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

Results of the Universal Neonatal Hearing Screening in a Tertiary Care Hospital in Mexico city

INTRODUCTION

Universal Neonatal Hearing Screening (UNHS) includes as its main objective, that all Newborns (NB) receive an audiological evaluation during their first month of life.

OBJECTIVE

To determine the prevalence of hearing loss in a population of healthy NB in a tertiary care hospital in Mexico City.

MATERIAL AND METHODS

A prospective cross-sectional study was designed. The period was from October 1, 2011 to May 15, 2019. UNHS was performed with a flowchart in three phases using Transient Evoked Otoacoustic Emissions and Brainstem auditory evoked potentials. Data were analyzed using descriptive statistics.

RESULTS

14,000 NB were evaluated, 28,000 ears. Gender was distributed in n = 7038 (50.3%) males and n = 6962 (49.7%) females. The mean age at the time of the first UNHS study was 48.3 ± 22.2 days. Hearing loss was confirmed in n = 31 (0.22%) NB, in 20 (64%) of the cases with hearing loss there were no documented audiological risk factors.

CONCLUSIONS

The prevalence of hearing loss was 2.2 per 1000 NB in a tertiary care hospital in Mexico City. Diagnosis and early habilitation of hearing loss in NB constitute quality indicators in health care and guarantee the best prognosis for NB with hearing loss.

Mothers' perspectives of newborn hearing screening programme

Background

Newborn hearing screening programs identifies newborns with hearing loss. The early identification enables prompt intervention through hearing rehabilitation. Accurate knowledge of the program and its benefit will impact on the uptake of the program by the citizenry. We hypothesized that there is a gap in the knowledge of parents on hearing screening and rehabilitation measures in Nigeria.

Aim

To determine the knowledge and perceptions of mothers of newborn children on hearing screening.

Methods

A cross sectional observational study among mothers of newborn children at immunization clinics. Semi structured questionnaire on gestational duration, mode of delivery, birth asphyxia, knowledge on hearing loss and newborn hearing screening were administered.

Results

Participants were 48 mothers with age range from 18 to 42 years. Awareness of newborn hearing screening was poor among the mothers; sources of information on newborn hearing screening were antenatal clinic, mass media and friends. The educational level of the participants had no association with awareness (p = 0.11), but the willingness to accept newborn hearing screening, was associated with socioeconomic status (p = 0.04) and the level of education (p = 0.02). The participants were not aware of factors responsible for hearing loss in childhood.

Conclusion

There is inadequate knowledge about newborn hearing screening and risk factors for infant hearing loss among the mothers, though they demonstrate willingness to accept the newborn hearing screening.

Funding

None declared.

A Hearing Screening Program for Children in Primary Schools in Tajikistan: A Telemedicine Model

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.

Educação em saúde com vistas à triagem neonatal e audição: uma revisão integrativa

O objetivo deste trabalho foi investigar estudos sobre educação em saúde e capacitação que abordassem o tema triagem neonatal e/ou audição. Trata-se de uma revisão integrativa, realizada em agosto de 2011, com busca na Biblioteca Virtual em Saúde, a partir dos Descritores em Ciências da Saúde: “Audição”;, “Capacitação”;, “Educação em Saúde”; e “Triagem Neonatal”;. A amostra final constituiu-se por 10 estudos. A base de dados com maior número de artigos foi a Medline e a maioria dos artigos (n=07) foi classificado com nível de evidência três. Nesta revisão integrativa, pode-se observar o quão é interessante adotar as estratégias de educação em saúde e/ou capacitação nos serviços de saúde como uma forma de educação permanente ou continuada. A população mais frequentemente estudada foi mães/pais e médicos. Ações educativas podem empoderar a população em relação à audição, englobando aspectos sobre a Triagem Auditiva Neonatal e seus procedimentos.

On the threshold of effective well infant nursery hearing screening in Western Sicily

OBJECTIVE

To determine the feasibility and effectiveness of well-infant nursery hearing screening programme for the early identification of hearing impairment, based on transient evoked otoacoustic emission (TEOAE) with a high "screen sensitivity" reducing the number of more expensive secondary level exams.

METHODS

The newborns were screened by non-specialist health workers in well babies nursery at the twentieth day of life for 6 years consecutive. Based on PASS/FAIL criteria and presence/absence of audiological risk factors the newborns were divided into four groups each one with its personal step programme: G1 - PASS without risk factor, free to go home; G2 - PASS with risk factor, retest at the age of 7 months; G3 - FAIL without risk factor, re-screening after 2 weeks for a maximum of four times before audiology assessment; G4 - FAIL with risk factor, retest after 2 weeks.

RESULTS

The coverage rate increased progressively from 89.8% to 92%. The referral rate was 1.51% after second stage with a specificity value of 98.78%. The four-stage screening performed for G3 reduced the numbers of global audiology assessment to 0.91% with a final global specificity of 99.4 ± 0.4%.

CONCLUSION

Less than 1% of infants underwent audiological assessment; the false positives resulted 0.62% with hearing loss global incidence of 2.95/1000 and a mean age of confirmation of 3.5 months of age. It is reasonable to think that this screening programme could be implement to overall 42 Western Sicily birth centres within few years.

Universal newborn hearing screening in 2010

PURPOSE OF REVIEW

The objectives of this review are to provide the reader with a current and concise review of the data and trends in universal newborn hearing screening. Within a relatively short period of time, the concept of screening all infants for hearing loss at the time of birth has evolved from a nascent process to a truly universal system in most developed countries. As a result, the focus and challenges of universal newborn hearing screening have shifted to topics of developing even more efficient and cost-effective approaches, and potentially melding physiologic hearing screenings with ancillary screening techniques.

RECENT FINDINGS

Enhancement of the universal newborn hearing screening process is likely to be accomplished by implementation of novel tools such as wideband reflectance technologies and intelligent incorporation of screening for common genetic and viral causes of congenital hearing loss.

SUMMARY

With such a rapidly evolving process, it will be critical for clinicians to understand the benefits and limitations of various newborn hearing screening methodologies in order to determine the most appropriate management of children referred from their universal newborn hearing screening. This will entail a working knowledge of emerging audiologic tools as well as infectious and genetic causes of pediatric hearing loss.

Sensorineural hearing loss in high school teenagers in Mexico City and its relationship with recreational noise

The aim of this study was to measure the frequency of hearing loss in a sample of typical public high-school students exposed to recreational noise, and determine associated risk factors. The sample was made up of 214 teenagers from a high-school in Mexico City; subjects were selected randomly per strata. We applied a questionnaire to identify risk factors for hearing loss and performed a battery of audiologic tests consisting of otoscopy, tympanometry, and pure-tone audiometry. The mean age of the sample was 16 +/- 1.07 years; 73% were male and 27%, female. Hearing loss was found in 21% of students. The main hearing loss-related risk factor was exposure to recreational noise: frequent attendance at discotheques and pop-music concerts; use of personal stereos; and noise exposure in school workshops. The high frequency of hearing loss in high school students from one Mexico City school (nearly one fifth of the sample) was found to be related to noise exposure mainly during recreational activities.

Early detection of hearing loss

The universal newborn hearing screening (UNHS) is currently spreading in Germany, as well, even though there can be no talk of a comprehensive establishment. The introduction of UNHS in several federal states such as Hamburg, Hessen, and Schleswig-Holstein can be ascribed to the personal commitment of individual pediatric audiologists. Apart from the procurement of the screening equipment and the training of the staff responsible for the examination of the newborns, the tracking, i.e. the follow-up on children with conspicuous test results, is of utmost importance. This involves significant administration effort and work and is subject to data protection laws that can differ substantially between the various federal states. Among audiologists, there is consensus that within the first three months of a child's life, a hearing loss must be diagnosed and that between the age of 3 and 6 months, the supply of a hearing aid must have been initiated. For this purpose, screening steps 1 (usually a TEOAE measurement) and 2 (AABR testing) need to be conducted in the maternity hospital. The follow-up of step 1 then comprises the repetition of the TEOAE- and AABR measurement for conspicuous children by a specialized physician. The follow-up of step 2 comprises the confirmatory diagnostics in a pediatric audiological center. This always implies BERA diagnostics during spontaneous sleep or under sedation. The subsequent early supply of a hearing aid should generally be conducted by a (pediatric) acoustician specialized on children.

Prevalence of early neurodevelopmental disabilities in Mexico: a systematic review

OBJECTIVE: Early neurodevelopment disabilities (END) such as cerebral palsy (CP), deafness, blindness, epilepsy, and mental retardation (MR) are very important public health concerns. Although no strong data on END can be obtained in Mexico, the few papers concerning END epidemiology deserve systematic and critical review. Thus, this was the objective of the present paper. METHOD: We performed a systematic review of papers published reporting on the prevalence of END in Mexico. We performed a search in several medical data bases such as PubMed, Artemisa, ImBioMed, and LiLaCS. Each paper was downloaded, read and discussed. We only selected papers published between 1999 and 2008. RESULTS: No data on CP and epilepsy prevalence in infants have been found. Data on deafness prevalence report hearing loss in 0.65/1,000 healthy newborns, and in 2.6/100 in high-risk very premature infants. With regard to blindness, prevalence of retinopathy of premature infants in any stage was reported at ca 10.61 and 22.2/100 in high-risk premature infants. Congenital hypothyroidism (CH) prevalence in infants was found in 4.2/10,000 live newborns after a national universal screening survey. CONCLUSION: No universal data regarding the prevalence of END in Mexico have been investigated, with the exception of CH. Mexico needs more research to determine epidemiologic data focused on designing actions to prevent, treat, and rehabilitate END.

Community-based infant hearing screening for early detection of permanent hearing loss in Lagos, Nigeria: a cross-sectional study

OBJECTIVE

To determine the feasibility and effectiveness of a community-based universal infant hearing screening programme for detecting permanent congenital and early-onset hearing loss (PCEHL) in Lagos, Nigeria.

METHODS

This is a cross-sectional study in which all infants aged 3 months or under attending four bacille Calmette-Guérin (BCG) immunization clinics accounting for over 75% of the BCG coverage in the study location were screened by community health workers between July 2005 and April 2006. Screening followed a two-stage protocol involving transient evoked otoacoustic emissions and automated auditory brainstem responses. The main outcome measures were screening coverage, referral rates, return rates for second-stage screening and evaluation, yield and age at PCEHL diagnosis.

FINDINGS

In total, 2003 (88%) of 2277 eligible infants attending the four BCG clinics were successfully screened between July 2005 and April 2006 at a mean age of 17.7 days, with no parent declining screening. The majority (55.2%) were born outside a hospital and, of such infants, 77% were born in traditional herbal maternity homes. The overall referral rate for diagnostic evaluation was 4.1%. Only 61% (50/82) of those referred returned for evaluation, and 45 of them were confirmed with PCEHL. Additionally, 11 infants who had previously passed the first screening stage were also found to have PCEHL, resulting in a yield of 28 per 1000 (56/2003). The mean age at diagnosis was 51 days. The sensitivity, specificity and positive predictive value of the first screening stage were 80.4%, 99.7% and 90.0%, respectively. The positive likelihood ratio was 268, while the negative likelihood ratio was 0.2.

CONCLUSION

Routine hearing screening of infants attending BCG immunization clinics by community health workers was feasible and effective for the early detection of PCEHL in Lagos, Nigeria. However, an efficient tracking and follow-up system is needed to improve return rates for second-stage screening and diagnostic evaluation.

Newborn hearing screening follow-up: factors affecting hearing aid fitting by 6 months of age

PURPOSE

To determine the extent to which the goal of hearing aid fitting by 6 months of age is being achieved and to identify barriers to achieving that goal.

METHOD

Screening and follow-up records from 114,121 infants born at 6 hospitals were collected over a 6-year period. Infants diagnosed with permanent hearing loss requiring amplification were categorized as fit on time, fit late, or lost to follow-up. Seven factors were empirically identified as potential barriers to timely intervention.

RESULTS

Ninety-one percent of referred infants returned for follow-up evaluation. Hearing aids were fit on 107 of the 192 infants requiring amplification. Thirty-nine percent were fit on time, and 61% were fit late or lost to follow-up. Unilateral hearing loss and late diagnosis were statistically significant (p < .0001) predictors for late fitting and loss to follow-up. Conductive hearing loss and coverage by Medicaid were also statistically significant (p < .0001) predictors for loss to follow-up.

CONCLUSION

High return rate for follow-up does not ensure hearing aid fitting by 6 months of age. Infants with unilateral hearing loss are at particular risk of being lost to follow-up.

Comparison of two-step transient evoked otoacoustic emissions (TEOAE) and automated auditory brainstem response (AABR) for universal newborn hearing screening programs

OBJECTIVE

Both transitory auditory otoemissions (TEOAE) and automated auditory brainstem responses (AABR) are considered adequate methods for universal hearing screening. The goal of this study was to compare the results obtained with each device, applying the same screening procedure.

MATERIALS AND METHODS

From 2001 to 2003, all the newborns in our health area (2454 infants) were evaluated with TEOAE (ILO92, otodynamics) and all those born from 2004 to 2006 (3117) were evaluated with AABR (AccuScreen, Fischer-Zoth). The population studied included all well newborns and those admitted to neonatal intensive care units (NICU). The first screening was normally undertaken with well babies during the first 48h of life, before hospital discharge. Infants referred from this first step underwent a second screening after hospital discharge, before they were a month old.

RESULTS

The results from each study group were compared and analyzed for significant differences. TEOAE screening yielded 10.2% fail results from the first screening step; AABR gave 2.6%. In the second screening step, 2% of the newborns screened with TEOAE were referred, whereas 0.32% of those screened with AABR were referred. These differences are statistically significant.

CONCLUSIONS

Although AABR screening tests involve a slightly higher cost in time and money than TEOAE, the results obtained compensate this difference. AABR gives fewer false positives and a lower referral rate; the percent of infants lost during follow-up is consequently smaller. Therefore, in our environment, universal newborn auditory screening with AABR is more effective than that with TEOAE.

Hospital-based universal newborn hearing screening for early detection of permanent congenital hearing loss in Lagos, Nigeria

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Progress towards early detection services for infants with hearing loss in developing countries

BACKGROUND

Early detection of infants with permanent hearing loss through infant hearing screening is recognised and routinely offered as a vital component of early childhood care in developed countries. This article investigates the initiatives and progress towards early detection of infants with hearing loss in developing countries against the backdrop of the dearth of epidemiological data from this region.

METHODS

A cross-sectional, descriptive study based on responses to a structured questionnaire eliciting information on the nature and scope of early hearing detection services; strategies for financing services; parental and professional attitudes towards screening; and the performance of screening programmes. Responses were complemented with relevant data from the internet and PubMed/Medline.

RESULTS

Pilot projects using objective screening tests are on-going in a growing number of countries. Screening services are provided at public/private hospitals and/or community health centres and at no charge only in a few countries. Attitudes amongst parents and health care workers are typically positive towards such programmes. Screening efficiency, as measured by referral rate at discharge, was generally found to be lower than desired but several programmes achieved other international benchmarks. Coverage is generally above 90% but poor follow-up rates remain a challenge in some countries. The mean age of diagnosis is usually less than six months, even for community-based programmes.

CONCLUSION

Lack of adequate resources by many governments may limit rapid nationwide introduction of services for early hearing detection and intervention, but may not deter such services altogether. Parents may be required to pay for services in some settings in line with the existing practice where healthcare services are predominantly financed by out-of-pocket spending rather than public funding. However, governments and their international development partners need to complement current voluntary initiatives through systematic scaling-up of public awareness and requisite manpower development towards sustainable service capacities at all levels of healthcare delivery.