Practice and challenges of newborn hearing screening: Analysis of a five-year database in Italy

Early identification and treatment of hearing impairments are essential for childrens development. International guidelines recommend a stepwise approach for conductive hearing screening in newborns. However, while the majority of countries around the world implemented universal newborn hearing screening, inconsistencies remain in terms of procedures and data management. In particular, Level 3 of the screening pathway--comprising diagnostic confirmation and therapeutic management--has received limited attention in the literature, despite its central role in determining program effectiveness and patient outcomes. This study investigates the clinical and organizational aspects of Level 3 within the neonatal hearing screening program of the Friuli-Venezia Giulia Region in Italy, analyzing data from 106 children enrolled between 2019 and 2023. The analysis considers the regional protocol, the roles of birthing centers, pediatricians, hospitals, and the Regional Center for Pediatric Hearing Loss Care, and subdivides Level 3 into four Phases (A-D) reflecting both organizational and diagnostic functions. By examining patient flow, false positives, loss to follow-up/documentation, and management practices, the study highlights how organizational factors--particularly the coordination between local and specialized facilities-- produce "cascade" outcomes directly affecting diagnostic timelines and treatment initiation. Findings provide critical insights into weaknesses of the current system and propose directions for improving program efficiency, accuracy, and overall quality of care.