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…     

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…     

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。     

父母对新生儿听力筛查的评价

听力障碍在新生儿中的发病率约为 0 .1%～0 .3% ,严重的听力障碍可影响儿童的言语 -语言及智力的发育 ,并可能影响其今后的学习、就业和生活。因此 ,欧美许多发达国家都以立法的形式规定 ,所有的新生儿必须进行听力筛查 ,有听力障碍的儿童需在 3个月前得到确诊 ,6个月前接受治疗[1] 。但是 ,靠传统意义上的普查和行为观察的方法是无法完成这一目标的 ,目前在临床上广为使用的是用耳声发射 (ｏｔｏａｃｏｕｓｔｉｃｅｍｉｓｓｉｏｎ ,ＯＡＥ)和脑干听觉诱发电位 (ａｕｄｉｔｏｒｙｂｒａｉｎｓｔｅｍｒｅｓｐｏｎｓｅ ,ＡＢＲ )两种方法来筛…     

1015例新生儿听力筛查分析

正常的听力是进行语言学习的前提，而听力障碍却是一种常见的出生缺陷，通过听力筛查能早期发现并予以使用一些适当的助听工具，使婴儿的语言发育不受或少受损害。     

香港新生儿听力筛查的现状

听力障碍（HI）是主要的残疾,正常活产儿和NICU听力障碍的发生率分别为13‰～3‰和2％～4％。听力障碍是常见的出生缺陷,发生率高于其他常规筛查的新生儿疾病,其发生率是新生儿甲状腺功能低下的10倍。香港每年出生55000名新生儿,其中约有165名听力障碍儿童。     

我国开展新生儿听力筛查的意义

根据调查,每1000名出生的新生儿中,约有1名～3名听力障碍。我国现有0岁～7岁聋儿80万人,每年还以3万名的速率递增。世界各国的情况也大致相仿。为此,1994年美国儿科学会发表声明,倡导新生儿听力筛查,要求至少在出生3个月内对所有新生儿或婴儿进行听力筛查。1995年世界卫生组织专门成立了防聋机构,发起世界范围内的防聋运动。1998年欧洲发表共同声明,呼吁各国尽早开展这一项目。     

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.     

健康教育对新生儿听力筛查实施的影响

目的 评估健康教育在实施新生儿听力筛查中的重要性.方法 调查1 216例接受健康教育及与896例未接受健康教育的产妇及其新生儿,比较两组家长对筛查的认知接受度和新生儿听力筛查率.结果 经健康教育后,新生儿听力的初筛率、复筛率提高,差异有统计学意义(P均＜ 0.01);家长对新生儿听力筛查目的 、必要性、结果的认可,以及对筛查结果和复查随访的接受度均显著提高,差异有统计学意义(P ＜ 0.01).结论 健康教育有利于提高家长对新生儿听力筛查的认知度,有助于新生儿听力筛查工作的顺利开展.     

自动脑干诱发电位技术在高胆红素血症新生儿听力筛查中的应用

目的探讨自动脑干诱发电位技术(AABR)在高胆红素血症新生儿听力筛查中的可行性和效果。方法选择2007年1月至2011年1月本院就诊并接受新生儿听力初筛和复筛的高胆红素血症足月新生儿(血清总胆红素值>220μmol/L)为观察组,同时在我院产科正常分娩的足月新生儿为对照组。听力初筛与复筛均使用AABR的两阶段模式,初筛时间为生后2～3天,无论通过与否均于出生后42～60天来我院进行复筛;复筛未通过的患儿,于生后3个月时回院行听性脑干反应(ABR)及听性稳态反应(ASSR)检测,并同时行第3次AABR检查。结果观察组1258例(2516耳),初筛通过1540耳,初筛通过率61.2%;对照组1514例(3028耳),初筛通过2913耳,初筛通过率96.2%,两组差异有统计学意义(χ2=1053.42,P<0.001)。观察组复筛通过2003耳,复筛通过率79.6%;对照组复筛通过2970耳,复筛通过率98.1%,两组差异有统计学意义(χ2=507.64,P<0.001)。轻度、中度、重度高胆红素血症患儿复筛通过率分别为87.9%、82.9%、69.4%,差异有统计学意义(χ2=81.49,P<0.001)。经ABR及ASSR检测,对照组2例患儿(2耳)、观察组29例患儿(38耳)确诊为听力障碍。结论高胆红素血症新生儿听力障碍发生率明显高于对照组;血清胆红素水平越高,听力筛查通过率越低。高胆红素血症患儿应进行听力筛查。     

Universal newborn hearing screening: a 27-month experience in the French region of Champagne-Ardenne

OBJECTIVES: This article reports the creation of a Universal Newborn Hearing Screening (UNHS) program in a French region, Champagne-Ardenne, and the results of its first 27 months. MATERIALS AND METHODS: We introduced a UNHS program in all the Champagne-Ardenne maternities in order to screen all newborns in the region. We used a two-step strategy. The first test consists of automated transiently evoked otoacoustic emissions (TEOAE) and is performed before discharge by a nurse or a midwife. If TEOAE are absent in both ears (positive screening test), the baby is referred to the second test, which could be either TEOAE or automated auditory brainstem response (aABR) 15 days after discharge, by a physician in an outpatient clinic. If the retest is positive in both ears, the baby is referred to diagnostic tests in a reference centre. This procedure also applies to newborns in neonatal intensive care units but, in those cases, the first test procedure is aABR because of the higher incidence of auditory neuropathies in those units. UNHS data are recorded with the other neonatal screening tests in the Regional Neonatal Screening Center, which facilitates the follow-up of newborns. RESULTS: A total of 33 873 newborns were screened, which represents a coverage rate of 92.42%. In those babies, 33 431 had a negative first test and 429 were retested. There were 34 positive retests. Among those 34 children, 27 were actually deaf (0.08%). The median age at diagnosis was shortened from 17 months to 10 weeks. CONCLUSION: Those 27-month results demonstrate the validity of our UNHS program, which relies on the cooperation with maternities, an easy protocol and a strong follow-up procedure.     

Neonatal hearing screening

Severe congenital hearing impairment is an important handicap affecting 0.1% of live-born infants and 1%–2% of graduates of Neonatal Intensive Care Units. The prognosis for intellectual, emotional, language and speech development in the hearing-impaired child is improved when the diagnosis is made early and intervention is begun before the age of 6 months. The usual age at diagnosis of hearing impairment is at least 18–30 months (or even later in cases of less severe hearing impairment) where there are no screening programmes. When screening is carried out using distraction methods at the age of approximately 9 months some hearing-impaired infants are missed and those discovered are at least 15–18 months before intervention begins. Neonatal screening could give hearing-impaired children the best chances for optimal care and development. Universal neonatal hearing screening is necessary, because, when neonatal hearing screening is restricted to high risk groups 30%–50% of infants with hearing loss are not discovered. The methods available for neonatal hearing screening are discussed in this paper.Conclusion In our view automated measurement of auditory brainstem responses is the most valuable method for universal neonatal hearing screening.     

Universal newborn hearing screening

The present statement reviews the evidence for universal newborn hearing screening (UNHS). A systematic review of the literature was conducted using Medline and using search dates from 1996 to the third week of August 2009. The following search terms were used: neonatal screening AND hearing loss AND hearing disorders. The key phrase "universal newborn hearing screening" was also searched. The Cochrane Central Register of Controlled Trials and systematic reviews was searched. Three systematic reviews, one controlled non-randomized trial and multiple cohort studies were found. It was determined that there was satisfactory evidence to support UNHS. The results of the available literature are consistent and indicate clear evidence that without UNHS, delayed diagnosis leads to significant harm for children and their families; with UNHS, diagnosis and intervention occur earlier; earlier intervention translates to improved language outcomes; and in well-run programs, there is negligible harm from screening.     

Automated auditory brainstem response in neonatal hearing screening

Severe congenital hearing impairment is an important handicap affecting 0.1% of apparently healthy liveborn infants and 1-2% of graduates of neonatal intensive care units. The prognosis for intellectual, emotional, language and speech development in the hearing-impaired child is improved when the diagnosis is made early and intervention is begun before the age of 6 mo. Universal screening is preferable, since about 50% of infants with hearing loss are not discovered if neonatal hearing screening is restricted to high-risk groups. The automated auditory brainstem response (AABR) screener is a dedicated hearing screening device which provides information not only about the outer/middle ear and cochlea but also about the auditory pathway up to the brainstem. AABR has an agreement with conventional auditory brainstem response up to 98%. It uses a 35 dB near hearing level click. No operator interpretation is needed and it can be used on the ward and during oxygen therapy without disturbance from ambient noise. Reported referral rates in a hospital-based screening programme at the time of discharge vary, with an average of 4%. AABR has also been used in a home-based setting, with the same results. The time necessary for screening varies with the setting, but ranges from 4 to 15min. Initial costs range from $15 to $25 per test, which is similar to neonatal screening for metabolic diseases. In addition to individual healthcare savings, early diagnosis may lead to savings on costs of intensive speech-language intervention and educational facilities.     

Ligurian experience on neonatal hearing screening: clinical and epidemiological aspects

AIM: Early identification and rehabilitation of newborns with congenital hearing impairment (HI) by Universal Neonatal Hearing Screening (UNHS). METHODS: The neonatal population was divided into two groups: babies with No Audiological Risk (NAR), and babies With Audiological Risk (WAR). NAR neonates underwent OAE testing, and in case of a doubtful (Refer) result, ABR testing was carried out. All WAR newborns underwent ABR testing within the third month of life. RESULTS: Between February 1, 2002 and December 31, 2004, UNHS was carried out on 32 502 newborns at the 13 regional birth centres, representing 98.7% of the whole regional neonatal population. The prevalence of HI in the population we tested was estimated at about 1 per thousand, while Bilateral Hearing Impairment (BHI) was estimated at 0.65 per thousand. A 3.7% prevalence of HI and a 2.8% prevalence of BHI was observed among the WAR population. Median age at the end of the diagnostic procedures was 6.7 months in the WAR population and 6.9 months in the NAR population. CONCLUSIONS: Our project is based on two levels of testing, which resulted in a 0.28% false-positive rate with 100% sensitivity and 99% specificity. Our screening is the first Italian experience that has been extended to a whole region and the results prove that regional neonatal hearing screening is feasible.     

婴儿听力筛查及听力损伤干预效果评估

目的了解我院新生儿听力障碍发生率和听力障碍干预效果,促进听力障碍婴儿言语智能发育。方法应用耳声发射分析仪和听觉脑干诱发电位对2007—2010年无锡市妇幼保健院出生的婴儿进行听力筛查和听力障碍诊断,对确诊听力障碍婴幼儿根据家长对干预的依从性分为干预组和非干预组,同时选择同期出生听力正常儿童为对照组,采用Gesell发育量表进行言语能发育商测定,评估干预效果。结果研究期间总共筛查11 697名婴儿,初筛未通过930例(79.5‰),复筛未通过183例(15.6‰),确诊听力障碍24例(2.1‰),听力障碍确诊率由2007年的3.9‰逐年下降至2010年的1.4‰。听力障碍婴幼儿干预组和非干预组言语能发育商均低于对照组[(82.5±10.3)、(67.0±14.4)比(94.5±5.7)],且非干预组低于干预组,差异均有统计学意义(P<0.05)。结论我院婴儿听力障碍的确诊率呈逐年下降趋势,佩戴助听器和语言训练综合干预有助于提高听力障碍婴幼儿的言语智能发育。     

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。     

Ten-year quality assurance of the nationwide hearing screening programme in Dutch neonatal intensive care units

Aim: To evaluate 10‐year quality assurance of newborn hearing screening (NHS) in Dutch neonatal intensive care units (NICU). Methods: Results of the two‐stage automated auditory brainstem response (AABR) screening and diagnostic examination in NICU graduates were centrally registered between October 1998 and December 2008. This registration facilitates screening, tracking and follow‐up after abnormal screening results. Outcome measures are referral rates, prevalence rate of hearing loss and (trends of) coverage rates and timeliness of follow‐up. Results: Thirty‐two thousand one hundred and two infants have been screened. Referral rates were 9.2% at the first and 26.3% at the second stage. Hearing loss was diagnosed in 728 infants (2.2%). Coverage rates were 98.7% at the first, 92.1% at the second stage, 92.3% for the diagnostic examination and 97.9% for the complete programme. After correction for gestational age, 95.8% of the infants had their first AABR <1 month, 81.8% of the referred infants had their second AABR <6 weeks and 67.1% were diagnosed <3 months. There was a positive trend in referred infants that had their second AABR <6 weeks (p = 0.004) as well as in infants diagnosed <3 months (p < 0.001). Conclusion: The NHS in Dutch NICUs is effective. Timely identification of hearing loss is improving over time.