Implementing Neonatal OAE Screening in Resource-Limited Tertiary Care: Operational Challenges and Solutions

Abstract

Aim: To evaluate the operational feasibility, technical performance, and efficiency of implementing neonatal otoacoustic emission (OAE) screening in a resource-limited tertiary care hospital and to identify practical solutions to common implementation challenges.

Methods: A retrospective operational analysis was conducted of 339 consecutive neonates who underwent OAE screening at a tertiary care hospital over 14 months (October 2021–November 2022). Data were analyzed for screening modality utilization (distortion product OAE [DPOAE] vs. transient evoked OAE [TEOAE]), technical failure rates, pass/refer outcomes, temporal trends in screening performance, and operational efficiency metrics. Statistical comparisons included chi-square tests for proportional differences and seasonal decomposition analysis for temporal trends.

Results: Of 339 screens performed, 313 (92.3%) yielded interpretable results with an 85.0% pass rate. DPOAE was utilized in 295 screens (87.0%), while TEOAE was used in 44 screens (13.0%). Technical failures included 5 "no seal" cases (1.5%), 4 "noisy" cases (1.2%), 3 "call again" cases (0.9%), and 1 "no result" case (0.3%). DPOAE demonstrated superior interpretability at 92.5% compared to TEOAE at 88.6% (p = 0.34). The program screened an average of 24.2 neonates per month. Seasonal analysis revealed significantly higher failure rates during monsoon months (14.6% vs. 5.2% during dry season, p = 0.012). Learning curve effects were evident with "no seal" failures decreasing from 9.1% in initial months to less than 0.5% by month 3.

Conclusion: Neonatal OAE screening is operationally feasible and sustainable in resource-limited tertiary care settings with acceptable technical performance. DPOAE modality offers superior reliability. Identified challenges including inadequate probe seal, excessive ambient noise, and infant behavioral factors are remediable through targeted interventions including screener training, acoustic environment optimization, and scheduling coordination. Seasonal environmental factors significantly impact performance and require adaptive resource planning.