The Impact of Direct Breastfeeding on the Accuracy of Distortion Product Otoacoustic Emissions (DPOAE) for Preterm Newborn Hearing Screening

Abstract

Purposes : To study the effect of direct breastfeeding on the pass/refer rate of DPOAE hearing screening in preterm newborns compared to other feeding methods. And to evaluate the accuracy of DPOAE hearing screening in identifying hearing loss in preterm newborns who are directly breastfeeding compared to standard screening methods.

Study design : Retrospective Cohort Study.

Materials and Methods : This research is a Retrospective Cohort Study comparing the results of hearing screening using DPOAE in preterm infants who are directly breastfed versus infants fed by other methods. Population: Preterm newborns undergoing hearing screening at Khon Kaen Hospital. Sample group: Divided into 2 groups: Group 1: Infants who are directly breastfed Group 2: Infants fed by other methods. Sample size: The sample size for this study was calculated from the pilot study results in preterm newborns who had their first DPOAE test result as Refer, totaling 90 participants (Divided into 2 groups, 45 each). Tools used for data collection.Data analysis used descriptive statistics including frequency, percentage, mean, standard deviation or median, and interquartile range. Inferential analysis used the Chi-square test or Fisher's exact test, employing statistical software for data analysis, with significance set at 0.05.

Main finding : The study found clear evidence that direct breastfeeding is associated with a significant reduction in the rate of false positives in hearing screening using Distortion Product Otoacoustic Emissions (DPOAE) and It also effectively helps to increase the accuracy of screening in preterm newborns, particularly those infants who are breastfed, who have a clearly higher pass rate in the second DPOAE screening (95.6% compared to 77.8% in other groups). In addition, the group that received breastfeeding directly from the breast also showed higher specificity and accuracy (97% compared to 80%) and had a much lower false positive rate (2.2% compared to 20%). These results therefore support the hypothesis that direct breastfeeding may be an important mechanism that helps improve the accuracy of early hearing screening in at-risk infants. The possible mechanism is to promote better functioning of the Eustachian tube and effectively help reduce temporary fluid accumulation in the middle ear.

Conclusion and recommendations : The study provides significant empirical evidence that feeding methods (particularly direct breastfeeding) are factors affecting the accuracy of DPOAE hearing screening in preterm infants, with a possible physiological mechanism being the improvement of Eustachian tube function and the reduction of negative middle ear pressure, resulting in a lower false positive rate. This finding has practical significance for enhancing the efficiency of the screening process by integrating breastfeeding information into the interpretation of results, planning of repeat tests, and referral decisions to achieve the ultimate goal of newborn hearing screening programmes, which is accurate and timely diagnosis, reducing stress and wasted resources, and promoting optimal development for every infant.