[Universal newborn hearing screening in Cantabria (Spain): results of the first two years]

AIMS

We present the results of the first 2 years of universal newborn hearing screening in Cantabria.

MATERIAL AND METHODS

We performed a descriptive study of screening with two levels of transient evoked otoacoustic emissions in 8,836 newborns, diagnostic confirmation with auditory brainstem response, and treatment.

RESULTS

The coverage of the first two levels of otoacoustic emissions was 98.4 % and 99.5 %. The incidence of risk factors was 3.08 %. A total of 6.7 % of those studied in the first stage were referred to the second, and 0.7 % of those studied in the second stage were referred to testing of auditory brainstem responses. Of the patents referred to the second stage, 97.6 % attended, and of those referred to the third stage 87.1 % attended. The positive predictive value after the second session of otoemissions was 7.9 %, and the false positive rate was 3.3 %. Sensorineural and bilateral hearing loss was diagnosed in 11 children, and permanent unilateral hypoacousia was diagnosed in one child, representing an incidence of 1.38/1,000 newborns. Sixty percent were diagnosed before the age of 3 months and 100 % before the age of 7 months. Fifty percent began treatment before the age of 6 months and 90 % before the age of 1 year. Of three cochlear implants indicated, two were implanted at 11 and 13 months. The cost was 1.3 3 per child screened and 867 3 for each case diagnosed.

CONCLUSIONS

All the objectives of the first and second stages of screening were achieved. The continuity index anticipated for the third stage (87.1 vs 95 %) and access to treatment at 6 months (50 % vs 100 %) were less satisfactory, although these results compare favorably with those of previously published studies.

[Program of hearing loss early detection in newborn infants in Cantabria. Results of the first year of activities]

AIMS

To report the findings in the first year of follow-up of the Cantabrian Program to screen newborn babies for congenital permanent hearing loss.

METHODS

The study population consisted of infants born during a year period in Cantabria (Spain). Universal hearing screening by transient evoked otoacoustic emissions (TEOAE) in 2 stage protocol was performed. Infants with failure scores in these 2 stages and those with risk factors for hearing loss were referred for diagnostic evaluation with auditory brainstem response. Hearing aids were recommended for those infants who had bilateral hearing loss and referrals to infant speech and language rehabilitation.

RESULTS

Out of the 4117 eligible babies, 3987 were studied. One hundred and ten (2.6) had risk factors for hearing loss, 3.5% were referred for audiological assessment and 1.2/1000 were diagnosed as having a permanent hearing loss. The false-positive rate was 0.72% after the two-stage screening procedure was performed. Positive predictive value for permanent hearing loss was 10%.

CONCLUSIONS

During the first year working with the Cantabrian Screening Program for congenital permanent hearing loss in newborn babies, the most part of the proposed aims have been achieved.

[Active immune-prophylaxis after allogeneic hematopoietic progenitor cell transplantation in pediatric patients]

There is considerable evidence supporting the disappearance of immunity against diseases for which there is active immune-prophylaxis available after allogeneic hematopoietic progenitor cell transplantation. These findings do not constitute merely an epidemiologic problem. From a strictly clinical point of view, these patients might benefit from the administration of different forms of vaccines against diseases to which they are particularly susceptible. There are, however, no unified criteria for the revaccination of these patients. Moreover, several surveys suggest that active immune-prophylaxis is frequently undervalued in these patients. In the present review, we provide up-to-date information on current trends as well as practical guidelines for the re-immunization of these patients in our environment.

[Tuberculosis infection prevalence in children younger than 7 years of age in Cantabria. What is the recommended periodicity for the tuberculin tes?]

OBJECTIVE

Because of the disparity between the recommendations regarding age and frequency for the realization of tuberculin testing during childhood, a study of tuberculous infection prevalence according to age was made in order to establish at which ages tuberculin testing would be recommendable and to determine if there is a difference in prevalence between vaccinated and non-vaccinated children.

PATIENTS AND METHODS

A study was carried out by performing annual tuberculin tests (4,454) using the Mantoux technique on 1,710 boys and girls between 1 and 6 years of age. Of these, 796 (46.54%) had been vaccinated with BCG at birth. Children on which a diagnostic tuberculin test had been carried out were excluded from the study. Indurations larger or equal to 10mm were considered positive, in vaccinated as well as in non-vaccinated children, until the publication and adoption of the criterion recommended by the National Concensus for Tuberculosis Control in Spain in 1992. Thereafter, indurations larger or equal to 5 mm in non-vaccinated children and larger than 14 mm in vaccinates children were considered positive.

RESULTS

The prevalence of tuberculosis infection was 0.49%, 1.87%, and 6,66% at one, 4 and 6 years of age, respectively, in non-vaccinated children and 0.31%, 2.25% and 8,69% at the same ages in vaccinated children was compared and no statistically significant difference was found.

CONCLUSIONS

We recommend the realization of tuberculin tests at one and 4 years of age and show that, in our medium, vaccinated children have a tuberculous infection prevalence during early childhood similar to their non-vaccinated counterparts.

[Results of podoscope screening in 948 non-selected children, with special reference to cavus foot]

OBJECTIVE

To ascertain the prevalence of cavus foot in a non-selected pediatric population, the percentage of secondary forms and to establish criteria for remission to the specialist.

PATIENTS AND METHODS

A randomized study of 948 healthy children older than four years, in which the sole footprint was studied through podoscope, was performed.

RESULTS

Cavus foot of different grades was present in 16.3% of the children studied, with a statistically significant difference in favor of girls. There were family antecedents in 60%. Symptoms and/or exploratory abnormal signs were presented in 19.3%, mainly pain, limp and sole dermatitis. Of the diagnoses made, 7.7% were referred to the specialist, with the diagnosis confirmed in 75% and treatment implemented in 50%. There were no cases of secondary cavus foot.

CONCLUSIONS

Cavus foot is very frequent in healthy children, has a familiar character and only exceptionally obeys the rules of a neuromuscular cause. We propose four criteria for the selection of patients for referral to the specialist.

[Prospective study of the prevalence of iron deficiency in breast-fed infants in Cantabria, its relation to the introduction of cow's milk and psychomotor development]

A prospective study was carried out on the prevalence of iron deficiency and/or iron deficiency anaemia in 196 healthy infants aged between eleven and fifteen months. The results are as follows: iron deficiency and/or iron deficiency anaemia; 46.4%, isolated iron deficiency 37.7% and iron deficiency anaemia, 8.7%. Significant differences were not found in relation with the age to the introduction of natural cow milk. No delays were found in psychomotor development (using Denver's test) related to anaemia or iron deficiency.

[Health recommendations for nursery schools (day care centers)]

A review is made of the health and sanitary conditions, preventive pediatrics, infraestructure, staff and material support as well as safety measures that should be available in day nurseries (creche). This review is made bearing in mind the absence of legislation on a national level to regulate this matters.

[Detection of nephro-urologic changes in infants using reactive strips. Experience at a puericulture practice]

In a group of 1.251 children under two (669 boys and 582 girls) that attended a puericulture office a detection program of urine alterations through reactive strips was carried out (at five and eighteen months). Eight asymptomatic bacteriurias in girls (1.37 per cent) and eight in boys (1.19 per cent) were confirmed. Of them the frequency of uropathies found was of a 37.5 per cent in girls and a 12.5 per cent in boys. Because of the frequency of asymptomatic bacteriuria, the possible associated nephrourologic alteration and the high cost of the method, we suggest the practice of this detection in primary pediatric offices on children under two.