对新生儿听力普遍筛查模式的研究

目的探讨开展新生儿听力普遍筛查的模式,获得新生儿听力损失发病的初步资料.方法采用耳声发射和脑干诱发电位两步筛查法.新生儿出生3～4d畸变产物耳声发射(DPOAE)进行初次听力筛查,出生42d时再次用同样方法对所有接受过初筛的婴儿进行复筛,复筛未通过者脑干诱发电位(ABR)诊断,异常者在6个月时再次复查ABR,两次ABR未通过者为听力损失.所有数据采用SPSS统计软件进行统计分析.结果住院期间筛查新生儿3944例,一次通过3242例,通过率82.2%,42d再次复查3284例,通过3167例,通过率96.4%,未通过117例中37例(31.6%)初筛通过.复筛未通过者ABR检查72例,有"例3个月内ABR未通过,至6个月时再次复查ABR,有20例转为正常,最后确诊不同程度听力损失7例,听力损失发病率1.77‰,其中1例DPOAE初筛通过.结论在我国开展新生儿听力筛查是完全可行的,住院期间普遍初筛和出生42d普遍复筛有利降低筛查假阴性和假阳性,两次ABR确诊有利提高诊断准确性,是较适合的模式,值得探讨和推广.新生儿听力损失发病率与文献报道相似.     

新生儿听力普遍筛查模式的建立与程序

目的：通过建立新生儿听力普遍筛查(universal newborn hearing sreening UNHS)模式，获得佛山地区出生婴儿听力损失的基本资料。方法：选择佛山市妇幼保健院2001-05-14／2002-12-25出生的活产新生儿在出院前接受耳声发射(otoacoustic emissions，OAE)测试，通过者予出院；未通过者在出生42d复查OAE，仍未通过者行听觉脑干诱发电位(auditory brainstem response，ABR)检查。所有ABR检查不通过者在3个月内接受全面的听力学诊断和评估，以确定听力损失的性质和程度。耳声发射测试采用畸变产物耳声发射(distonion product otoacoustic cenllssions,DPOAE)。结果：3244例新生儿中2910例(89．70%)初筛通过OAE测试，未通过测试的313例于生后42d复查OAE有309例通过。OAE测试总的通过率99．2％；接受ABR检查者共4例，3例未通过测试。经系统的听力学诊断与评估，此3例患儿伴有不同程度的听力损伤，占受试对象的0．92％。；新生儿重症监护病房中高危新生儿听力损伤的发生率(4．8％。，2／417)显著高于爱婴区未患病的新生(0.35%，1／2827)，差异有显著性意义(x^2=7．76，P&;lt;0．01)。结论：充分发挥保健机构特色建立OAE两步筛查、ABR初步诊断方案，对建立新生儿听力普遍筛查模式，促进听力筛查工作的普遍开展有重要作用。     

新生儿听力筛查调查

目的了解与筛查人员相关的因素对新生儿听力筛查的影响。方法利用手持式畸变产物耳声发射仪对1 000例正常新生儿出生3 d后进行听力筛查并对所得结果进行统计分析。结果初筛1 000例,通过998例,未通过率为0.2%,2个月复筛确诊听力损失2例。结论耳声发射是早期发现新生儿听力障碍的有效方法。但影响新生儿听力筛查的因素较多,而耐心、细致的护理工作是做好新生儿听力筛查、减少假阳性的要点和关键。     

新生儿听力筛查结果分析

听力障碍是常见的出生缺陷,先天性听力障碍在新生儿中的发病率约为0.1%~0.3%[1],但早期发现、早期干预可降低听力障碍对患儿带来的影响,对有效减少聋哑残疾起到重要作用。本资料通过2009-10-2010-10对1 158例新生儿听力初筛、复筛、诊断、干预情况进行总结分析,对基层医院做好听力筛查及聋儿早期诊治工作提供一定的指导意义。     

浅谈新生儿听力筛查的体会

目的浅谈新生儿听力筛查的过程、注意事项、结果分析及诊疗程序。方法应用手持式耳声发射听力筛查仪对新生儿进行听力筛查。结果1420例新生儿听力筛查中,双耳均通过者1258例,占88.6%;一侧未通过者40例,占2.8%;双耳均未通过者20例,占1.4%;未复查者102例,占7.2%。经听性脑干反应(ABR)检查一侧或双侧阈值大于30dBnHL有5例,占3.5‰。结论早期发现听力损伤患儿,以减低听力损伤对儿童的不良影响。     

新生儿1614例听力筛查结果分析

目的 通过对新生儿的听力筛查,了解新生儿听力损失的发病情况.方法 应用瞬态耳声发射技术(TEO-AE)对新生儿进行听力的初筛与复筛.结果 新生儿听力筛查1614例(同期住院1662例)听力筛查率97.11％,2例诊断为听力障碍,听力障碍发生率1.33‰.结论 耳声发射技术是一种适用于临床的快速、简便、无创的新生儿听力筛查方法,可以早期发现听力损失儿,尽早进行听力干预,提高其社会适应能力,总体提高我国的人口素质.     

新生儿听力筛查初最佳测试时间探讨

目的：探讨新生儿听力筛查的最佳时间,减少筛查假阳性的发生率。方法：3 653例在成都市第六人民医院出生的正常新生儿分为两组：出生后24 h（A组2 305例）和72 h（B组1 348例）分别进行耳声发射听力筛查。结果：A组筛查通过率为81.9%（1 888/2 305）;B组筛查通过率为93.9%（1 266/1 348）。两组筛查通过率差异有统计学意义（P〈0.01）。结论：出生后72 h进行听力筛查可提高初筛通过率,减少复筛人数,节约筛查成本。     

加强新生儿听力筛查管理的几点建议

2004-12卫生部向全国颁布[2004]439号文件[1],首次正式将"新生儿听力筛查技术规范"纳入新生儿疾病筛查技术规范.我院从2005-02开展新生儿听力筛查至今,在工作中经过不断摸索和总结,逐渐规范了新生儿听力筛查的操作流程和转诊流程,进一步提高了新生儿听力筛查工作的质量,现汇报如下.     

自动听觉脑干反应技术应用于新生儿听力筛查的临床分析与护理

目的 探讨自动听觉脑干诱发电位技术(automatic auditory brainstem reaponae,AABR)应用于新生儿听力普遍筛查的可行性及效果,总结应用该技术的护理要点.方法 采用美国NATUS公司生产的ALGO3i快速脑干诱发电位筛查仪,运用自动听觉脑干诱发电位技术对2 368例新生儿在出生48 h后至出院前进行听力初筛,初筛未通过者,在出生后42 d进行复筛,如仍未通过,则转至广州市儿童医院新生儿听力筛查中心行诊断性测定.结果 2 368例筛查对象中初筛通过2 195例,需要复筛173例,实际复筛133例,复筛通过119例,新生儿先天性听力损失在筛查儿中发病率为2.53‰、转诊率5.91‰、假阳性率0.12%、暂未出现假阴性.结论 AABR具有快速、方便、安全、敏感性和特异性高、低转诊率等优点,能及早发现新生儿听力损失,是一种较为理想的新生儿听力筛查方法.筛查时注重采取相应护理措施,以提高筛查覆盖率,降低初筛假阳性率,并做好筛查质量监控.     

新生儿9299例听力筛查结果分析

目的探讨通过新生儿听力筛查早期发现新生儿听力损伤,以便进行早期诊断和干预。方法应用先进的瑞声达听力技术（中国）有限公司生产的Accuscreen听力筛查仪,对2008-01-2008-12在本院产科出生的9 299例活产儿新生儿进行听力筛查。结果初次筛查未通过1 558例,占16.75%,其中双耳未通过有531例;复筛1 182例,复筛率为76%,复筛未通过有141例,复筛未通过率达12%,经反复交待追访,20例均到专科医院进行听力障碍确诊并进行早期干预治疗。结论通过新生儿听力筛查,新生儿听力损失可做到早发现、早干预,有效减少儿童永久性听力损伤的发生率。     

Advocating for universal newborn hearing screening

Universal newborn hearing screening and follow-up is an important detection and intervention program promoting childhood development and the acquisition of fundamental language, social, and cognitive skills. These skills provide the basis for later success in school and in society. Nursing has an important role to play in advocating for newborn hearing screening and in supporting families throughout the screening process.     

Universal newborn hearing screening

Congenital hearing loss is estimated to affect one in every 1,000 newborns. Causes of hearing loss can be conductive, sensorineural, mixed, or central. Known risk factors for congenital hearing loss include cytomegalovirus infection and premature birth necessitating a stay in the neonatal intensive care unit. However, up to 42 percent of profoundly hearing-impaired children will be missed using only risk-based screening. Universal newborn hearing screening is a way to identify hearing-impaired newborns with or without risk factors. Newborns with positive screening tests should be referred for definitive testing and intervention services. Whether early intervention in hearing-impaired children identified with universal screening improves language and communication skills has not been established by good-quality studies. However, universal screening has been endorsed by most national children's health organizations because of the ease of administering the screening tests and the ability to identify children who may need early intervention.     

新生儿听力筛查系统的建立与实施过程中的护理

目的：探讨专业指导提升新生儿听力筛查系统建立与实施过程中护理的效果。方法选取2015年1~8月院内生产的新生儿2400例,采用数字随机表法随机分为实验组(1200例)和对照组(1200例)。两组新生儿均应用耳声发射技术,在分娩后3天内至产妇出院前(新生儿重症监护室则为高危儿出院前)为新生儿进行听力筛查,高危儿在病情稳定后进行筛查。初筛未通过于出生后42天复筛,如复筛仍未通过则于三个月龄进行听力学诊断。实验组由2名经过听力筛查系统培训且具有主管护师以上职称的人员负责建立听力筛查系统,指导协助护士工作,同时对疑似听力障碍的新生儿进行相应的护理干预。对照组单纯性在护士轮班时行普遍听力筛查及护理工作。观察两组新生儿初筛、复筛、诊断及干预情况。结果实验组初筛率95.42%,初筛未通过11.70%,参与复筛89.55%,未通过复筛38.33%;对照组初筛率为92.83%,初筛未通过13.91%,参与复筛70.32%,未通过53.21%。实验组诊断阳性率39.53%,干预率93.02%;对照组诊断阳性率23.40%,干预率82.98%。上述比较两组差异显著( P<0.05)。结论建立新生儿听力筛查系统有利于提高新生儿听力初筛率、复筛率、诊断率以及干预率,降低失访率,有利于听力障碍儿童的早发现早治疗。     

A nurse-managed universal newborn hearing screen program

Hearing loss is one of the most common major birth defects, yet the average age for identifying significant hearing loss in children in the United States is 30 months.Hearing loss directly affects a child's ability to develop normal language skills, impairs his or her ability to communicate with others in the environment, and has been shown to correlate with poor academic performance. However, if hearing loss is detected early and interventions are begun before 6 months of age, children with hearing loss develop language, cognitive, and speech skills comparable to their non-hearing-impaired peers. Only 38 states mandate universal newborn hearing screening before discharge from the hospital.This article describes an institutional universal hearing screening program developed by nursing, which collaborated with physicians, audiologists, and otolaryngologists. Careful planning, including a thorough literature review, networking with area hospitals, and dialoging with experts in the field led to a successful program.The outcomes from this program compare favorably to nationally published data.     

新生儿听力筛查的实施与体会

目的：新生儿听力筛查可以早期发现婴幼儿听力障碍,以便及早进行干预,减少听力损伤对婴幼儿各方面的影响。方法：采用新生儿听力耳声发射筛查仪在新生儿出生后自然睡眠或安静状态下进行检查,一般仅用5～10min就可以完成测试。结果：接受筛查的新生儿1276例,其中经产道分娩486例,初筛通过率为93.83%（456/486）;剖宫产790例,初筛通过率为85.95%（679/790）。孕周≥37周者初筛通过率为94.97%（1151/1212）,孕周〈37周者初筛通过率为84.38%（54/64）。新生儿出现病理性黄疸初筛通过率为81.92%（281/343）,未出现病理性黄疸初筛通过率为93.03%（868/933）。结论：新生儿听力筛查对于新生儿听功能障碍的早期诊断、早期预防、早期治疗有着十分重要的意义。     

Update on newborn hearing screening programs

As a result of legislation supporting the position statement of the American Academy of Pediatrics (AAP) Joint Committee on Hearing, newborn hearing screening programs have become a protocol of care in hospital nurseries throughout the United States. The current goals are to screen all infants by 1 month of age, confirm hearing loss with audiologic examination by 3 months of age, and treat with comprehensive early intervention services before 6 months of age. This article will review the development of the Joint Committee on Infant Hearing position statements, examine legislation and health policy initiatives for universal newborn hearing screening, and determine nursing's role in meeting the goals.