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Oregon PRAMS: Presentations

The Use of PRAMS to Assess Newborn Hearing Screening, Oregon, 2000

Kenneth D. Rosenberg, MD, MPH, Alfredo P. Sandoval, MS, MBA, Tina Kent
Oregon Health Division, Portland, Oregon
Background. Newborn hearing screening (NHS) is an important procedure to detect deafness; it is the first step in getting infants with hearing loss into early intervention. A state law mandating NHS (for all babies born in hospitals with more than 200 live births per year) in was passed by the Oregon legislature in 1999 and went into effect July 1, 2000. We sought a method to estimate the increase in NHS associated with the new legislation.

Methods. The Pregnancy Risk Assessment Monitoring System (PRAMS) is a stratified random survey of postpartum women with oversampling by race/ethnicity and birthweight. Oregon PRAMS began in 1998. Starting in May 2000, a question was inserted into Oregon PRAMS asking whether the baby got a hearing screening test in the hospital. The analysis was done using unweighted data.

Results. The question was answered by 564 women. The responses were categorized according to child's date of birth. We found that the proportion of newborns receiving NHS increased from 47% (February-May 2000) to 66% (June 2000) to 85% (July 2000, when the law went into effect) to 91% (August-September 2000). Because of potential bias among respondents, the trend may be more important than the proportions. Infants of respondents may have been more likely to receive NHS than infants of non-respondents. Infants of respondents from oversampled racial/ethnic groups may have been less likely to receive NHS than infants of non-Hispanic white women.

Conclusions. PRAMS was an elegant way to estimate the proportion of newborns receiving hearing screening during the period when the new law went into effect. The proportion of newborns who received NHS began to dramatically increase in the month before the law mandating NHS took effect. Over 90% of newborns were getting NHS one month after the law took effect. States should be encouraged, where possible, to use this methodology in reporting the proportion of NHS to the Maternal and Child Health Bureau for inclusion in the Title V Information System.

Public Health Implications. Improved infrastructure like PRAMS creates flexibility and opportunities for creativity in addressing a wide range of public health needs, some unanticipated. A law mandating NHS by hospitals can dramatically increase the proportion of newborns receiving NHS.

CDC Maternal and Chid Health Epidemiology Workshop, December 12, 2001.