ears should be thoroughly cleaned, and the external auditory canal should be examined and the condition of the middle ear assessed. In our retrospective study evaluating healthy newborns without risk factors who underwent initial screening with ABR regarding the timing of the test, the likelihood of bilateral pass rates increased as the day of the test increased.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e: Concept – F.A., S.G., S.Ç.; Design – S.G.,; Supervision – S.G., S.Ç.; Resources – F.A., S.Ç.; Materials – S.G.; Data Collection and/or Processing – F.A.,M.T., S.Ç.; Analysis and/or Interpretation – F.A., S.G.; Literature Search – S.G., S.Ç.; Writing Manuscript – F.A., S.G., S.Ç.; Critical Review – S.Ç.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding source:\u003c/strong\u003e No funding was received for this research\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e The author declares that he has no conflict of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompliance with Ethical Standards\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval:\u0026nbsp;\u003c/strong\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. The study protocol was approved by Clinical Research Ethics Committee in 26 June 2024 with decision number 26/2024\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials:\u003c/strong\u003e The data that support the findings of this study are available on request from the corresponding author.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eErenberg A, Lemons J, Sia C, Trunkel D, Ziring P. Newborn and infant hearing loss: detection and intervention. American Academy of Pediatrics. Task Force on Newborn and Infant Hearing, 1998\u0026ndash;1999. Pediatrics 1999;103:527\u0026ndash;530. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1542/peds.103.2.527\u003c/span\u003e\u003cspan address=\"10.1542/peds.103.2.527\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMehl AL, Thomson V. Newborn hearing screening: the great omission. Pediatrics 1998;101:E4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1542/peds.101.1.e4\u003c/span\u003e\u003cspan address=\"10.1542/peds.101.1.e4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Academy of Pediatrics, Joint Committee on Infant Hearing. Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics, 2007;120(4), 898\u0026ndash;921. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1542/peds.2007-2333\u003c/span\u003e\u003cspan address=\"10.1542/peds.2007-2333\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKemaloğlu YK. Yenidoğan İşitme Taramaları. E. Belgin ve A. S. Şahlı (Ed.), G\u0026uuml;neş Tıp Kitapevleri. Temel Odyoloji, Ankara 2015, ss. 191\u0026ndash;217.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKorres SG, Balatsouras DG, Gkoritsa E, Eliopoulos P, Rallis E, Ferekidis E. Success rate of newborn and follow-up screening of hearing using otoacoustic emissions. 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Eur Arch Otorhinolaryngol. 2011;268(10):1399\u0026ndash;1406. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00405-011-1672-1\u003c/span\u003e\u003cspan address=\"10.1007/s00405-011-1672-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bratislava-medical-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Bratislava Medical Journal](https://link.springer.com/journal/44411)","snPcode":"44411","submissionUrl":"https://submission.springernature.com/new-submission/44411/3","title":"Bratislava Medical Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"newborn, newborn hearing screening test, screening ABR","lastPublishedDoi":"10.21203/rs.3.rs-8138968/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8138968/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThe aim of this study is to examine the effect of the time interval between birth and the first hearing screening test on screening results, to determine the most appropriate screening time between birth and discharge, and to reduce parental anxiety and costs.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eOur study included all newborns screened with the ABR device between October 20, 2023, and March 31, 2024, as part of the newborn hearing screening program at the audiology clinic. Only those who passed bilaterally were given a \u0026ldquo;Pass\u0026rdquo; result. Those who remained unilateral or bilateral were given a \u0026ldquo;Fail\u0026rdquo; result and were referred.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study included 1,838 participants, 50.1% of whom were female and 49.9% male. It was determined that 1,131 participants passed bilaterally, 707 remained bilateral, 1,268 passed on the right, and 1,222 passed on the left. When the groups were compared within themselves and in pairs, the success rate of the screening test performed on the 5th day and thereafter was higher, and there was a statistically significant difference.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eAccording to our study, the likelihood of bilateral passing increases as the day of the test increases, especially after the third day.\u003c/p\u003e","manuscriptTitle":"Newborn hearing screening: When should it be performed for the first time?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-17 18:47:12","doi":"10.21203/rs.3.rs-8138968/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-06T09:02:29+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-29T14:27:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"162817578424555831979564453453904066581","date":"2025-12-17T12:24:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"127572464382798480448458772699011927125","date":"2025-12-14T20:27:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-12T11:55:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-18T13:58:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-18T13:58:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"Bratislava Medical Journal","date":"2025-11-17T20:49:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bratislava-medical-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Bratislava Medical Journal](https://link.springer.com/journal/44411)","snPcode":"44411","submissionUrl":"https://submission.springernature.com/new-submission/44411/3","title":"Bratislava Medical Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"00de4287-8264-4b1a-a0cd-09713048689d","owner":[],"postedDate":"December 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-27T07:09:26+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-17 18:47:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8138968","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8138968","identity":"rs-8138968","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}