{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T16:15:30Z","timestamp":1788279330225,"version":"build-2803163510"},"reference-count":97,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Universal newborn hearing screening (UNHS) has significantly improved early detection of congenital hearing loss; however, discrepancies persist between prevalence at birth and latter childhood. These findings suggest the presence of hidden or delayed-onset forms of hearing impairments as a consequence of false-negative UNHS results. Methods: A bibliographic search was conducted in PubMed and Scopus for the period 2000\u20132026. A total of 103 papers met the inclusion criteria. This narrative review synthesizes recent literature on the limitations of current hearing screening strategies, focusing on false-positive and false-negative screening results, auditory neuropathy spectrum disorder (ANSD), genetic etiologies, and congenital cytomegalovirus (cCMV) infection as potential causes. Emphasis is placed on mechanisms underlying missed diagnoses and their clinical implications. Results: Current screening protocols, particularly those based on otoacoustic emissions (OAE), may fail to detect mild, progressive, or neural hearing loss. False-negative results are frequently associated with genetic mutations (e.g., GJB2), cCMV infection, and ANSD, whereas false-positive findings are often associated with transient middle ear conditions and early timing of testing. Automated auditory brainstem responses (AABR)-based approaches for hearing screening improve detection of neural dysfunction but are influenced by auditory pathway maturation, which may complicate interpretation of results in early life. Evidence indicates that a substantial proportion of sensorineural hearing loss identified later in childhood may not be detectable at birth using existing protocols. Conclusions: Hidden and delayed-onset sensorineural hearing loss represent significant challenges and limitations of current UNHS programs. Optimization of screening strategies\u2014including broader implementation of AABR, integration of genetic and cCMV testing, and careful consideration of screening timing\u2014may improve early detection of hearing loss and reduce long-term developmental consequences. Future updates of international guidelines should address these gaps to enhance diagnostic accuracy and clinical outcomes.<\/jats:p>","DOI":"10.3390\/children13091179","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T15:08:43Z","timestamp":1788275323000},"page":"1179","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hidden and Delayed-Onset Hearing Loss in Children: Limitations of Newborn Hearing Screening and Future Directions"],"prefix":"10.3390","volume":"13","author":[{"given":"Alenka","family":"Kravos","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000 Maribor, Slovenia"},{"name":"Faculty of Medicine, University of Maribor, Taborska Ulica 8, 2000 Maribor, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1016\/S0030-6665(05)70196-1","article-title":"Benefits of Early Intervention for Children with Hearing Loss","volume":"32","year":"1999","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1438","DOI":"10.1056\/NEJMra0911225","article-title":"Profound Deafness in Childhood","volume":"363","author":"Kral","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"E43","DOI":"10.1542\/peds.106.3.e43","article-title":"Early Intervention and Language Development in Children Who Are Deaf and Hard of Hearing","volume":"106","author":"Moeller","year":"2000","journal-title":"Pediatrics"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2131","DOI":"10.1056\/NEJMoa054915","article-title":"Language Ability after Early Detection of Permanent Childhood Hearing Impairment","volume":"354","author":"Kennedy","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1542\/peds.102.5.1161","article-title":"Language of Early- and Later-Identified Children with Hearing Loss","volume":"102","author":"Sedey","year":"1998","journal-title":"Pediatrics"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"192","DOI":"10.3390\/audiolres11020017","article-title":"Hearing Loss in Children: Clinical-Epidemiological Data from Two Different Provinces of the Same Region","volume":"11","author":"Palma","year":"2021","journal-title":"Audiol. Res."},{"key":"ref_7","first-page":"110915","article-title":"Hearing Loss in Newborns and Infants: A Review","volume":"150","author":"Greczka","year":"2022","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2195","DOI":"10.1001\/jama.2020.17647","article-title":"Hearing Loss in Children: A Review","volume":"324","author":"Lieu","year":"2020","journal-title":"JAMA"},{"key":"ref_9","unstructured":"(2019). Year 2019 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs. J. Early Hear. Detect. Interv., 4, 1\u201344."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1053\/j.semperi.2009.12.009","article-title":"The Evolution of Early Hearing Detection and Intervention Programs in the United States","volume":"34","author":"White","year":"2010","journal-title":"Semin. Perinatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1016\/j.ijporl.2010.05.024","article-title":"Risk Factors for Sensorineural Hearing Loss in NICU Infants Compared to Normal Hearing NICU Controls","volume":"74","author":"Coenraad","year":"2010","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"National Institutes of Health Consensus Development Panel (1993). Early Identification of Hearing Impairment in Infants and Young Children. Int. J. Pediatr. Otorhinolaryngol., 27, 201\u2013202.","DOI":"10.1016\/0165-5876(93)90137-R"},{"key":"ref_13","first-page":"110651","article-title":"Prevalence of Hearing Loss in Children and Adolescents","volume":"143","author":"Attias","year":"2021","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_14","first-page":"S228","article-title":"Age at Intervention and Language Outcomes in Children at 5 Years of Age","volume":"143","author":"Ching","year":"2017","journal-title":"Pediatrics"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"369","DOI":"10.3345\/cep.2022.01011","article-title":"Hearing Loss in Neonates and Infants","volume":"66","author":"Choe","year":"2023","journal-title":"Clin. Exp. Pediatr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"111785","DOI":"10.1016\/j.ijporl.2023.111785","article-title":"Estimated Prevalence of Permanent Hearing Loss among Newborns and 6-Year-Olds: An Evaluation of the Three Auditory Screenings in Uppsala","volume":"176","author":"Erixon","year":"2024","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1038\/nrneurol.2016.10","article-title":"Auditory Neuropathy\u2014Neural and Synaptic Mechanisms","volume":"12","author":"Moser","year":"2016","journal-title":"Nat. Rev. Neurol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3397","DOI":"10.1007\/s00405-024-08527-x","article-title":"Late-Onset, Progressive Sensorineural Hearing Loss in the Paediatric Population: A Systematic Review","volume":"281","author":"Corazzi","year":"2024","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Layman, W.S., and Zuo, J. (2015). Epigenetic Regulation in the Inner Ear and Its Potential Roles in Development, Protection, and Regeneration. Front. Cell. Neurosci., 8.","DOI":"10.3389\/fncel.2014.00446"},{"key":"ref_20","first-page":"2085","article-title":"The Epidemiology of Deafness","volume":"393","author":"Sheffield","year":"2019","journal-title":"Lancet"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e20162610","DOI":"10.1542\/peds.2016-2610","article-title":"Hearing Loss in Children with Asymptomatic Congenital Cytomegalovirus Infection","volume":"139","author":"Lanzieri","year":"2017","journal-title":"Pediatrics"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/j.pedneo.2020.05.014","article-title":"Maturation of the Auditory System in Normal-Hearing Newborns with a Very or Extremely Premature Birth","volume":"61","author":"Verkerk","year":"2020","journal-title":"Pediatr. Neonatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"4357","DOI":"10.1007\/s00405-026-10205-z","article-title":"Effects of Auditory Pathway Maturation on Hearing Loss Diagnosis","volume":"283","author":"Savioli","year":"2026","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e104936","DOI":"10.7554\/eLife.104936","article-title":"Cochlear Synaptopathy: Unravelling Hidden Hearing Loss","volume":"13","author":"Ponsot","year":"2024","journal-title":"eLife"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1001\/jama.279.14.1071","article-title":"Prevalence of Hearing Loss among Children 6 to 19 Years of Age: The Third National Health and Nutrition Examination Survey","volume":"279","author":"Niskar","year":"1998","journal-title":"JAMA"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1016\/j.otohns.2008.12.022","article-title":"The Epidemiology of Hearing Impairment in the United States: Newborns, Children, and Adolescents","volume":"140","author":"Mehra","year":"2009","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.ijporl.2016.12.029","article-title":"Prevalence and Independent Risk Factors for Hearing Impairment among Very Low Birth Weight Infants","volume":"93","author":"Wang","year":"2017","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Wroblewska-Seniuk, K., Greczka, G., Dabrowski, P., Szyfter-Harris, J., and Mazela, J. (2017). Hearing Impairment in Premature Newborns\u2014Analysis Based on the National Hearing Screening Database in Poland. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0184359"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e010501","DOI":"10.1136\/bmjgh-2022-010501","article-title":"Prevalence and Global Estimates of Unsafe Listening Practices in Adolescents and Young Adults: A Systematic Review and Meta-Analysis","volume":"7","author":"Dillard","year":"2022","journal-title":"BMJ Glob. Health"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1136\/bmj.323.7312.536","article-title":"Prevalence of Permanent Childhood Hearing Impairment in the United Kingdom and Implications for Universal Neonatal Hearing Screening: Questionnaire Based Ascertainment Study","volume":"323","author":"Fortnum","year":"2001","journal-title":"BMJ"},{"key":"ref_31","unstructured":"World Health Organization (2021). World Report on Hearing, World Health Organization. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240020481."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1820","DOI":"10.2105\/AJPH.2016.303299","article-title":"Prevalence of Hearing Loss by Severity in the United States","volume":"106","author":"Goman","year":"2016","journal-title":"Am. J. Public Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e235","DOI":"10.1093\/geront\/gnz009","article-title":"Hearing Loss and Depression in Older Adults: A Systematic Review and Meta-Analysis","volume":"60","author":"Lawrence","year":"2020","journal-title":"Gerontologist"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1016\/S0140-6736(21)00516-X","article-title":"Hearing Loss Prevalence and Years Lived with Disability, 1990\u20132019: Findings from the Global Burden of Disease Study 2019","volume":"397","author":"Haile","year":"2021","journal-title":"Lancet"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1093\/eurpub\/ckr176","article-title":"Global and Regional Hearing Impairment Prevalence: An Analysis of 42 Studies in 29 Countries","volume":"23","author":"Stevens","year":"2013","journal-title":"Eur. J. Public Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1002\/lary.29590","article-title":"The History of Pediatric and Adult Hearing Screening","volume":"131","author":"Ruben","year":"2021","journal-title":"Laryngoscope"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1121\/1.382104","article-title":"Stimulated Acoustic Emissions from within the Human Auditory System","volume":"64","author":"Kemp","year":"1978","journal-title":"J. Acoust. Soc. Am."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1093\/brain\/94.4.681","article-title":"Auditory-Evoked Far Fields Averaged from the Scalp of Humans","volume":"94","author":"Jewett","year":"1971","journal-title":"Brain"},{"key":"ref_39","first-page":"1132","article-title":"Neonatal Screening for Hearing Impairment","volume":"66","author":"Watkin","year":"1991","journal-title":"Arch. Dis. Child."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"12006","DOI":"10.7189\/jogh.12.12006","article-title":"Effectiveness of Universal Newborn Hearing Screening: A Systematic Review and Meta-Analysis","volume":"12","author":"Edmond","year":"2022","journal-title":"J. Glob. Health"},{"key":"ref_41","unstructured":"Centers for Disease Control and Prevention (2026, July 05). Summary of American Early Hearing Detection and Intervention (EHDI) Data, Available online: https:\/\/www.cdc.gov\/ncbddd\/hearingloss\/ehdi-data.html."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"S59","DOI":"10.1542\/peds.2010-0354K","article-title":"Improving Follow-Up to Newborn Hearing Screening: A Learning-Collaborative Experience","volume":"126","author":"Russ","year":"2010","journal-title":"Pediatrics"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Joint Committee on Infant Hearing (2000). Year 2000 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs. Pediatrics, 106, 798\u2013817.","DOI":"10.1542\/peds.106.4.798"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.jcomdis.2004.04.008","article-title":"Levels of evidence: Universal newborn hearing screening (UNHS) and early hearing detection and intervention systems (EHDI)","volume":"37","year":"2004","journal-title":"J. Commun. Disord."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e2023063288","DOI":"10.1542\/peds.2023-063288","article-title":"Hearing Assessment in Infants, Children, and Adolescents: Recommendations Beyond Neonatal Screening","volume":"152","author":"Bower","year":"2023","journal-title":"Pediatrics"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Harris, A.B., Seeliger, E., Hess, C., Sedey, A.L., Kristensen, K., Lee, Y., and Chung, W. (2022). Early Identification of Hearing Loss and Language Development at 32 Months of Age. J. Otorhinolaryngol. Hear. Balance Med., 3.","DOI":"10.3390\/ohbm3040008"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/j.ijporl.2004.11.006","article-title":"Failed Newborn Hearing Screens as Presentation for Otitis Media with Effusion in the Newborn","volume":"69","author":"Boone","year":"2005","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"402","DOI":"10.5152\/iao.2023.22987","article-title":"Newborn Hearing Screening: Early Ear Examination Improves the Pass Rate","volume":"19","author":"Schwarz","year":"2023","journal-title":"J. Int. Adv. Otol."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Kaveh, M., Mirjalali, S.N., Shariat, M., and Zarkesh, M.R. (2021). Perinatal Factors Influencing the Neonatal Hearing Screening Results. BMC Pediatr., 21.","DOI":"10.1186\/s12887-020-02476-0"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"F462","DOI":"10.1136\/adc.2007.124214","article-title":"Hearing Loss in Children with Very Low Birth Weight: Current Review of Epidemiology and Pathophysiology","volume":"93","author":"Cristobal","year":"2008","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/S0165-5876(98)00185-2","article-title":"Prevalence Rates of Otitis Media with Effusion from 0 to 2 Years of Age: A Comparison between Healthy-Born and High-Risk-Born Infants","volume":"47","author":"Engel","year":"1999","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1097\/00129492-200405000-00020","article-title":"Neonatal Middle Ear Effusion Predicts Chronic Otitis Media with Effusion","volume":"25","author":"Doyle","year":"2004","journal-title":"Otol. Neurotol."},{"key":"ref_53","unstructured":"British Society of Audiology (2023). Recommended Procedure: Clinical Application of Otoacoustic Emissions (OAEs), British Society of Audiology. Available online: https:\/\/www.thebsa.org.uk."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"109978","DOI":"10.1016\/j.ijporl.2020.109978","article-title":"The Effects of Otitis Media with Effusion on the Measurement of Auditory Evoked Potentials","volume":"133","author":"Borges","year":"2020","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"31","DOI":"10.3390\/rjpm2020031","article-title":"Neonatal Hearing Screening\u2014Short Review","volume":"2","author":"Dima","year":"2023","journal-title":"Rom. J. Prev. Med."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Tanaka, S., and Kaga, K. (2023). The Complexity of Hearing Aid Fitting: Children with Congenital Sensorineural Hearing Loss and Middle Ear Effusion. Children, 10.","DOI":"10.3390\/children10101630"},{"key":"ref_57","unstructured":"Stapells, D.R. (2015). Frequency-Specific Threshold Assessment in Young Infants Using the ABR. Auditory Evoked Potentials: Basic Principles and Clinical Application, Lippincott Williams & Wilkins."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Kleinhuis, J.J.G., de Graaff-Korf, K., van Straaten, H.L.M., van Dommelen, P., and Benard, M.R. (2024). An Eight-Year Follow-Up on Auditory Outcomes after Neonatal Hearing Screening. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0297363"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Geal Dor, M., Gross, M., and Adelman, C. (2024). Follow-Up of Neonatal Hearing Screening in the Risk Factor Group for Hearing Loss: Results from a Tertiary Medical Center. Children, 11.","DOI":"10.3390\/children11111336"},{"key":"ref_60","first-page":"11","article-title":"Hearing Impairment in Infants with Asphyxia","volume":"26","author":"Madrimova","year":"2022","journal-title":"Int. Tinnitus J."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1016\/j.tins.2019.03.006","article-title":"Mechanisms of Hair Cell Damage and Repair","volume":"42","author":"Wagner","year":"2019","journal-title":"Trends Neurosci."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"14487","DOI":"10.1038\/ncomms14487","article-title":"Transient Auditory Nerve Demyelination as a New Mechanism for Hidden Hearing Loss","volume":"8","author":"Wan","year":"2017","journal-title":"Nat. Commun."},{"key":"ref_63","first-page":"7912127","article-title":"Recovery of Abnormal ABR in Neonates and Infants at Risk of Hearing Loss","volume":"2017","author":"Psarommatis","year":"2017","journal-title":"Int. J. Otolaryngol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1001\/jamaoto.2013.1229","article-title":"Children with Sensorineural Hearing Loss after Passing the Newborn Hearing Screen","volume":"139","author":"Dedhia","year":"2013","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Grasel, S.S., Beck, R.M.O., and Almeida, E.R. (2025). Delayed-Onset Hearing Loss in First-Grade Students Who Passed Newborn Hearing Screening. Front. Pediatr., 13.","DOI":"10.3389\/fped.2025.1623225"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1542\/peds.2004-1688","article-title":"A Multicenter Evaluation of How Many Infants with Permanent Hearing Loss Pass a Two-Stage Newborn Hearing Screening Protocol","volume":"116","author":"Johnson","year":"2005","journal-title":"Pediatrics"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Morris, J.A., Gonzalez, T., Blanton, S.H., Angeli, S.I., and Liu, X.Z. (2026). GJB2-Related Hearing Loss: Genotype\u2013Phenotype Correlations, Natural History, and Emerging Therapeutic Strategies. Int. J. Mol. Sci., 27.","DOI":"10.3390\/ijms27010491"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.heares.2011.05.009","article-title":"Hearing Loss Associated with Enlargement of the Vestibular Aqueduct: Mechanistic Insights from Clinical Phenotypes, Genotypes, and Mouse Models","volume":"281","author":"Griffith","year":"2011","journal-title":"Hear. Res."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.nbd.2014.02.002","article-title":"Slc26a4-Insufficiency Causes Fluctuating Hearing Loss and Stria Vascularis Dysfunction","volume":"66","author":"Ito","year":"2014","journal-title":"Neurobiol. Dis."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1097\/01.aud.0000240492.78561.d3","article-title":"Does Universal Newborn Hearing Screening Identify All Children with GJB2 (Connexin 26) Deafness? Penetrance of GJB2 Deafness","volume":"27","author":"Norris","year":"2006","journal-title":"Ear Hear."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1097\/AUD.0000000000001411","article-title":"Congenital Cytomegalovirus-Associated Sensorineural Hearing Loss in Children: Identification Following Universal Newborn Hearing Screening, Effect of Antiviral Treatment, and Long-Term Hearing Outcomes","volume":"45","author":"Rohren","year":"2024","journal-title":"Ear Hear."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"2151","DOI":"10.1056\/NEJMra050700","article-title":"Newborn Hearing Screening\u2014A Silent Revolution","volume":"354","author":"Morton","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.amjoto.2017.06.002","article-title":"Analysis of Archived Newborn Dried Blood Spots Identifies Congenital Cytomegalovirus as a Major Cause of Unexplained Pediatric Sensorineural Hearing Loss","volume":"38","author":"Meyer","year":"2017","journal-title":"Am. J. Otolaryngol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1016\/S0022-3476(97)70248-8","article-title":"Progressive and Fluctuating Sensorineural Hearing Loss in Children with Asymptomatic Congenital Cytomegalovirus Infection","volume":"130","author":"Fowler","year":"1997","journal-title":"J. Pediatr."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1542\/peds.2014-1173","article-title":"Hearing Loss and Congenital Cytomegalovirus Infection: A Systematic Review","volume":"134","author":"Goderis","year":"2014","journal-title":"Pediatrics"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"2471","DOI":"10.1038\/s41390-025-04232-5","article-title":"Beyond Hearing Loss: Exploring Neurological and Neurodevelopmental Sequelae in Asymptomatic Congenital Cytomegalovirus Infection","volume":"98","author":"Swanson","year":"2025","journal-title":"Pediatr. Res."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1055\/s-0042-1748054","article-title":"Longitudinal Investigation of Hearing Disorders in Children with Congenital Cytomegalovirus","volume":"11","author":"Dahle","year":"2000","journal-title":"J. Am. Acad. Audiol."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"De Siati, R.D., Rosenzweig, F., Gersdorff, G., Gregoire, A., Rombaux, P., and Deggouj, N. (2020). Auditory Neuropathy Spectrum Disorders: From Diagnosis to Treatment: Literature Review and Case Reports. J. Clin. Med., 9.","DOI":"10.3390\/jcm9041074"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"3141","DOI":"10.1093\/brain\/awv270","article-title":"Pathophysiological Mechanisms and Functional Hearing Consequences of Auditory Neuropathy","volume":"138","author":"Rance","year":"2015","journal-title":"Brain"},{"key":"ref_80","first-page":"993","article-title":"Auditory Neuropathy Spectrum Disorder (ANSD) in Referrals from Neonatal Hearing Screening at a Well-Baby Nursery","volume":"175","author":"Boudewyns","year":"2016","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1177\/01945998211029836","article-title":"Diagnosis of Auditory Neuropathy Spectrum Disorder in the Neonatal Intensive Care Unit Population","volume":"166","author":"Mahomva","year":"2022","journal-title":"Otolaryngol.\u2013Head Neck Surg."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1016\/j.ijporl.2015.04.021","article-title":"Outcomes with OAE and AABR screening in the first 48 h\u2014Implications for newborn hearing screening in developing countries","volume":"79","author":"Swanepoel","year":"2015","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Joint Committee on Infant Hearing (2007). Year 2007 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs. Pediatrics, 120, 898\u2013921.","DOI":"10.1542\/peds.2007-2333"},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Mackey, A.R., Buss\u00e9, A.M.L., Del Vecchio, V., M\u00e4ki-Torkko, E., Korver, A.M.H., and Uhl\u00e9n, I.M. (2022). Protocol and Programme Factors Associated with Referral Rate and Loss to Follow-Up from Newborn Hearing Screening: A Systematic Review. BMC Pediatr., 22.","DOI":"10.1186\/s12887-022-03218-0"},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Vonk, L., van Dommelen, P., Eekhout, I., Uilenburg, N.N., Verkerk, P.H., and van der Ploeg, C.K.P.B. (2026). Optimal Timing for Neonatal Hearing Screening in Well-Babies. Int. J. Neonatal Screen., 12.","DOI":"10.3390\/ijns12010007"},{"key":"ref_86","first-page":"254","article-title":"Timing in Neural Maturation: Arrest, Delay, Precociousness, and Temporal Determination","volume":"22","author":"Sarnat","year":"2015","journal-title":"Semin. Pediatr. Neurol."},{"key":"ref_87","first-page":"511","article-title":"Critical Periods of Vulnerability for the Developing Nervous System: Evidence from Humans and Animal Models","volume":"108","author":"Rice","year":"2000","journal-title":"Environ. Health Perspect."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1111\/coa.12794","article-title":"Newborn Hearing Screening in Prematurity: Fate of Screening Failures and Auditory Maturation","volume":"42","author":"Yang","year":"2017","journal-title":"Clin. Otolaryngol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"2013","DOI":"10.1002\/lary.24054","article-title":"Auditory Maturation in Premature Infants: A Potential Pitfall for Early Cochlear Implantation","volume":"123","author":"Hof","year":"2013","journal-title":"Laryngoscope"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.1016\/j.ijporl.2006.05.005","article-title":"Transient infantile auditory neuropathy and its clinical implications","volume":"70","author":"Psarommatis","year":"2006","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_91","doi-asserted-by":"crossref","unstructured":"Manz, K., Nennstiel, U., Marzi, C., Mansmann, U., and Brockow, I. (2025). Quality Measures of Two-Stage Newborn Hearing Screening: Systematic Review and Meta-Analysis. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1566478"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1097\/00003446-200010000-00013","article-title":"Identification of Neonatal Hearing Impairment: Evaluation of Transient Evoked Otoacoustic Emission, Distortion Product Otoacoustic Emission, and Auditory Brainstem Response Test Performance","volume":"21","author":"Norton","year":"2000","journal-title":"Ear Hear."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.ijporl.2017.02.021","article-title":"The Results of Newborn Hearing Screening by Means of Transient Otoacoustic Emissions\u2014Has Anything Changed over 10 Years?","volume":"96","author":"Greczka","year":"2017","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1542\/peds.2004-2806","article-title":"Newborn Hearing Screening in the NICU: Profile of Failed Auditory Brainstem Response\/Passed Otoacoustic Emission","volume":"116","author":"Berg","year":"2005","journal-title":"Pediatrics"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1016\/j.ijporl.2010.08.010","article-title":"Is Discordance in TEOAE and AABR Outcomes Predictable in Newborns?","volume":"74","author":"Olusanya","year":"2010","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"a035493","DOI":"10.1101\/cshperspect.a035493","article-title":"Hidden Hearing Loss: A Disorder with Multiple Etiologies and Mechanisms","volume":"10","author":"Kohrman","year":"2020","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"2011","DOI":"10.1007\/s00405-023-08439-2","article-title":"The Challenge of a Mature Final Diagnosis of Hearing Loss Severity and Early Cochlear Implantation","volume":"281","author":"Mahrous","year":"2024","journal-title":"Eur. Arch. Otorhinolaryngol."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/9\/1179\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T15:18:37Z","timestamp":1788275917000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/9\/1179"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,1]]},"references-count":97,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["children13091179"],"URL":"https:\/\/doi.org\/10.3390\/children13091179","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,1]]}}}