大连地区217641例新生儿听力筛查结果回顾性分析

目的了解大连地区新生儿听力障碍的发病状况,发现听力筛查过程中存在的主要问题。方法对近5年大连地区出生的新生儿,在出生后3～5天内用畸变产物耳声发射(Disto rtio n pro duct o toacoustic emission,DPOAE)筛查仪进行初筛,初筛不通过者在42天进行复筛,复筛不通过者3个月内进行听觉脑干反应(auditory brainstem response,ABR)、多频听觉稳态反应(auditory steady state response,ASSR)、40Hz相关电位(40Hz-auditory evoked related potentials,40Hz–AERP)、声导抗测听等检查,对患儿进行综合听觉评估。结果 5年时间内大连地区应该筛查新生儿总数233856人,实际筛查217641人,初筛率为93.1%;初筛通过率为90.6%(197254/217641),复筛率为74.3%(漏检率为25.7%,5236/20387),复筛通过率90.5%(12194/15151),复筛不通过2957人;新生儿听力障碍诊治中心接诊2069人,就诊率为70%(2069/2957);确诊为听力障碍373例(607耳),听力障碍发病率为1.71‰;双耳听力障碍234例(轻、中、重、极重度听力障碍发病率分别为0.23‰、0.36‰、0.19‰、0.29‰),单耳听力障碍139例;有45例(45/106)重度-极重度听力障碍患儿6个月内没有确诊,其中9例为初筛不通过而没有进行复筛,36例初筛、复筛均不通过却没有及时就诊。结论大连地区新生儿听力障碍发病率与既往报道类似;完善听力障碍高危儿童的召回制度,提高复筛率和就诊率是减少听力障碍儿童漏诊的关键。

Retrospective analysis of hearing screening in 217641 newborns in Dalian

Objectives To understand hearing loss among newborns in Dalian region and major problems in the screening process.Methods Newborns in Dalian region in recent five years were tested with OAE within 3~5 days of birth.Infants who failed were re-screened by DPOAE within 42 days after birth.Babies failed the re-screening were tested by ABR,ASSR,40 Hz related potentials and immittance audiometry,as well as a complete auditory evaluation within 3 months after birth.Results The number of newborns who should take hearing screening in the five years was 233 856,and the number of newborns who actually received screening was 217 641 ( 93.1%).The first screening pass rate was 90.6%(197 254/217 641).The re-screening rate was 74.3% with a pass rate of 90.5%(12 194/15 151).Of the 2957 newborns who failed the re-screening,only 2069 (70%)were actually seen in the Newborn Hearing Disorder Center.Hearing loss (in one or both ears)was confirmed in 373 cases (1.71‰),bilateral in 234 cases and unilateral in 139 cases.The rate of mild,moderate,severe and profound hearing loss was 0.23‰,0.36‰,0.19‰ and 0.29‰ respectively.In 45 of the 106 newborns with serve to profound hearing loss,the diagnosis was not established within the first six months.Of these 45 newborns,9 failed the first screening and did not go through re-screening,while the rest 36 cases failed both first screening and rescreening but did not follow up on the referral for full audiological evaluation.Conclusion The incidence of hearing loss among newborns in Dalian region from this study is similar to previous reports.The key to reduce missed diagnosis in hearing loss in children is to improve follow up in screening,and to improve compliance in re-screening and full audiological evaluation when indicated.