Universal newborn hearing screening coming soon: "hear's" why

How the NICU environment sounds to a preterm infant: update

PURPOSE

To replicate a previously published descriptive study of sound levels in the NICU.

STUDY DESIGN AND METHODS

A descriptive study of nursery ambient sound levels and sound levels associated with nursery equipment and care activities was conducted in a Level III NICU. Measurements were obtained using a sound level meter and evaluated in light of previous findings.

RESULTS

Contrasted with 16 years ago, room sound levels were reduced; however sound levels associated with caregiving, equipment, and activities continue to be high.

CLINICAL IMPLICATIONS

Sound levels continue to be a clinical challenge for NICU nurses. This study suggests some modification of care practices and equipment selection that could reduce sound levels and concludes that sound reduction is a continuing need in neonatal care.

Functional magnetic resonance imaging of hearing-impaired children under sedation before cochlear implantation

OBJECTIVE

To investigate functional magnetic resonance imaging (fMRI) in pediatric cochlear implantation candidates with residual hearing who are under sedation for evaluation of auditory function.

DESIGN

During fMRI, subjects heard a random sequence of tones (250-4000 Hz) presented 10 dB above hearing thresholds. Tones were interleaved with silence in a block-periodic fMRI design with 30-second on-off intervals. Twenty-four axial sections (5 mm thick) covering most of the brain were obtained every 3 seconds for a total acquisition time of 5.5 minutes.

SETTING

Single tertiary academic medical institution.

PATIENTS

Severely to profoundly hearing-impaired children (n=10; mean age, 49.1 months). During fMRI, subjects were awake (n=2) or sedated with pentobarbital sodium if their weight was 10 kg or greater (n=4) or chloral hydrate if their weight was less than 10 kg (n=4).

MAIN OUTCOME MEASURES

Detection of brain activation by fMRI in the primary auditory cortex (A1) in hearing-impaired patients under sedation, and correlation of A1 activation with hearing levels measured after cochlear implantation.

RESULTS

In most subjects, fMRI detected significant levels of activation in the A1 region before cochlear implantation. The improvement in hearing threshold after cochlear implantation correlated strongly (linear regression coefficient, R=0.88) with the amount of activation in the A1 region detected by fMRI before cochlear implantation.

CONCLUSIONS

Functional MRI can be considered a means of assessing residual function in the A1 region in sedated hearing-impaired toddlers. With improvements in acquisition, processing, and sedation methods, fMRI may be translated into a prognostic indicator for outcome after cochlear implantation in infants.

Universal newborn hearing screening: fine-tuning the process

PURPOSE OF REVIEW

Universal newborn hearing screening (UNHS) is rapidly becoming the standard of care in hospitals across the country. The goals of Healthy People 2010 are to provide newborn hearing screening to all infants, ensure follow-up audiologic evaluations by 3 months of age, and provide smooth transition to early intervention by 6 months of age. Programs implemented in the 1990s are beginning to report data that will be useful to states new to screening. This article reviews recent trends, suggests appropriate screening protocols, and identifies areas for improvement in UNHS.

RECENT FINDINGS

Recent studies indicate the following: (1) screening programs can be cost-effective with low referral rates; (2) maternal stress is not necessarily a byproduct of screenings that end in referral; and (3) developmental outcomes for hearing-impaired infants born in screening hospitals are particularly encouraging. Areas for improvement include the following: (1) compliance in follow-up testing and (2) the establishment of a cohesive multidisciplinary team to manage the infant and provide support to the family.

SUMMARY

Hearing screening is only the first step in the care of a hearing-impaired infant. Programs need to ensure that families understand the necessity of follow-up testing without creating undue stress. The transition to early intervention should be seamless, with a cohesive team of health care professionals capable of providing medical, audiologic, communication, and educational management for the infant as well as emotional support for the family.

Current concepts in universal newborn hearing screening and early hearing detection and intervention programs

Newborns are routinely screened for hearing loss; screening typically occurs in the newborn nursery and newborn intensive care unit. Understanding the process and outcomes of initial hearing screening and ongoing early hearing detection and intervention programs (EHDI) are important roles of the newborn/neonatal intensive care (NICU) nurse. Infants that require NICU care are at higher risk of hearing loss and need close follow-up and repeat hearing testing throughout their first 3 years of life. Parents experience anxiety and worry related to potential hearing loss problems and need guidance, education, and information on infant hearing to ensure the best possible outcome for their infant.

The "geriatric" NICU patient

AT ONE END OF THE NICU spectrum of patients is the acutely ill premature or term baby. This is the patient who requires the fast-paced and intellectually stimulating nursing care that often attracts NICU nurses to the specialty. At the other end of the spectrum is the chronically ill baby. This is the patient who is past the acute stage but is in the NICU for much longer than anyone expected because of a chronic medical condition. This category of infants includes those with chronic lung disease, tracheostomies with or without ventilator dependence, short-bowel syndrome, and other conditions that require continued specialized care. As they grow, these infants present with conditions that would normally be dealt with on a regular pediatric floor, in the pediatrician’s or primary care physician’s office, or in a neonatal follow-up clinic.