From Prevalence to Prediction: A Cross-Sectional Study to Develop a Novel Risk Score for Hearing Loss in High-Risk Neonates in South India

Background and aim: Neonates admitted to the neonatal intensive care unit (NICU) with multiple risk factors are more likely to develop hearing loss.This study aimed to determine the prevalence of hearing loss, identify its predictive factors, and develop a novel clinical risk score for hearing loss among high-risk neonates.Materials and methods: This cross-sectional study included 105 high-risk neonates admitted to the NICU from July 2024 to June 2025.The hearing assessment protocol included transient-evoked otoacoustic emissions at discharge and at six weeks of corrected age, followed by diagnostic brainstem-evoked response audiometry at three months.Associations between risk factors and hearing loss were analyzed using logistic regression.A novel clinical risk score was developed using the factors significantly associated with hearing loss.Results: The prevalence of hearing loss among high-risk neonates was 4.8% (95% CI, 1.6%-10.8%).Hearing loss was significantly associated with intrauterine toxoplasmosis, perinatal asphyxia, neonatal hyperbilirubinemia (NNH) requiring exchange transfusion, stage II or higher hypoxic-ischemic encephalopathy, neonatal sepsis, neonatal seizures, syndromic or craniofacial anomalies, and ototoxic drug exposure (p < 0.05).The clinical risk prediction model, developed using significant predictive factors and assigning double weight to intrauterine toxoplasmosis and NNH requiring exchange transfusion, achieved a sensitivity of 60% and a specificity of 96% at a cutoff score of ≥3.Conclusions: The prevalence of hearing loss among high-risk neonates was 4.8%.The novel clinical risk score developed in this study may help guide targeted screening, timely diagnosis, and early intervention for hearing loss.