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Year : 2020  |  Volume : 26  |  Issue : 4  |  Page : 263-264

Neonatal hearing screening during breastfeeding

1 Department of E.N.T., Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India
2 Department of Speech Language and Hearing Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
3 Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research (DU), Chennai, Tamil Nadu, India

Date of Submission25-Jun-2020
Date of Decision25-Jul-2020
Date of Acceptance04-Aug-2020
Date of Web Publication23-Apr-2021

Correspondence Address:
Dr. Heramba Ganapathy Selvarajan
Department of Speech Language and Hearing Sciences, Sri Ramachandra Institute of Higher Education and Research (DU), Chennai, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/indianjotol.INDIANJOTOL_139_20

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How to cite this article:
Adinarayanan DS, Selvarajan HG, Ninan B. Neonatal hearing screening during breastfeeding. Indian J Otol 2020;26:263-4

How to cite this URL:
Adinarayanan DS, Selvarajan HG, Ninan B. Neonatal hearing screening during breastfeeding. Indian J Otol [serial online] 2020 [cited 2021 Oct 23];26:263-4. Available from: https://www.indianjotol.org/text.asp?2020/26/4/263/314338


I want to bring to your notice that the Joint Committee on Infant Hearing recommends all newborns to be screened before hospital discharge.[1] Usually, the baby has to sleep or stay calm during screening. The screening appointment before hospital discharge will be cancelled either because the child is being breastfed, or crying due to hunger. Terminating the test because the child is being breastfed or crying, leads to incomplete coverage of mandatory screening programs. Therefore, we investigated the feasibility of hearing screening during breastfeeding as an augmentative condition.

In this study, both Distortion-Product Otoacoustic Emissions (DPOAE) and Automated Auditory Brainstem Response (AABR) techniques were used for screening newborns. Fifty six ears of newborns were conventionally tested (during sleep condition) and another fifty six ears were tested during breastfeeding (for crying babies). An independent samples t test was used to evaluate possible group differences in time taken and the number of attempts to complete the screening [Figure 1]a. Although DPOAE did not have any duration difference, AABR test required a longer duration for breastfed babies. Placement of electrodes and cleaning the skin for AABR took more time. The number of attempts was significantly higher for breastfed babies with both testing techniques [Figure 1]b. However, screening could be successfully completed for all the breastfed babies just like conventional testing showing a promising methodology to improve screening coverage before hospital discharge.
Figure 1: (a) Mean duration (in seconds) for both tests and methods (b) Mean number of attempts for both tests and methods

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All ears tested in conventional condition passed the initial screening in both DPOAE and AABR tests. In breastfeeding condition, 7 out of 56 ears (12%) in DPOAE technique had refer results. Out of seven, four ears were rescreened after 2 weeks and all passed in the second screening. Three out of 56 ears (5%) in AABR technique had refer results and one ear was retested and passed the second screening. Among the I screening refer, three in DPOAE and two in AABR did not turn up for second screening and were lost to follow-up.

Breastfeeding helps to calm the neonate, reducing the discomfort. Components of breastfeeding that are possibly analgesic consist of the physical presence of the mother, skin-to-skin interaction with mother,[2] diversion of attention,[3] and sweetness.[4] Higher concentration of tryptophan, a precursor of melatonin which upsurges the concentration of beta-endorphins is prevailing in breast milk when compared to artificial formulas.[5] Screening in breast feeding condition is feasible. It could be used as an alternate method to test crying babies and to improve the screening coverage. AABR in breastfeeding conditions requires more time and effort than DPOAE screening. Initial active suckling phase will be noisier and hence the testing personnel need to wait for a few minutes to facilitate the completion of hearing screening in the breastfed condition. The experience of the testing personnel also plays a major role in the successful completion of hearing screening.

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Conflicts of interest

There are no conflicts of interest.

  References Top

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;120:898-921.  Back to cited text no. 1
Blass EM, Shide DJ, Zaw-Mon C, Sorrentino J. Mother as shield: Differential effects of contact and nursing on pain responsivity in infant rats – Evidence for nonopioid mediation. Behav Neurosci 1995;109:342-53.  Back to cited text no. 2
Gunnar MR, Fisch RO, Malone S. The effects of a pacifying stimulus on behavioral and adrenocortical responses to circumcision in the newborn. J Am Acad Child Psychiatry 1984;23:34-8.  Back to cited text no. 3
Blass EM. Milk-induced hypoalgesia in human newborns. Pediatrics 1997;99:825-9.  Back to cited text no. 4
Heine WE. The significance of tryptophan in infant nutrition. Adv Exp Med Biol 1999;467:705-10.  Back to cited text no. 5


  [Figure 1]


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