新生儿重症监护病房听力联合筛查结果及随访分析

目的：分析我院新生儿重症监护病房TEOAE加AABR联合听力筛查的结果及随访情况。方法：回顾分析我院新生儿重症监护病房574例高危新生儿的听力筛查结果,复查诊断结果。对未按时前来复诊的婴儿通过电话随访向其家长了解失访就诊的原因。结果：574例中,有472例通过了入院时的TEOAE和AABR联合筛查;102例未通过TEOAE和AABR联合筛查。33例参加复查的婴儿中13例通过了听力复筛;未通过复查的20例进行了听力学诊断,有8例听力正常,12例有不同程度的听力损失;69例失访,失访率高达67．6％。失访原因为：患儿家长联系方式的更改;医患沟通不畅导致家长对听力筛查结果不了解;家长自觉小孩听力尚可而认为不必复查;已在外院复查;婴儿患有其他严重疾病导致家长对患儿听力结果不再重视而最终失访等。结论：NICU患儿联合听力筛查未通过率为17．8％;听力损失检出率高;高达67．6％的失访率值得我们反思,应针对原因减少失访,使听力有问题的儿童能够早发现、早干预。     

新生儿重症监护病房中高危新生儿听力筛查研究

目的探讨新生儿重症监护病房(NICU)中高危新生儿采用听力筛查模式和听力障碍发病情况与危险因素。方法采用畸变产物耳声发射(DPOAE)对NICU中高危新生儿病情稳定时进行初筛,未通过者4～6周后作第二次复查,仍未通过者分别于4～6月龄和1岁时进行听觉脑干诱发电位(ABR)检查,两次ABR均未通过者确诊为真性听力损失。结果随机筛查63例高危儿,初检结果阳性22例,阳性率为34.9%,其中有关脑损伤危险因素的阳性率高达71.4%。复检22例,复检率100%,复检阳性5例,通过率为77.3%。4～6月龄和1岁时作ABR检查,确诊有听力障碍2例,其中1例为葡萄糖6磷酸脱氢酶(G6PD)缺乏发生核黄胆,另1例为迟发性维生素K缺乏症引起颅内出血。63例高危新生儿中听力障碍发病率为3.2%。其听力障碍原因均与脑损伤有关。结论NICU中高危新生儿是听力障碍的高发人群,应该常规进行听力筛查,中枢神经系统受损是导致听力障碍的高危因素,DPOAE结合ABR是一种较好的高危新生儿听力筛查方法。     

重症监护病房新生儿听力筛查模式初探

目的：探索重症监护病房（NICU）新生儿听力筛查模式,初步了解听力损失在此类人群的患病情况。方法：采用自动听性脑干反应（AABR）2阶段筛查方案,即NICU新生儿在出院或转入普通病房前以AABR进行听力初筛,未通过者出院1个月后门诊接受AABR复筛。复筛仍未通过者,3个月内转诊到我院儿童听力中心,进行全面的听力学诊断评估。结果：对2007—09—200808从NICU出院的824例新生儿进行了听力筛查,70例（8．5％）未通过出院前的AABR初筛,其中55例（78．6％）1个月后接受了AABR复筛,9例未通过。后者经全面的听力学诊断评估,3例确诊患不同程度的感音神经性听力损失,1例患听神经病。听力损失总患病率0．48％。结论：AABR两步法可能是NICU新生儿合适的听力筛查模式;本组新生儿听力损失患病率低于已往文献报道。     

重症监护病房新生儿听力筛查结果分析——重点讨论听神经病的筛查

目的基于对我院新生儿重症监护病房(neonatal intensive care unit,NICU)新生儿的筛查,初步获得听神经病(auditory neuropathy,AN)在此类人群中患病情况的基本资料,探讨适合于我国国情的NICU新生儿听力筛查模式。方法采用自动听性脑干反应(automated auditory brainstem response,AABR)两阶段筛查方案,即:NICU新生儿在出院前或病情稳定时以AABR进行听力初筛,对未通过者发放复筛通知单,嘱出院1个月后门诊接受AABR复筛。复筛仍未通过者,于3个月内转诊到我院儿童听力中心,进行包括听性脑干反应(ABR)、畸变产物耳声发射(distortion product otoacoustic emission,DPOAE)和声导抗测试在内的全面听力学诊断评估。如ABR波V反应阈>35dBnHL,则认为有听力损失。AN诊断依据:ABR缺失、严重异常或阈值≥70dBnHL,伴DPOAE正常和声导抗测试鼓室图呈单峰型或双峰型。结果对2007年9月—2009年4月从我院NICU出院的1343名新生儿进行了听力筛查。117例(8.7%)未通过出院前的AABR初筛,其中88例(75.2%)1月后接受了AABR复筛,22例未通过。后者经全面的听力学诊断评估,10例(7.4‰)双侧或单侧ABR阈值>35dBnHL,诊断有听力损失,其中2例(1.5‰)分别表现为双耳ABR缺失和阈值>70dBnHL,而DPOAE正常、鼓室图为单峰型以及镫骨肌声反射未引出,诊断为AN。结论本组NICU新生儿听力损失总发病率(7.4‰)及听神经病发病率(1.5‰)低于已往文献报道。本研究未发现任何可以预测AN发生的听力损失高危因素,这可能与目标人群样本量较小有关。AABR两阶段筛查法是NICU新生儿合适的听力筛查模式。     

正常和重症监护病房新生儿听力筛查结果分析

目的分析正常和重症监护室(NICU)新生儿听力筛查的结果,了解其初、复筛率及听力损失检出率。方法应用DPOAE对2009年1月1日～2010年12月29日出生的正常和NICU新生儿进行听力筛查,正常新生儿于生后2～5天初筛,NICU新生儿在病情稳定后进行初筛;初筛未通过者于42天行DPOAE复筛,复筛仍未通过者于3月龄行ABR和/或ASSR检查。结果正常新生儿3 778例,接受筛查3 668例,初筛率97.09%(3 668/3 778),初筛未通过342例(9.32%,342/3 668),复筛144例(42.11%,144/342),复筛未通过40例(27.78%,40/144),转诊25例,最终确诊先天性听力损失7例(1.91‰,7/3 668)。NICU新生儿2 665例,全部接受初筛,初筛率100%,初筛未通过330例(12.38%,330/2 665),复筛46例(13.94%,46/330),复筛未通过8例(17.39%,8/46),实际转诊6例,最终确诊先天性听力损失2例(0.75‰,2/2 665),其中1例为缺血缺氧性脑病,另1例为新生儿窒息。两组听力损失检出率1.42‰(9/6 333),其中中度6例,重度2例,极重度1例;单耳3例,双耳6例。结论本组正常和NICU新生儿听力筛查复筛率明显低于推荐标准,NICU新生儿听力损失的检出率低于其它地区。     

上海地区开展新生儿听力筛查工作回顾与展望

国外研究表明,正常新生儿听力障碍发生率为0.1%～0.3%,而重症监护病房的新生儿听力障碍发生率可高达2%～4%.该疾病在新生儿出生缺陷中发生率如此之高,如果没有及早发现和及时干预治疗,将导致言语和语言发育障碍、社会适应能力低下、注意力缺陷和学习困难等,重者将导致聋哑.因此．开展新生儿听力筛查，以早期发现听力障碍显得尤为主要。     

新生儿听力筛查-诊断-干预

国外研究表明，听力障碍在正常新生儿中的发病率约为0．1％-03％。而在重症监护病房抢救的新生儿．其听力障碍的发病率可高达2％-4％。我国初步统计，新生儿听力障碍约为3‰，7岁以下聋哑儿童约80万人．每年新增聋儿近3万。     

新生儿听力筛查-诊断-干预

国外研究表明，听力障碍在健康新生儿中的发病率约0．1％～0．3％。重症监护病房新生儿可高达2％-4％。我国初步统计新生儿中听力障碍约为0.3％，7岁以下聋哑儿童80万人，每年新增3万人。     

新生儿听力筛查现状与面临的挑战

听力障碍是新生儿最常见的先天性缺陷之一,约占全部新生儿出生缺陷的20％,国外有文献报道其发生率为1‰～2‰。国内文献报道,我国普通病房新生儿耳聋发病率在0．06％～0．57％之间,新生儿重症监护病房（neonatal intensive care unit,NICU）新生儿在0．37％～7．35％之间。     

3371例重症监护病房新生儿听力筛查结果分析

目的分析我院3371例重症监护病房新生儿自动听性脑干反应(AABR)听力筛查的结果,探讨影响NI-CU新生儿听力筛查阳性率的因素。方法筛查对象为2016年01月至2016年12月湖南省妇幼保健院NICU收治的3371例新生儿,全部采用AABR进行听力筛查,计算筛查结果的阳性率,分析新生儿住院疾病因素与听力筛查阳性率之间的关系,并对确诊听力损伤的患儿进行追踪随访。结果性别与新生儿听力筛查阳性率之间无显著差异(χ~2=0.95,P=0.329);耳别、多胎、感染、高胆红素血症、早产、或低体重等因素与新生儿听力筛查阳性率之间均有统计学差异(耳别:χ~2=104.25,P=0.000;多胎:χ~2=8.152,P=0.004;感染:χ~2=13.845,P=0.000;高胆红素血症:χ~2=43.266,P=0.000;低体重:χ~2=5.076,P=0.024;早产:χ~2=9.399,P=0.002)。复筛未通过且3月龄内确诊有听力损失者共13例。结论耳别、多胎、感染、高胆红素血症、早产、低体重等可能是导致新生儿AABR听力筛查阳性率偏高的原因。     

抚触护理应用在新生儿听力筛查中的效果及价值研究

目的探析新生儿听力筛查中采取抚触护理的临床效果及价值。方法选取2018年7月~2020年9月于本院实施听力筛查新生儿,统计90例,按双盲法原则分组,即对照组(n=45)和观察组(n=45),对照组于听力筛查中行常规护理,观察组加用抚触护理,比较两组效果。结果观察组听力筛查成功率及测试状态优良率相比于对照组明显升高(P<0.05)。结论新生儿听力筛查中采取抚触护理效果令人满意,可进行听力筛查成功率的明显提高,优化听力筛查质量,应用可行性强,具临床运用价值。     

785例新生儿听力筛查初筛结果分析

目的 分析不同胎龄、不同体重新生儿听力筛查通过率的特点,为选择适当的初筛时间,提高初筛通过率提供依据.方法 对张家港市第—人民医院2011年11月～2012年3月出生的785例新生儿采用全自动耳声发射筛查仪进行听力筛查,按照不同年龄、体重对筛查结果进行总结分析.结果 785例新生儿中,初筛通过674例,占85.86％;初筛未通过111例,占14.14％;复筛通过16例,占2.06％.新生儿胎龄和体重与初筛通过率及假阳性率密切相关,差异有统计学意义（P＜0.05）.结论 根据新生儿出生时胎龄、体重的不同,选择合适的初筛时间,可有效提高初筛通过率,降低假阳性率的发生。     

Comparative study of percutaneous dilatational tracheostomy and conventional tracheostomy in the intensive care unit

Objective: Tracheostomy is a one of the earliest described surgical procedure dating back to 2000 B.C. Percutaneous tracheostomy is becoming increasingly popular as an alternative method for conventional tracheostomy in the intensive care unit. In this study we compare the results of the use of these 2 techniques in 32 patients who underwent elective tracheostomy in the intensive care unit.Study Design: Prospective randomized comparative study.Setting: Tertiary care hospital.Patients: Adult intubated patients selected randomly in the intensive care unit with normal cervical soft tissue, laryngeal framework, palpable cricoid cartilage and normal coagulation parameters.Results: 17 patients underwent conventional tracheostomy and 15 patients underwent percutaneous dilatational tracheostomy. Demographic data and duration of intubation comparable between two groups. The mean operative time, blood loss and complications were lower in percutaneous than in conventional tracheostomy.Conclusions: PDT is quicker to perform and has lower blood loss and complication rates compared to conventional tracheostomy. However percutaneous tracheostomy is not indicated in emergencies and in children. The cost of the percutaneous kit and use of bronchoscopy adds to the cost. It is a good alternative to conventional tracheostomy in properly selected patients.     

The effectiveness of the promotion of newborn hearing screening in Taiwan

Objective

Hearing is a critical ability for the development of a child's speech and language. Many studies in different countries have shown the universal newborn hearing screening and early intervention has greatly reduced the negative impact caused by congenital hearing loss. The first universal newborn hearing screening program in Taiwan took place in MacKay Memorial Hospital in 1998 and was subsequently endorsed by the government. The incidence of bilateral congenital hearing impairment in Taiwan is approximately 2.6 per 1000 live birth. The aim of this paper is to analyze the age of diagnosis, hearing aid fitting, and intervention of congenitally hearing impaired children with and without hearing screening after public awareness and government endorsement of newborn hearing screening.

Materials and methods

There were 263 hearing impaired children participated in this study, receiving their auditory habilitation therapy at Children's Hearing Foundation from 2006 to 2010. 114 of those children went through newborn hearing screening and 149 without it. The age of diagnosis, hearing aid fitting, and auditory intervention were compared between these two groups. The age of diagnosis and intervention of congenitally hearing impaired children among different years were analyzed too.

Results

The average age of diagnosis was 8.7 months, the age of hearing aid fitting was 12.4 months and age of auditory intervention was 18.8 months for the group of hearing impaired children with newborn hearing screening. For hearing impaired children without newborn screening, their average age of diagnosis was 27.5 months; age of hearing aid fitting was 31.3 months and age of auditory intervention was 40.5 months. There were significant differences in the age of diagnosis, hearing aid fitting and auditory intervention between congenitally hearing impaired children with and without hearing screening.

Conclusions

This research indicates that newborn hearing screening facilitates early identification, diagnosis and intervention of congenitally hearing impaired children in Taiwan. The age of identification, diagnosis and intervention of congenital hearing impaired children has also been reduced gradually over the years after government endorsement of newborn hearing screening in Taiwan.     

An initial overestimation of sensorineural hearing loss in NICU infants after failure on neonatal hearing screening

Objective

Infants admitted to neonatal intensive care units have a higher incidence of significant congenital hearing loss. We classified audiologic diagnoses and follow-up in infants who had been admitted to our neonatal intensive care unit.

Methods

We included all infants admitted to the neonatal intensive care unit at Sophia Children's Hospital between 2004 and 2009 who had been referred for auditory brainstem response measurement after failing neonatal hearing screening with automated auditory brainstem response. We retrospectively analyzed the results of auditory brainstem response measurement.

Results

Between 2004 and 2009 3316 infants admitted to our neonatal intensive care unit had neonatal hearing screening. 103 infants failed neonatal hearing screening: 46 girls and 57 boys. After first auditory brainstem response measurement we found 18% had normal hearing or a minimal hearing loss. The remainder had a type of hearing loss, distributed as follows: 15% conductive, 32% symmetric sensorineural, 14% asymmetric sensorineural, and 21% absent auditory brainstem responses. Repeated auditory brainstem response measurement showed a shift in hearing outcome. The main difference was an improvement from symmetric sensorineural hearing loss to normal hearing. However, in a small percentage of children, the hearing deteriorated.

Conclusions

As many as 58% of infants in this high-risk population who failed the neonatal hearing screening were diagnosed with sensorineural hearing loss or absent auditory brainstem responses. An initial overestimation of sensorineural hearing loss of about 10% was seen at first auditory brainstem response measurement. This may be partially explained by a conductive component that has resolved. Finally, in a small percentage of children the hearing deteriorated.