基层医院新生儿听力筛查模式探讨

目的探讨在基层医院开展新生儿听力筛查工作的方法。方法采用瞬态诱发耳声发射(TEOAE)对新生儿进行听力筛查,初筛未通过者于生后42 d左右进行复筛,复筛仍未通过者于出生3个月左右进行听性脑干诱发反应(ABR)等诊断性听力检查,并跟踪随访。结果初筛覆盖率为86.10%,初筛未通过率34.20%,复筛未通过率6.5%,不同程度听力损失婴幼儿占筛查总人数4.69‰。结论基层医院开展新生儿听力普遍筛查很有必要。     

新生儿听力筛查

听力障碍是常见的出生缺陷。国外的研究表明 ,正常新生儿中双侧听力障碍的发生率约 0 1%～ 0 3%,其中 ,重度至极重度听力障碍的发生率约为 0 1%[1] 。国内类似的统计数据不多 ,有报道正常新生儿听力障碍发生率为 0 3%,其中中重度以上者占 0 0 5 %;在经过重症监护病房抢救的新生儿中 ,听力障碍发生率高达 2 2 6 %,其中重度以上者为1%[2 ] 。正常的听力是进行语言学习的前提。听力正常的婴儿一般在 4～ 9个月 ,最迟不超过 11个月便能呀呀学语 ,这是语言发育的重要阶段性标志。而严重听力障碍的儿童由于缺乏语言刺激和环境的影响 ,不能在…     

2008/2010新生儿听力筛查变化趋势回顾性分析

目的总结2008-01/2010-12开封市妇产医院新生儿听力筛查变化趋势和相关因素,为今后工作的开展提供技术支持。方法采用MADSEN瞬态声诱发耳声发射仪(TEOAE)收集2008-01/2010-12新生儿听力筛查的资料按初筛、复筛及听力损伤分布情况统计分析,复筛未通过转耳科专业最终确诊。结果初筛漏筛率从12.80%降低到1.55%,未通过率从22.35%降低到10.84%;复筛漏筛率从41.79%降低到5.07%,未通过率为2.16%~3.51%,明显低于初筛;共确诊15例听力损伤患儿。结论新生儿听力筛查漏筛率逐年降低,复筛未通过率明显低于初筛,新生儿听力损伤主要分布在经过新生儿病房治疗出院的新生儿。     

上海地区2378名新生儿听力筛查分析

为探索如何开展新生儿听力筛查工作，研究正常新生儿和新生儿监护室（ＮＩＣＵ）重症监护儿的听力障碍发病情况及听力障碍高危因素。对上海地区２３７８名新生儿进行听力筛查。正常新生儿组和ＮＩＣＵ重症监护儿组分别为１９７９人和３９９人。分别做听觉行为测定、信访和电话访问、脑干听觉诱发电位（ＡＢＲ）检查。结果：正常新生儿组和ＮＩＣＵ组的听力障碍发生率分别为０．３０％和２２．６０％，其中重度以上听力障碍分别为０．０５％和１．００％。提示高胆红素血症、庆大霉素注射史、卡那霉素注射史、低出生体重和化脓性脑膜炎可能是听力障碍的高危因素。     

诱发畸变耳声发射法对4996例新生儿听力筛查结果分析

目的探讨早期发现小儿听力障碍的筛查方法.方法采用诱发畸变耳声发射法(DPOAE)对4996例新生儿进行听力筛查,连续监测异常者,最后由脑干听觉诱发电位(ABR)确诊.结果DPOAE法筛查阳性36例(0.72%)经ABR确诊10例听觉障碍,其中单耳聋4例,双耳聋6例;轻度听觉障碍1例,中度4例,重度5例.结论DPOAE测试法适合于新生儿听力筛查,是可靠、有效、快速、简便的好方法;新生儿科工作者必须重视小儿听力筛查,早期干预,以达聋而不哑.     

新生儿听力筛查1988例分析

听力障碍是常见的出生缺陷。新生儿中双侧听力障碍的发生率约在0.1%~0.3%[1]。我国聋人口基数大,每年新产生聋儿较多。其中重者导致聋哑,轻者导致语言障碍、社会适应能力低下、注意力缺陷和学习困难等心理行为问题,给整个社会造成了沉重的负担。然而目前的各种治疗方法,其疗效的保证都需依赖于听力障碍的早期发现。据美国婴幼儿听力联合委员会的报告,接受新生儿听力筛查的婴幼儿,其听损伤可以在3个月以内确诊[2],对及早制定治疗和康复计划非常有利。因此,及早发现小儿的听力障碍,并进行早期干预,对保障和提高儿童健康水平具有非常重要的意义…     

未通过听力初筛新生儿家长知信行状况及相关因素分析

目的了解家长对新生儿听力筛查的知晓度、认可度、心理状态以及依从性,进一步分析其影响因素。方法 2010年9月至2011年6月,采用问卷调查的形式,在北京妇产医院(三级医院)及海淀区妇幼保健院(二级医院)对未通过新生儿听力筛查的家长进行相关问卷的调查。结果共发放问卷680份,全部收回。有效问卷653份,有效率(96%)。数据分析显示,384例(58.8%)家长表示在入院宣教时了解到新生儿听力筛查,仅90例(13.7%)家长表示在产前宣教时即了解到。647例(99.1%)家长认为筛查有必要,但仅479例(73.4%)家长认可普筛中使用诱发型耳声发射(OAE)和自动听觉脑干诱发电位(AABR)联合筛查。517例(79.2%)家长对初筛结果未通过表示担心。对于降低假阳性转诊的三阶段筛查模式,464例(71.0%)家长表示愿意接受。经多因素Logistic回归分析显示,母亲学历和分娩医院级别越高者,家长的担心情绪越低(P<0.05);母亲学历高者,更容易接受三阶段筛查模式(P<0.05)。结论大部分家长对新生儿听力筛查持认可态度,但对其认知程度和依从性有待提高。母亲学历及分娩医院级别越高,家长对初筛未通过的担心情绪越低。加强宣教力度才能更好的推进听力筛查工作的进一步发展。     

基层地区新生儿医院内两步听力筛查模式探讨

目的 探讨基层地区医院内两步听力筛查模式的有效性.方法 选择2008年11月至2010年4月出生于安阳市妇幼保健院、并接受瞬态诱发性耳声发射筛查的新生儿,医院内第一次初筛单耳或双耳未通过的新生儿于出院前进行第二次初筛或生后42天进行复筛.记录听力筛查时间及双耳筛查结果,按完成听力筛查的时间将新生儿分组,分析通过率与筛查时间的关系、医院内一次初筛和两次初筛后总的通过率,以及医院内第二次初筛与42天复筛两组人群的通过率.结果 (1)完成听力第一次初筛的新生儿共10 060例,总体通过率49.1％ (4944/10 060),通过率随出生后筛查时间的延迟而提高.(2)未通过第一次初筛的新生儿中30.0％ (1535/5116)出院前接受第二次初筛,通过率78.4％(1204/1535),两次初筛后总体通过率61.1％ (6148/10 060),与一次初筛通过率(49.1％)差异有统计学意义(x2=291.3,P＜0.001).(3)未通过医院内听力初筛的婴儿中39.1％ (1531/3912)于42天接受复筛,通过率92.7％(1420/1531),与医院内第二次初筛通过率(78.4％)差异有统计学意义(x2=127.3,P＜0.001).结论 新生儿听力筛查时间是影响通过率的关键因素,随着出生后筛查时间的延迟,初筛通过率逐步提高;医院内两步筛查可提高初筛通过率,但医院内第二次初筛通过率低于42天复筛通过率.     

新生儿听力筛查的临床应用

新生儿听觉障碍分为先天性听觉障碍和与分娩诸多高危因素相关的获得性听力损伤,其确切发病率尚鲜有报道。为了解我国新生儿听力障碍的发病率及相关因素,配合我科对小婴儿神经发育早期干预的研究,我们应用畸变产物耳声发射测定仪(DPOAE)对近两年我院新生儿的听力进行检测,现将结果报告如下。     

嘉定区8299例新生儿听力筛查情况分析

目的为了更好开展新生儿听力筛查工作，提高筛查率，使听障儿童聋而不哑。方法对嘉定区4个产院自2002年4月～2004年3月出生的新生儿进行听力测试，以及对确诊为先天性听障儿家长进行高危因素调查。结果新生儿听力测试初筛率为82．2％，未通过率为8％；复查率为70．4％，复查未通过率为11．7％；最终确诊为听力障碍发生率为1.45‰。听障儿童高危因素调查中，胎儿宫内窘迫为首位因素。结论做好新生儿听力筛查随访追踪，提高复查率，使聋儿聋而不哑。提高产科质量，减少胎儿宫内窘迫及低体重儿的出生，减少孕期危害因素。     

The Parkland Memorial Hospital experience in ensuring compliance with Universal Newborn Hearing Screening follow-up

OBJECTIVE: Reduce false-positive results and loss to follow-up through systematic modifications in Universal Newborn Hearing Screening at a large public hospital. STUDY DESIGN: During a pilot program, neonates who failed technician-performed automated auditory brain stem response were scheduled for diagnostic evaluation. In year 1, audiologists rescreened neonates who failed, and those who did not pass were screened as outpatients. For years 2 through 4, neonates who failed were rescreened by technicians before inpatient audiology rescreening. RESULTS: For the pilot, 3759 neonates were screened; 1% (n = 43) failed and 44% (n = 19) were lost to follow-up. In year 1, 15,297 neonates were screened and 2% (n = 365) failed; audiology rescreening reduced this to <1% (n = 129). Outpatient rescreening yielded 0.5% (n = 70) who failed; 17% (n = 12) were lost to follow-up. In year 2, 16,384 neonates were screened, 3% (n = 456) failed, and 1% (n = 167) failed after technician rescreen; audiology rescreening reduced inpatient fails to 0.6% (n = 108), and 0.4% (n = 61) failed outpatient rescreening; 11% (n = 7) were lost to follow-up. Results for years 3 and 4 were similar to year 2, with further reduction in loss to follow-up to 11% (n = 6) and 1.7% (n = 1). CONCLUSIONS: Successful Universal Newborn Hearing Screening with reduced false-positive results and loss to follow-up can be accomplished with a planned schedule of inpatient rescreens and outpatient rescreening at the birthing facility.     

Infant,Maternal, and Hospital Factors' Role in Loss to Follow-up After Failed Newborn Hearing Screening

Objective

Completion of newborn hearing screening (NBHS) is recommended by 1 month old. Delays and loss to follow-up and documentation (LTF/LTD) after failed NBHS are common. Committees of experts have established hospital guidelines to reduce LTF/LTD. We aimed to identify maternal and infant factors associated with LTF/LTD and determine if adherence to hospital guidelines is associated with timely completion of follow-up screening.

Newborn Screening for Lysosomal Storage Disorders

Lysosomal storage disorders (LSDs) are a heterogeneous group of approximately 50 rare inherited metabolic conditions that result from enzyme deficiencies that interfere with lysosome function. Although often grouped together, there is great variability regarding age of onset, severity, treatment, and outcomes for each disorder and subtype. Currently, laboratory methods are available to test newborns for seven of these conditions. Although newborn screening programs remain state-based, each at a different phase of condition review and implementation, if newborn screening for LSDs has not yet been adopted by the state within which you practice, it likely will. Given the extremely low prevalence and limited provider familiarity with these conditions, this article provides an overview of LSDs and the seven conditions for which newborn screening is available. It offers information about each of the conditions including enzyme deficiency, mode of inheritance, incidence rates, types, clinical course, and available as well as potential treatment options.