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Huang EY, DeSell M, White AD, Walsh J, Jenks CM. Results and patient satisfaction from an early access infant hearing detection clinic. Int J Pediatr Otorhinolaryngol 2023; 164:111396. [PMID: 36450185 DOI: 10.1016/j.ijporl.2022.111396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/27/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION National recommendations in the United States specify that all infants with hearing impairment should be identified by 3 months of age. Infants who fail universal newborn hearing screening (UNHS) require follow up testing after hospital discharge. Follow up testing may be difficult to obtain in some communities within the ideal time frame. A rapid access multidisciplinary clinic was established for failed UNHS. The objective of this study is to report outcomes and patient satisfaction from an early access hearing detection clinic. METHODS Infants that failed UNHS were seen in the multidisciplinary clinic between 1/1/19 and 2/28/22. Patients underwent automated auditory brainstem response (ABR) and distortion product otoacoustic emissions testing and consulted with an otolaryngology nurse practitioner. Failed results were followed by diagnostic ABR. Surveys were administered at the beginning and end of the appointment. RESULTS In total, 169 infants were seen at a mean age of 8.4 weeks (95%CI 7.5, 9.4). Repeat testing was abnormal in 38 (22.4%). Diagnostic ABR was performed at an average age of 13.7 weeks (n = 34, 95% CI: 10.8, 16.6) and led to a diagnosis of hearing loss in 18 infants. Twenty-seven parents completed surveys at the initial visit. Anxiety level among patients with normal repeat testing (n = 20) decreased from 1.9 to 1.2 (p = .002), while anxiety level among those with abnormal repeat testing (n = 7) was not statistically different before and after (2.1 vs 2.7, p = .2). Satisfaction level was 3.7 ± 0.7 (scored 1-4). All parents reported having a better understanding of their child's hearing problem after the visit. DISCUSSION This novel nurse practitioner-led early hearing detection clinic enabled timely diagnosis of hearing loss and reassurance to families without hearing loss. Age at hearing loss diagnosis compares favorably to published cohorts.
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Affiliation(s)
- Emily Y Huang
- Department Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Melinda DeSell
- Department Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alicia D White
- Department Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan Walsh
- Department Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carolyn M Jenks
- Department Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Fitzgibbons EJ, Driscoll C, Myers J, Nicholls K, Beswick R. Predicting hearing loss from 10 years of universal newborn hearing screening results and risk factors. Int J Audiol 2021; 60:1030-1038. [PMID: 33593173 DOI: 10.1080/14992027.2021.1871975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study investigated whether demographic variables, risk factor presence or absence and universal newborn hearing screening (UNHS) results can be used to predict permanent childhood hearing loss (PCHL) in infants referred from screening. DESIGN Retrospective analysis of a UNHS database. STUDY SAMPLE Data were extracted from the state-wide UNHS database storing details of the 613,027 infants who were born in Queensland, Australia between 1 January 2007 and 31 December 2016 and participated in UNHS. This study included the 6735 children who were referred from the UNHS program for diagnostic audiology due to failing the screen in one or both ears or bypassing screening. RESULTS Factors with a significant positive association with PCHL that were incorporated into a logistic regression model were: female gender, non-indigenous status, family history of PCHL, craniofacial anomalies and syndromes associated with PCHL, and a bilateral refer result on screening. CONCLUSIONS Odds of PCHL vary among infants referred for diagnostic assessment from UNHS programs. When an infant refers on the newborn hearing screen, information about their gender, indigenous status, identified risk factors and specific screening outcome can be used to predict the likelihood of a congenital PCHL diagnosis.
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Affiliation(s)
- E Jane Fitzgibbons
- Healthy Hearing Program, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Carlie Driscoll
- School of Health and Rehabilitation Services, University of Queensland, Brisbane, Australia
| | - Joshua Myers
- School of Health and Rehabilitation Services, University of Queensland, Brisbane, Australia
| | - Kelly Nicholls
- Healthy Hearing Program, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Rachael Beswick
- Healthy Hearing Program, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
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Kim SY, Choi BY, Jung EY, Park H, Yoo HN, Park KH. Risk factors for failure in the newborn hearing screen test in very preterm twins. Pediatr Neonatol 2018; 59:586-594. [PMID: 29428705 DOI: 10.1016/j.pedneo.2018.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/26/2017] [Accepted: 01/12/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We aimed to identify prenatal and postnatal risk factors associated with abnormal newborn hearing screen (NHS) results and subsequently confirmed sensorineural hearing loss (SNHL) in preterm twin neonates. METHODS Electronic medical records of 159 twin neonates who were born alive after ≤32 weeks were retrospectively reviewed for hearing loss in both ears. Histopathologic examination of the placenta was performed and clinical data, including method of conception and factors specific to twins, were retrieved from a computerized perinatal database. The main outcome measure was failure to pass the NHS test. The generalized estimation equations model was used for twins. RESULTS Thirty-two neonates (20.1%) had a "refer" result, and, on the confirmation test, permanent SNHL was identified in 4.4% (7/159) of all neonates. Neonates who had a "refer" result on the NHS test were more likely to be of lower birth weight, more likely to have been conceived with the use of in vitro fertilization (IVF), and more likely to have higher rates of intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia. However, monochorionic placentation, death of the co-twin, or being born first was not associated with a "refer" result on the NHS test. Multivariable logistic regression revealed that conception after IVF and the presence of IVH were the only variables to be statistically significantly associated with "refer" on the NHS test. No parameters studied were found to be significantly different between the SNHL and no SNHL groups, probably because of the relatively small number of cases of SNHL. CONCLUSION In preterm twin newborns, IVF and the presence of IVH were independently associated with an increased risk of abnormal NHS results, whereas the factors specific to twins were not associated with abnormal NHS results.
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Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Byung Yoon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Eun Young Jung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyunsoo Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ha-Na Yoo
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyo Hoon Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
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Inflammatory and Immune Proteins in Umbilical Cord Blood: Association with Hearing Screening Test Failure in Preterm Neonates. Mediators Inflamm 2018; 2018:4209359. [PMID: 30327582 PMCID: PMC6169214 DOI: 10.1155/2018/4209359] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/26/2018] [Indexed: 12/03/2022] Open
Abstract
Objective We aimed to determine whether elevated levels of various inflammatory and immune proteins in umbilical cord blood are associated with an increased risk of newborn hearing screening (NHS) test failure in preterm neonates. Methods This retrospective cohort study included 127 premature singleton infants who were born at ≤33.6 weeks. Umbilical cord plasma at birth was assayed for interleukin (IL)-6, complement C3a and C5a, matrix metalloproteinase (MMP)-9, macrophage colony-stimulating factor (M-CSF), and endostatin levels using ELISA kits. Neonatal blood C-reactive protein (CRP) levels were measured within 2 hours of birth. The primary outcome measure was a uni- or bilateral refer result on an NHS test. Univariate and multivariate analyses were applied. Results Fifteen (11.8%) infants failed the NHS test. In the univariate analyses, high IL-6 and low C3a levels in umbilical cord plasma, funisitis, and an elevated CRP level (>5 mg/L) in the immediate postnatal period were significantly associated with NHS test failure. However, the levels of umbilical cord plasma MMP-9, C5a, M-CSF, and endostatin were not significantly different between infants who passed and those who failed the NHS test. Multiple logistic regression analyses indicated that elevated umbilical cord plasma C3a levels were independently associated with a reduced risk of NHS test failure, whereas elevated levels of umbilical cord plasma IL-6 and high CRP levels in the immediate postnatal period were significantly associated with NHS test failure. Conclusions Our data demonstrated that in preterm neonates, a systemic fetal inflammatory response reflected by umbilical cord plasma IL-6 and immediate postnatal CRP levels may contribute to the risk for NHS test failure, whereas the changes in complement activation fragments initiated in utero may have protective effect of hearing screen failure.
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Leinonen E, Gissler M, Haataja L, Rahkonen P, Andersson S, Metsäranta M, Rahkonen L. Low Apgar scores at both one and five minutes are associated with long-term neurological morbidity. Acta Paediatr 2018; 107:942-951. [PMID: 29359524 DOI: 10.1111/apa.14234] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/29/2017] [Accepted: 01/17/2018] [Indexed: 11/27/2022]
Abstract
AIM This study evaluated the associations between low Apgar scores at one and five minutes and long-term neurological impairments. METHODS This study used population-based data on 399,815 singletons born in Finland in 2004-2010 and multivariable logistic regression to examine any associations between low (0-3) and intermediate (4-6) Apgar scores and cerebral palsy, epilepsy, intellectual disability and sensorineural defects by the age of four years. RESULTS The odd ratios (OR) and 95% confidence intervals (95% CI) showed that low Apgar scores were associated with cerebral palsy at one and five minutes (ORs 2.08, 95% CI 1.32-3.26 and 5.19, 95% CI 3.06-8.80), epilepsy (ORs 1.62, 95% CI 1.13-2.33 and 4.79, 95% CI 3.03-7.56), and intellectual disability (ORs 2.46, 95% CI 1.45-4.16 and 6.21, 95% CI 3.33-11.58). Only a low five-minute Apgar score was associated with sensorineural defects (OR 3.13, 95% CI 1.95-5.02). Neurological impairment risks were increased by low Apgar scores at both one and five minutes (OR 11.1, 95% CI 8.6-14.5), but 90.3% of children with persistent low Apgar scores had no impairment. CONCLUSION Low one-minute and five-minute Apgar scores were associated with long-term neurological morbidity, especially when both scores were low.
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Affiliation(s)
- Elina Leinonen
- Children′s Hospital; University of Helsinki; Helsinki University Hospital; Helsinki Finland
| | - Mika Gissler
- Information Services Department; National Institute for Health and Welfare; Helsinki Finland
- Division of Family Medicine; Department of Neurobiology, Care Sciences and Society; Karolinska Institute; Stockholm Sweden
| | - Leena Haataja
- Children′s Hospital; University of Helsinki; Helsinki University Hospital; Helsinki Finland
| | - Petri Rahkonen
- Children′s Hospital; University of Helsinki; Helsinki University Hospital; Helsinki Finland
| | - Sture Andersson
- Children′s Hospital; University of Helsinki; Helsinki University Hospital; Helsinki Finland
| | - Marjo Metsäranta
- Children′s Hospital; University of Helsinki; Helsinki University Hospital; Helsinki Finland
| | - Leena Rahkonen
- Department of Obstetrics and Gynecology; University of Helsinki; Helsinki University Hospital; Helsinki Finland
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Poonual W, Navacharoen N, Kangsanarak J, Namwongprom S, Saokaew S. Hearing loss screening tool (COBRA score) for newborns in primary care setting. KOREAN JOURNAL OF PEDIATRICS 2017; 60:353-358. [PMID: 29234358 PMCID: PMC5725340 DOI: 10.3345/kjp.2017.60.11.353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 03/08/2017] [Accepted: 03/31/2017] [Indexed: 12/04/2022]
Abstract
Purpose To develop and evaluate a simple screening tool to assess hearing loss in newborns. A derived score was compared with the standard clinical practice tool. Methods This cohort study was designed to screen the hearing of newborns using transiently evoked otoacoustic emission and auditory brain stem response, and to determine the risk factors associated with hearing loss of newborns in 3 tertiary hospitals in Northern Thailand. Data were prospectively collected from November 1, 2010 to May 31, 2012. To develop the risk score, clinical-risk indicators were measured by Poisson risk regression. The regression coefficients were transformed into item scores dividing each regression-coefficient with the smallest coefficient in the model, rounding the number to its nearest integer, and adding up to a total score. Results Five clinical risk factors (Craniofacial anomaly, Ototoxicity, Birth weight, family history [Relative] of congenital sensorineural hearing loss, and Apgar score) were included in our COBRA score. The screening tool detected, by area under the receiver operating characteristic curve, more than 80% of existing hearing loss. The positive-likelihood ratio of hearing loss in patients with scores of 4, 6, and 8 were 25.21 (95% confidence interval [CI], 14.69–43.26), 58.52 (95% CI, 36.26–94.44), and 51.56 (95% CI, 33.74–78.82), respectively. This result was similar to the standard tool (The Joint Committee on Infant Hearing) of 26.72 (95% CI, 20.59–34.66). Conclusion A simple screening tool of five predictors provides good prediction indices for newborn hearing loss, which may motivate parents to bring children for further appropriate testing and investigations.
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Affiliation(s)
- Watcharapol Poonual
- Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Thailand
| | - Niramon Navacharoen
- Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Thailand
| | - Jaran Kangsanarak
- Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Thailand
| | - Sirianong Namwongprom
- Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Thailand.,Department of Radiology, Faculty of Medicine, Chiang Mai University, Thailand
| | - Surasak Saokaew
- Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.,Center of Pharmaceutical Outcomes Research (CPOR), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.,School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
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Kim SH, Choi BY, Park J, Jung EY, Cho SH, Park KH. Maternal and Placental Factors Associated with Congenital Hearing Loss in Very Preterm Neonates. Pediatr Neonatol 2017; 58:236-244. [PMID: 27596679 DOI: 10.1016/j.pedneo.2016.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/21/2016] [Accepted: 05/01/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Sensorineural hearing loss (SNHL) is a multifactorial disease that more frequently affects preterm newborns. Although a number of maternal conditions have been reported to be associated with preterm birth, little information is available concerning maternal risk factors for the development of SNHL. We aimed to identify maternal and placental risk factors associated with a "refer" result on the newborn hearing screening (NHS) test and subsequently confirmed SNHL in very preterm neonates. METHODS This retrospective cohort study included 267 singleton neonates who were born alive after ≤ 32 weeks. Histopathologic examination of the placenta was performed, and clinical data were retrieved from a computerized perinatal database. Cases with two abnormal findings, "refer" on the NHS test, and presence of SNHL on the confirmation test were retrospectively reviewed based on electronic medical records. RESULTS Forty-two neonates (15.7%) showed a "refer" result, and, on the confirmation test, permanent SNHL was identified in 1.87% (5/267) of all neonates. Multivariate regression analysis revealed that the presence of funisitis was independently associated with a "refer" on the NHS test, whereas use of antenatal corticosteroids was statistically significantly associated with a reduced incidence of "refer" on the screening test. Neither histologic chorioamnionitis nor prematurity (as defined by low gestational age and birth weight) was associated with a "refer" on the NHS test. By contrast, multivariate analysis with occurrence of SNHL as a dependent variable identified no significant associations with the parameters studied, probably owing to the small total number of neonates with permanent SNHL. CONCLUSION Presence of funisitis was significantly and independently associated with increased risk of abnormal NHS results, while administration of antenatal corticosteroids was related to a normal NHS result. These findings support the hypothesis that a systemic fetal inflammatory response, manifested as funisitis, might play a role in the pathogenesis of SNHL in preterm neonates.
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Affiliation(s)
- Shin Hye Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Byung Yoon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jaehong Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Eun Young Jung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Soo-Hyun Cho
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyo Hoon Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
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Tweed EJ, Mackay DF, Nelson SM, Cooper SA, Pell JP. Five-minute Apgar score and educational outcomes: retrospective cohort study of 751,369 children. Arch Dis Child Fetal Neonatal Ed 2016; 101:F121-6. [PMID: 26297221 DOI: 10.1136/archdischild-2015-308483] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 07/30/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND The Apgar score is used worldwide for assessing the clinical condition and short-term prognosis of newborn infants. Evidence for a relationship with long-term educational outcomes is conflicting. We investigated whether Apgar score at 5 min after birth was associated with additional support needs (ASN) and educational attainment. METHODS Data on pregnancy, delivery and later educational outcomes for children attending Scottish schools between 2006 and 2011 were collated by linking individual-level data from national educational and maternity databases. The relationship between Apgar score and overall ASN, type-specific ASN and educational attainment was assessed using binary, multinomial and generalised ordinal logistic regression models, respectively. Missing covariate data were imputed. RESULTS Of the 751,369 children eligible, 9741 (1.3%) had a low or intermediate Apgar score and 49,962 (6.6%) had ASN. Low Apgar score was independently associated with overall ASN status (adjusted OR for Apgar ≤3, OR 1.52 95% CI 1.35 to 1.70), as well as ASN due to cognitive (OR 1.26, 95% CI 1.09 to 1.47), sensory (OR 2.49 95% CI 1.66 to 3.73) and motor (OR 3.57, 95% CI 2.86 to 4.47) impairments. There was a dose-response relationship between Apgar score and overall ASN status: of those scoring 0-3, 10.1% had ASN, compared with 9.1% of those scoring 4-7 and 6.6% of those scoring 7-10. A low Apgar score was associated with lower educational attainment, but this was not robust to adjustment for confounders. CONCLUSIONS Apgar scores are associated with long-term as well as short-term prognoses, and with educational as well as clinical outcomes at the population level.
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Affiliation(s)
- Emily J Tweed
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel F Mackay
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Sally-Ann Cooper
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jill P Pell
- Institute for Health and Wellbeing, University of Glasgow, Glasgow, UK
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