发挥保健机构特色 建立新生儿听力普遍筛查模式

目的 :发挥保健机构特色建立新生儿听力普遍筛查 ( universal newborn hearing screening UNHS )模式 ,获得本地区出生婴儿听力损失的基本资料。方法 :选择本院出生的活产新生儿于生后 4 8～ 72 h接受耳声发射 ( otoacoustic emissions,OAE)测试 ,通过者予出院 ;未通过者在出生 4 2 d复查 OAE,仍未通过者行听觉脑干诱发电位反应 ( 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 ( distortion productotoacoustic emissions,DPOAE)。结果 :32 4 4例新生儿中 2 910例 ( 89.7% )初筛通过OAE测试 ,未通过测试的 313例于生后 4 2 d复查 OAE,30 9例通过。OAE测试总的通过率 99.2 % ;接受 ABR检查 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( NICU)中高危新生儿听力损伤的发生率 ( 4 .8‰ ) ,显著高于爱婴区未患病的新生儿 ( 0 .35 % ,χ2 =7.76 ,P<0 .0 1)。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

The development of health care's Characteristic and establishment of a mould for universal newborn hearing screening

Objective:To explore a model for universal newborn hearing screening (UNHS) in the basic health care that would be suitable in the basic health care ,in which the basic information of the infant with hearing loss in these areas.Methods:3 244 neonates at live birth after 48~72 hours in our hospital were tested by otoacoustic emissions (OAE),the abnormal cases who did not passed the test at primary were retested by OAE on the day forty-second day after birth, and the abnormal cases who did not passed the testament at the second testament would be tested by auditory brainstem response (ABR). All the infants who were still abnormal in ABR would be diagnosed and evaluated by audiology in three months and then the degrees of hearing lose would be confirmed. OAE were made by distortion product otoacoustic(DPOAE).Results:89.7%(2910/3244) of infant passed through the criteria at the primary OAE test, but 313 who did not pass were retested by OAE on 42 day after birth, and 309 of them did pass. The total incidence of passage OAE test is 99.2%. 3 of 4 infants(0.92‰ of the cases who were tested) who did not pass the second OAE test were identified hearing impairment in different degrees by the systemic audiologic evolution. The incidence of hearing impairment of the neonates who were treated in neonate intensive care unit (NICU)(4.8‰,2/417)is higher remarkably than that of those in the friendly baby care 〔(0.35%), χ 2=7.76, P <0.01〕 .Conclusion:The efficient development of health care's characteristic,establishment to steps of screening in OAE,and primary dignosis,all of these were important in the establishment of a mould for universal newborn hearing screening and the improvement of its work.