Universelles Neugeborenen-Hörscreening

Background

In order to prepare for the introduction of a universal newborn hearing screening program on a larger scale, TEOAE and ABR were recorded on automated screening instruments from both ears of 501 newborns at the University Hospital Heidelberg over a period of 13 months. The parents of children in whom OAE and ABR could not be detected in both ears, were requested to allow a complete exploration of the auditory status of the children at the department of pediatric audiology.

Subjects and methods

Internally available data networks were used for the acquisition and evaluation of data and for the organization of tracking and follow-up. Of the children 35% exhibited risk factors for congenital hearing impairment.

Results

The pass rate was 98.7% for the exclusion of binaural and 91.6% for monaural hearing disorders (TEOAE or ABR detectable). On the basis of the data it can be shown how pass rates can be optimized by selecting a suitable moment for the examination and by prescribing a minimum number of test repetitions (3 for TEOAE and 2 for AABR).

Conclusion

Quality control of screening programs should include these parameters and, in particular the number of repetitions of test measurements in all screening steps.     

Universelles Neugeborenen-Hörscreening – Einstellung und Ängste der Mütter

Maternal anxiety in the event of a false positive result is an argument against universal hearing screening in newborns. The aim of this study was to investigate the mothers' attitudes towards neonatal hearing screening and their anxiety in case of a positive result. The study comprises 75 mothers. Using a standardized interview 40 mothers were questioned, 38 of whom already knew about this type of health check. Despite the possibility of a false positive result 33 mothers consented to the general newborn hearing screening. The positive attitude towards screening was associated with knowledge about the test and presence during its performance. Of 20 additional mothers who were interviewed about their anxiety following a positive result their baby had received on the first test, only 2 declared to be very worried. Of 15 additional mothers whose babies had failed the screening, 4 mothers were worried, 2 of whom stated that they had not been well enough informed about the screening. Both scepticism towards neonatal hearing screening and anxiety following a positive result were associated with lack of information and absence during testing.     

Modellprojekt Neugeborenen-Hörscreening in der Oberpfalz

Background

In May 2003, a newborn auditory screening program was initiated in the Upper Palatinate.

Methods

Sequential OAE- and BERA-screening was conducted in all hospitals with obstetric facilities. The Screening Center at the Public Health Authority was responsible for the coordination of the screening process, completeness of participation, the follow-up of all subjects with a positive screening test and the quality of instrumental screening.

Results

A total of 96% of 17,469 newborns were screened. The referral rate at discharge was 1.6% (0.4% for bilateral positive findings). For 97% of the positive screening results, a definite diagnosis to confirm or exclude hearing loss was achieved; for 43% only after intervention by the Screening Center. Fifteen children with profound bilateral hearing impairment were identified of whom eight were only detected by the intervention of the Screening Center.

Conclusion

The effective structures established in the Upper Palatinate provide a standard for the quality of neonatal auditory screening achievable in Germany.     

Ergebnisqualität im universellen Neugeborenen-Hörscreening

Background

Bearing in mind the impending evaluation of newborn hearing screening in Germany, this study investigated whether multicenter analysis of the screening results from four German states is possible and to what extent the results meet national quality and outcome criteria.

Materials and methods

The screening data from 170 hospitals and a total of 533,150 newborns (21?% of all German newborns) from 2009 to 2012 were evaluated according to definite rules and analyzed in terms of averages, as well as over time.

Results

During the investigated period and averaged over the hospitals, the quality criteria “percentage of screened newborns” (91.4?%) and “percentage requiring further follow-up” (5.0?%), the “day of screening” (day 4), as well as the target parameter “age at diagnosis” (4.8 months) were not met. Steady improvements were observed over time: in the last year of the evaluation, 95.3?% of children were examined; only 4.8?% required follow-up and the age at diagnosis decreased to 4.2 months. On average, 83?% of the babies were screened before day 4. The steady reduction in variance of most of the variables from the participating hospitals indicates continual improvement.

Conclusion

A multicenter analysis of screening data is possible and valid in the case of good quality data.     

Universelles Neugeborenen-H?rscreening – Einstellung und ?ngste der Mütter

Als Argument gegen die Einführung des generellen H?rscreenings bei Neugeborenen wird die Beunruhigung der Mütter bei falsch-positivem Ergebnis angeführt. Ziel der vorliegenden Studie war es, Einstellungen und ?ngste der Mütter beim H?rscreening zu ermitteln. Insgesamt wurden 75 Mütter einbezogen.     

Sequenzielles Neugeborenen-Hörscreening (TEOAE/AABR) reduziert Recall-Rate

BACKGROUND: 1-2/1,000 newborns are affected by connatal permanent hearing impairment. Clinical diagnosis is often delayed. This demands newborn hearing screening (NHS). Some questions regarding the optimal method remain unsolved. METHODS: The newborns in the obstetrical department (low-risk group) are tested by automated transitory evoked otoacustic emissions (TEOAE). TEOAE-fail is followed by automated auditory brainstem response (AABR) examination. All sick newborns admitted to the pediatric department (high-risk group) are primarily tested using AABR. Pathological AABR-testing leads to pedaudiological diagnostic work-up. RESULTS: In the low-risk group, 82 out of 1,584 newborns failed TEOAE-testing (recall 5.18%). Only 5 of these patients failed consecutive AABR examination (recall 0.32%). Permanent hearing loss was finally confirmed in 3 children (0.13%). 10 out of 755 newborns in the high-risk group failed AABR-testing (1.32%). In 6 of these children, hearing loss was confirmed (0.79%). CONCLUSION: A two-tier screening process as described is able to reduce recall rate, overall expenses and parental anxiety.     

Mitarbeiterbefragung als Instrument der Qualitätssicherung im Neugeborenen-Hörscreening

Background and objectives

Studies drawing information not only from technical data but also from surveying human resources behind the universal newborn hearing screening (UNHS) appear to be a rarity. This study aims at showing how the state of both knowledge and practical skills among the screening staff are essential aspects in future quality management.

Materials and methods

A self-developed questionnaire was sent to hospital staff addressing a total of 710 nurses who were registered as having undertaken a UNHS training course. Questions were aimed at aspects of organization, personal practical skills, current problems and improvement possibilities.

Results

High rates of occupancy, lack of trained personnel, technical issues and background noise disturbances were considered to be factors that increased time pressure and slowed down procedures. Of the participants 16 % considered communicating a “refer” result to parents a difficult step and 8 % felt insecure when explaining the aims and procedures to parents. There was a high interest in further training sessions.

Conclusions

This survey served well to reveal aspects of improvement in screening procedures and meeting staff needs. The training sessions should outline practical aspects of conducting screening and also professional, sensitive communication to parents.     

Modelle für ein universelles Neugeborenen-Hörscreening in der Diskussion

Ohne ZusammenfassungHerrn Prof. em. Dr. Chlodwig Beck zum 80. Geburtstag gewidmet.     

Grundlagen für das Neugeborenen-Hörscreening (Standard of Care)

Ohne Zusammenfassung     

Erwartungen werdender Mütter an das Neugeborenen-H?rscreening

Background

To implement universal newborn hearing screening (UNHS) for maximum effectiveness, it is necessary – in addition to implementing a reliable screening procedure when testing the child – to consider psycho-social factors relevant in this context. In this respect parental estimations and expectancies play an important role.

Method

In a questionnaire survey 187 expectant mothers were asked about their knowledge and attitudes concerning UNHS, and their expectations concerning the availability of concrete support if their child were to have positive test results at the primary postnatal screening. A self-developed scale was conducted asking the mothers to make statements regarding their attitude about UNHS, possible risks (parent-child relationship, stress experiences) as well as concrete expectations concerning support (counseling, contacts with other persons concerned, informative literature).

Results

The results show that the expectant mothers in this study expressed high approval for conducting UNHS. This is comparable with results from former studies. In addition, as many as a quarter of the expectant mothers expressed worries relating to the effects on the parent-child relationship and higher parental stress levels. In nearly all areas investigated, at least half of the expectant mothers said that providing targeted support if necessary is important to help them cope sufficiently with the challenges associated with the consequences of UNHS.

Conclusion

The results of this study demonstrate the importance of a reliable tracking system as required by the guidelines for using UNHS to detect children’s hearing loss at an early stage. The data suggest that in order to use UNHS responsible, consultations should be offered immediately to affected families. This would allow parents to have psycho-social support available as the need arises to cope with the primary screening results; further, this support should help parents learn about other family-centered support services such as case management.     

Hörscreening von Neugeborenen mit Risikofaktoren

OBJECTIVE: This prospective study reports on the prevalence of hearing impairment in an at-risk neonatal intensive care unit (NICU) population. DESIGN: From 1990 to 1998, 1062 neonates were screened with the use of transitory evoked otoacoustic emissions (TEOAE) and brainstem evoked response audiometry (BERA). RESULTS: 934 infants passed the primary screen for both ears, 75 for one ear, adding up to 95%. 17 infants (1.6%) were lost to follow-up. In fourteen infants (1.3%), bilateral hearing impairment above 30 dB was confirmed. While all children with hearing impairment belonged to the group of 862 children receiving aminoglycosides, only one of them presented no other risk factors. In twelve of the hearing impaired children other anamnestic factors, i.e. dysmorphism, prenatal rubella or cytomegaly, family history of hearing loss or severe peri- and postnatal complications seem to be more probable causes of the identified hearing loss. In one of these children, delayed onset or progression of hearing loss is suspected. CONCLUSIONS: From our data, aminoglycosides are not an important risk factor for hearing impairment, when serum levels are continuously monitored, as in our cohort. After adjustment for other risk factors, birth weight between 1000 gr and 1500 gr and a gestational age between 29 and 31 weeks were no predictive markers for hearing impairment. It might be speculated that the improved medical treatment in a NICU reduces the probability of hearing impairment for those two groups. Conductive hearing loss as a possible additional cause for hearing impairment was not studied in detail, but the high percentage of malformations detected (four out of fourteen hearing impaired infants) demands further monitoring, close follow-up, adequate treatment and counselling.     

Qualitätssicherung eines universellen Neugeborenen-Hörscreenings

Statutory implementation of a universal newborn hearing screening requires a continuous quality assurance monitoring. Therefore, at the Annual Meeting in 2007, the members of the German Society of Phoniatrics and Pediatric Audiology passed a recommendation on measures of quality assurance applied to newborn hearing screening. This recommendation describes the procedures, performance, location, time frame, and technical prerequisites of the screening and of potentially necessary follow-ups, the definition of hearing loss to be detected, the performing and responsible professional groups and their qualifications for the screening, the regulation of repeat and control screenings, the confirmation diagnostics and initiation of therapy, the information of parents, the documentation of screening results, the aims and organization of a tracking system, the tasks of regional screening centers and of a supraregional institution for the quality assurance of the hearing screening, the central collection of person and screening-related quality relevant data, and the accessibility of defined data sets as predisposition for cost analyses and quality reports.     

Das universelle Neugeborenenhörscreening als Anwendung automatisierter audiologischer Methoden

Ohne Zusammenfassung

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Universal newborn hearing screening with automated audiological methods

     

Kostenanalyse des universellen Neugeborenen-Hörscreenings für Kliniken am Beispiel Hessens

Background

The implementation of a universal newborn hearing screening (UNHS) in Germany in 2009 requires a realistic cost calculation for health insurance companies and participating clinics

Material and methods

Screening costs from 60 Hessian clinics were analyzed over 2.5 years whereby 94,203 children had been screened either with a 2-step (TEOAE, AABR) or a 1-step procedure (AABR).

Results

The TEOAE-AABR screening at EUR 13.16 per child was more cost-efficient. For a population with a high rate of at-risk babies a sole AABR device with screening costs of EUR 16.87 presents a more efficient alternative. High quality of screening performance and qualification of screening staff markedly reduced total cost. Overhead costs for tracking, quality assurance, control of completeness, and securing structural screening requirements, considered as essential screening costs, were calculated at EUR 4.00 per child. The total costs in Hesse would therefore be EUR 17.16 per child for TEOAE-AABR screening and EUR 20.87 per child for an AABR screening.

Conclusion

In a mixed calculation which can be cautiously extrapolated from the Hessian data for Germany as a whole, costs would be EUR 18.40 per registered child.     

Empfehlungen der AGERA zum Einsatz objektiver H?rprüfmethoden im Rahmen der p?daudiologischen Konfirmationsdiagnostik (Follow-up) nach nicht bestandenem Neugeborenen-H?rscreening

This paper presents the recommendations compiled by the German Electric Response Audiometry Working Group (Arbeitsgruppe Elektrische Reaktions-Audiometrie, AGERA) and the Association of German Audiologists and Neuro-otologists (Arbeitsgemeinschaft Deutschsprachiger Audiologen und Neurootologen, ADANO) for infants that fail newborn hearing screening (NHS) tests. Outlined are procedures for follow-up diagnosis using objective hearing tests to rule out or confirm a therapeutically relevant auditory defect and assessment of the severity thereof.     

Hörscreening mit automatisch bewerteten TEOAE und einem neuen Verfahren automatisch bewerteter FAEP Optimierung und Feldversuch

BACKGROUND AND OBJECTIVE: To make a rational decision as to which screening test might be adequate as a universal newborn hearing screening, different methods have to be tested under "real-life" conditions. In addition, a good reference is required as "golden standard." PATIENTS/METHODS: In the study presented here, an ABR with a novel algorithm for threshold-estimation was optimized and compared to TEOAE (Echoscreen) and DPOAE (GSI 60) in a three-step protocol using a standard click-evoked ABR (Evoselect) as reference of sensitivity and specificity. RESULTS: 26 ears were found to be hearing-impaired. All of them were also detected by each of the screening method (sensitivity 100%). Specificity in the final "step 2" of the study was around 87.7/92.3% for Echoscreen, 82.4/84.4% for DPOAE and 82.4/89.1 for Evoflash (left/right, respectively). Differences were not at all significant (X2-test, p > > 0.05). In summary, results were somewhat inferior to those found by other authors, probably due to more difficult conditions in the "real-life" setting. CONCLUSIONS: A higher rate of false-alarm shows that a two-step screening is necessary. Therefore, increased resources for diagnostic procedures are required.     

Die Gehörknöchelchen im Röntgenbild

Zusammenfassung Eine Methode zur Sichtbarmachung der Gehörknöchelchen mittels Bleiweiß wird beschrieben.Eine Aufnahmerichtung wird angegeben, welche die Ossicula im Röntgenbild deutlich zeigt und leicht mit einer kleinen Einstellvorrichtung zu bestimmen ist. Der Apparat wird näher beschrieben.Mit 11 Textabbildungen.     

Virusmeningitis und Hörvermögen

Ohne Zusammenfassung