Newborn hearing screening: analysis and outcomes after 100,000 births in Upper-Normandy French region

OBJECTIVES

Neonatal hearing impairment is a common disorder with a prevalence of 1 to 2‰ worldwide, with significant consequences on overall development when rehabilitated too late. New-born hearing screening has been implemented in the 1990s in most European countries and the USA. The Upper-Normandy region of France has been conducting a pilot program since 1999. The aim of this prospective study was to evaluate and critically analyse it.

METHODS

The Upper-Normandy universal new-born hearing screening program is performed in two steps. Between 1999 and 2004, first, we administered a Transient Evoked Oto Acoustic Emission (TEOAE) test was administered a few days after birth for healthy newborns without risk factors. For newborns admitted to a neonatal intensive care unit (NICU) or presenting risk factors, was administered an automated auditory brainstem response (AABR) test prior to discharge. Second, newborns who failed the initial hearing screening were retested as outpatients using TEOAE. Since 2004, infants who failed the initial screen were tested with AABR 3 to 4 weeks later as outpatients, providing an opportunity to compare the two protocols.

RESULTS

Overall screening coverage in the Upper-Normandy region is 99.8%. First step coverage is 99.58% in well-infant nurseries and 97.09% in the NICU. The test-retest procedure during the first step and the use of AABR for the second resulted in higher follow-up rates and lower false positive rates.

CONCLUSIONS

The Upper-Normandy region universal newborn hearing screening program facilitated diagnosis and rehabilitation of infants before age of 9 months, most notably when severe to profound hearing impairment was found.

Patient-specific electromechanical models of the heart for the prediction of pacing acute effects in CRT: a preliminary clinical validation

Cardiac resynchronisation therapy (CRT) is an effective treatment for patients with congestive heart failure and a wide QRS complex. However, up to 30% of patients are non-responders to therapy in terms of exercise capacity or left ventricular reverse remodelling. A number of controversies still remain surrounding patient selection, targeted lead implantation and optimisation of this important treatment. The development of biophysical models to predict the response to CRT represents a potential strategy to address these issues. In this article, we present how the personalisation of an electromechanical model of the myocardium can predict the acute haemodynamic changes associated with CRT. In order to introduce such an approach as a clinical application, we needed to design models that can be individualised from images and electrophysiological mapping of the left ventricle. In this paper the personalisation of the anatomy, the electrophysiology, the kinematics and the mechanics are described. The acute effects of pacing on pressure development were predicted with the in silico model for several pacing conditions on two patients, achieving good agreement with invasive haemodynamic measurements: the mean error on dP/dt(max) is 47.5±35mmHgs(-1), less than 5% error. These promising results demonstrate the potential of physiological models personalised from images and electrophysiology signals to improve patient selection and plan CRT.

[Traissac voice prosthesis. Apropos of 9 years experiences]

BACKGROUND

Long term results are discussed.

PATIENTS

A retrospective study of 9 years (1/01/89, 1/01/98) concern 107 laryngectomized patients with 9 patients a part from this period, and 30% without prosthesis. Among 80 patients with prosthesis, 57% had received primary TEPs (tracheoesophageal puncture), 21% delayed primary TEPs and 22% secondary TEPs. Oesophageal voice is always learned with tracheoesophageal voice.

RESULTS

We find a success rate (1 month) in 75% of cases, with a maximum follow up time of 8 years (the average is 3 years 1 month). We find a success rate with a long-term result in 66% of cases. Prosthesis removal exists in 30% of cases and oesophageal voice is successfull once out of 3 in this cases. Mean lifetime Traissac's prosthesis is 18 months. After removal, non closed fistulas can exist in 40% of cases, and surgery is always successful.

DISCUSSION

Material Traissac's prosthesis explains extended lifetime.

CONCLUSION

Traissac's prosthesis gave us satisfaction during a use of 8 years.

Absence of complement activation in vitro by sodium meglumine ioxitalamate

The effect of radiographic contrast media on proteins of the complement system in vitro was investigated using protein level measurement and crossed immunoelectrophoresis. Despite the 20% loss of total serum hemolytic activity (CH50) induced by sodium meglumine ioxitalamate (0.5 M), no significant changes in C3c, C3N or B were detected by radial immunodiffusion. These contrast media did not cause electrophoretic conversion of C3, as assessed by the absence of split product, and the small degree of spontaneous C3 conversion (loss of 20% C3N antigen and the presence of two peaks with C3c antigen) which occurred when serum was incubated in polypropylene tubes, was inhibited by the contrast media. The effects of sodium meglumine ioxitalamate and zymosan in vitro on complement activation were compared.