Implementation and Evaluation of a Newborn Hearing Screening Database in a Resource-Limited Setting: Advantages and Limitations

<b>Background:</b> Congenital hearing loss affects 1-3 per 1000 newborns and requires early detection to prevent developmental delays. Although Thailand implements universal screening, fragmented data systems limit effectiveness. To address this, Chiangrai Prachanukroh Hospital introduced a dedicated newborn hearing screening (NHS) database in 2023 to improve tracking, coordination, and monitoring in a resource-limited setting. <b>Objectives:</b> To evaluate the advantages and limitations of NHS database integration on screening coverage, referral rates, follow-up completion, and diagnostic timeliness. <b>Methods:</b> A retrospective analytic study was conducted over 24 months, comparing outcomes before (July 2022-June 2023) and after (July 2023-June 2024) database implementation. Key indicators included screening coverage, follow-up attendance, diagnostic ABR completion, and workflow efficiency, with the study period also encompassing the implementation of the database and adaptations to the screening algorithm. Data were analyzed using the chi-square test and fisher's exact tests, supplemented by qualitative observations of system performance. <b>Results:</b> Among 8290 newborns, screening coverage before one month increased from 83.47% to 96.64% (<i>p</i> < 0.001), while referral rates decreased from 18.44% to 6.47% (<i>p</i> < 0.001). Diagnostic ABR completion improved from 7.41% to 52.63% within three months (<i>p</i> < 0.001) and from 59.26% to 84.21% within six months (<i>p</i> = 0.06). The database improved workflow coordination, but challenges persisted, including incomplete data, limited interoperability, caregiver-related follow-up barriers, and low hearing-aid uptake. <b>Conclusions:</b> Integration of the NHS database, as well as protocol changes, improved screening coverage, referral accuracy, and diagnostic timeliness, but follow-up and early intervention barriers persisted. Continued progress will require stronger interoperability, improved family engagement, and digital infrastructure investment, with tele-audiology and decision-support tools helping expand access and efficiency.