多地区农村的新生儿听力筛查

目的：探讨在农村地区开展新生儿听力筛查的可行性，为在全国农村地区推广此项工作提供参考依据。方法：研究对象为2004—01—2005—12出生于农村地区九个县的新生儿12638例。采用瞬态诱发性耳声发射的快速筛查程序对出生后2～7d的新生儿实施听力筛查；筛查未通过者于出生后4～6周复筛，复筛未通过者进行跟踪随访和听力学诊断性检查。结果：12638例中10845例（85．8％）新生儿接受了筛查，其中正常新生儿9963例（91．9％），高危新生儿882例（8．1％）。初筛通过7450例（68．7％），未通过3395例（31．3％）。拒绝筛查1793例，占14．2％（1793／12638），其中正常新生儿833例（46．5％），高危新生儿960例（53．5％）。未通过初筛应进行复筛的新生儿3395例，实际复筛2536例（74．7％），未能复筛859例（25．3％）。复筛或初筛未通过应接受听力诊断120例，实际接受听力诊断79例（65．8％），52例确诊听力损失的患儿中6例（7．6％）为双侧极重度听力损失，9例（11．4％）为重度听力损失（双耳7例，单耳2例），11例（13．9％）为中度听力损失（双耳5例，单耳6例），26例（32．9％）为轻度听力损失（双耳11例，单耳15例）；27例（34．2％）听力正常。本组先天性听力损失（包括单耳和双耳）的总发生率为0．5％（52／10845），双侧听力损失的发生率为0．3％（29／10845）。正常新生儿听力损失发生率0．2％（22／9963）；高危新生儿听力损失发生率为3．4％（30／882）。13例双侧重度、极重度听力损失患儿中8例（61．5％）配戴了助听器，1例（7．7％）接受了人工耳蜗植入。结论：在农村地区开展新生儿听力筛查是必要的也是可行的。解决失访率高和转诊率低、提高高危新生儿筛查率仍是目前亟待解决的问题。

Study on multi-area universal newborn hearing screening in countryside of China

Objective:To investigate the feasibility of universal newborn hearing screening in countryside in order to provide reliable evidence in launching this program all over the countryside of China. Method:Subjects were 12 638 infants who were born in 9 counties from Jan 2004 to Dec 2005. TEOAE was used for the fast hearing screening. Infants were screened on the 2-7 days after the birth. The re-screening was conducted in 4-6 weeks if failed in the initial screening,and follow-up were provided continually if they also failed in the re-screening. Result; Ten thouand eight hundred and forty-five of 12 638(85. 8%) were screened including 9 963(91. 9%) normal newborns and 882(8. 1%) newborns with high-risk. Seven thouand four hundred and fifty (68. 7%) newborns passed the initial screening, and 3 395 (31. 3%) people failed. One thouand seven hundred and ninty-three (14. 2%) infants were refused to be screened.Only 2 536 (74. 7%) were re-screened on time, and 859(25. 3%) did not receive re-screening. One hundred and twenty were failed in the re-screening or first screening, and 79 (65. 8%)of them received diagnostic assessment. Among the infants received diagnostic assessment, 6(7.6%)ca-ses were found to have profound hearing loss in both ears, 9(11. 4%)cases were found to be severe hearing loss(7 in both ears and 2 in single ear) , 11(13. 9%)cases were found to be moderate hearing loss (5 in both ear and 6 in single ear), 26 (32. 9%) were found to have slight hearing loss (11 in both ear and 15 in single ears), and 27 (34.2%) were normal. Fifty-two infants were diagnosed as hearing loss with a prevalence of congenital hearing loss(in binaural and monaural) of 0. 5%(52/10845)and a prevalence of bilateral hearing loss of 0. 3%(29/10845). A prevalence of congenital hearing loss was 0. 2% (22/9 963) in well infants and 3. 4% (30/882) in high risk infants. Among the 13 cases of children with severe and profound hearing loss in both ears children, 8(61. 5%)cases were fitted with hearing aids and 1 (7. 7%) case was implanted with cochlear implants. Conclusion:It is necessary and feasible to conduct hearing screening program in the rural area. However, the suitable model to perform the program in the countryside needs to be set up as soon as possible in order to get more poor infants to participate into the hearing screening program for free and increase the screening rate.