Universal newborn hearing screening in Mexico: Results of the first 2 years

ArticleinInternational Journal of Pediatric Otorhinolaryngology 70(11):1863-70 · December 2006with22 Reads
Impact Factor: 1.19 · DOI: 10.1016/j.ijporl.2006.06.008 · Source: PubMed
Abstract

The purpose of this study is to present the results of the first 2 years of universal newborn hearing screening and the prevalence of congenital hearing loss in Monterrey, Mexico. We performed a descriptive study of the first 2 years after starting of the newborn screening program in a private hospital in Mexico. The program is organized into levels. We using for initial evaluation an automated auditory brainstem response (AABR). If the test was positive, the audiologist conducted and auditory brainstem response (ABR) test and other specialized testing was performed. Babies with hearing impairment were referred for early intervention. A total of 3066 newborns were screened (99.9%). The prevalence of sensorineural and bilateral hearing loss was of 0.65/1000 newborns. Seventy-three neonates (2.37%) had a risk factor for hearing impairment. A total of 0.22% (n=7) of those studied were referred for ABR testing. Of the patients referred to the audiologist, 100% were seen. The positive predictive value for sensorineural hearing loss was 71.4% (95% CI 30.2-94.8) and the false positive rate was 0.065%. Of the subjects screened, 100% were diagnosed before the age of 3 months, but all babies began treatment after the age of 6 months. No cochlear implants were indicated. This is the first report of a universal hearing screening program in Mexico. Even though this study had a reduced sample, the findings of hearing loss rate in this study are similar to the results found in other countries.

    • "The first neonatal screening programs (NHS) in Poland were designed in the 1980s and subsequent studies took place in the mid-1990s [4,5] . The results of the Polish NHS/EDHI program suggest that the incidence of congenital hearing disorders ranges from 2 to 7 per 1000 births, estimates which have been verified by other studies in the literature67891011. A child might present a hearing loss caused by acquired hearing or genetic disorders, usually in the form progressive hearing loss [12] . "
    [Show abstract] [Hide abstract] ABSTRACT: Background: According to the guidelines of the European Scientific Consensus on Hearing (European Federation of Audiology Societies ‘EFAS’ Congress, June 2011, Warsaw, Poland), the detection and treatment of communication disorders in early school-age children is of the highest importance. This objective was adopted by the Polish president of the EFAS Council from the second half of 2011; as a result, pilot programs on children’s hearing screening were initiated in various European countries. This paper reports data from a pilot program in Dushanbe, Tajikistan. Material/Methods: We randomly selected 143 children from 2 primary schools. Each child was assessed by pure tone audiometry and 2 questionnaires (dedicated to parents and children). The study allowed the validation of: (i) hearing screening procedures in young children, and (ii) data collection via a telemedicine model. Results: Hearing impairments were identified in 34 cases (23.7%) with a 50% ratio between unilateral and bilateral losses. We found a higher incidence of hearing impairment in children than that reported in previous Polish studies. Conclusions: The data from the present study suggest that it is possible to use a telemedicine model to assess the hearing status of children and to provide a long-distance expert assistance. The latter is very important for rural areas without specialized medical services.
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    • "Testing at a later age, for example at the 34th week, might provide better test feasibility scores and lower false-positive rates. In support of our hypotheses, more recent studies have used better-tuned screening procedures or newer OAE technology (fourth-generation OAE screeners ) and have reported very low false-positive rates compatible with the estimates of the present study [Connolly et al., 2005; Yee-Arellano et al., 2006; Mansur Tatli et al., 2007]. The DPOAE scoring criteria, for the NICU infants, were based on the assumption of a normal cochlear function as revealed by the TEOAE information. "
    [Show abstract] [Hide abstract] ABSTRACT: To identify the optimal test protocol to screen for hearing problems in newborns, an evaluation of three distortion product otoacoustic emission (DPOAE) protocols was conducted in neonates, from a well-baby nursery (WBN) and from a neonatal intensive care unit (NICU) and compared to the performance in newborns of a more standard protocol based on transient-evoked OAEs (TEOAEs). The DPOAE protocols used asymmetrical stimulus intensities (L(1) > L(2)) with a frequency ratio of 1.22, in the following format: (P1), L(1) = 60, L(2) = 50 dB SPL; (P2), L(1) = 65, L(2) = 55 dB SPL, and (P3), L(1) = 75, L(2) = 65 dB SPL. Linear TEOAE responses, evoked by click stimuli of 75 dB peSPL, were used as controls of normal cochlear function. Five frequencies at 1.5, 2.0, 3.0, 4.0 and 5.0 kHz were tested with a common commercially available macro-based software subroutine (Otodynamics Corp, ILO-92). The project evaluated the responses from 1200 WBN infants (average age 48 h) and 350 low-birth-weight NICU infants, all randomly selected. Statistical analyses comparing the signal-to-noise ratios (S/N), at the predefined f(2) frequencies, indicated that the P1 and P2 DPOAE protocols generated similar responses. Significant S/N differences were observed in the P3 to P2 dataset comparisons. DPOAE scoring criteria were estimated from the P3 dataset using a one-sided, distribution-free confidence intervals. The scoring criteria for a 'pass' were estimated as a minimum S/N of 6.0, 7.0 and 6.0 dB at 2.0, 3.0 and 4.0 kHz, respectively. In terms of feasibility, the P3 protocol generated responses in 98% of the WBN and 94.8% of the NICU infants. All three DPOAE protocols demonstrated shorter time-recording requirements than the standard TEOAE test. The false-positive and false-negative rates for the NICU infants were estimated as 0.0028 and 0.003%, respectively.
    Full-text · Article · Aug 2008 · Audiology and Neurotology
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    • "The mean age of confirmation of hearing loss of almost 8 months (233 days) far exceeded the JCIH target of 3 months and may be considered as another limitation of this study. The age of diagnosis in comparable studies in developing countries range from 3 to 6 months [24,27,31,35]. In fact, it was not unlikely that some of the parents had started to suspect their babies hearing status by the time they showed up for diagnostic evaluation as all the five babies that so returned were confirmed with hearing loss. "
    [Show abstract] [Hide abstract] ABSTRACT: To determine the feasibility and effectiveness of hospital-based universal newborn hearing screening programme for the early detection of permanent congenital or early-onset hearing loss (PCEHL) in Lagos, Nigeria. A cross-sectional pilot study based on a two-stage universal newborn hearing screening by non-specialist health workers using transient evoked otoacoustic emissions (TEOAE) and automated auditory brainstem-response (AABR) in an inner-city maternity hospital over a consecutive period of 40 weeks. The main outcome measures were the practicality of screening by non-specialist staff with minimal training, functionality of screening instruments in an inner-city environment, screening coverage, referral rate, return rate for diagnosis, yield of PCEHL and average age of PCEHL confirmation. Universal hearing screening of newborns by non-specialist staff without prior audiological experience is feasible in an inner-city environment in Lagos after a training period of two-weeks. Notwithstanding excessive ambient noise within and outside the wards, it was possible to identify a test site for TEOAE screening within the hospital. The screening coverage was 98.7% (1330/1347) of all eligible newborns and the mean age of screening was 2.6 days. Forty-four babies out of the 1274 who completed the two-stage screening were referred yielding a referral rate of 3.5%. Only 16% (7/44) of babies scheduled for diagnostic evaluation returned and all were confirmed with hearing loss resulting in an incidence of 5.5 (7/1274) per 1000 live births or a programme yield of 5.3 (7/1330) per 1000. Six infants had bilateral hearing loss and the degree was severe (> or =70 dB nHL) in three infants, moderate (40 dB nHL) in one infant and mild (<40 dB nHL) in two infants. The age at diagnosis ranged from 46 days to 360 days and only two infants were diagnosed within 90 days. Hospital-based universal hearing screening of newborns before discharge is feasible in Nigeria. Non-specialist staff are valuable in achieving a satisfactory referral rate with a two-stage screening protocol. However, a more efficient tracking and follow-up system is needed to improve the return rate for diagnosis and age of confirmation of hearing loss.
    Full-text · Article · Jul 2008 · International Journal of Pediatric Otorhinolaryngology
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