Why is newborn hearing
screening important ?
Semiramis ZizlavskyPre PITO 8, Sept 2,2013 Jakarta
INTRODUCTION• Babies : develop speech and language from
the time they are born. • Listening and interacting with sounds and
voices around them.• Baby is born with hearing loss: speech and
language development can be delayed.• Hearing screening testing : highly accurate.
earlier identification and treatment of infants
- What is newborn hearing screening- Why hearing screening is important ?- Principles of Screening- Target- Risk Factors- Benefit of Hearing Screening- Risk of Newborn Hearing Screening- Timing to test- How to do ?- Important to thinks
What is newborn hearing screening ?
Newborn hearing screening…….. programs are designed to identify hearing loss in infants shortly after birth
• Prevalence ; 2-3 per 1000 newborn will have HL Indonesia : 1-3 per 1000 1/1000 WBN 10/1000 NICU
Why is early identification of hearing loss important
• Hearing loss is the most common birth condition
• Previous methods for detecting hearing loss have been ineffective (behavioral observation)
• Undetected hearing loss can delay speech, language, social and academic
development
Incidence of Congenital Conditions (Per 10,000)
0
5
10
15
20
25
30
35
Hearing loss Clef t lip or palate
Down syndrome
Limb defects Spina bifida Sickle cell anemia
PKU
Num
ber p
er 1
0,00
0
Congenital Condition Type
Screening
Quick
Cheap
Not Invasive
Accurate, reproducible
Principles of Principles of Screening
Target
Universal Hearing
Screening
All Babies
Targeted Hearing
Screening
Risk Factors
RISK FACTORS (JCIH 2000) 0-28 day-NICU > 48 hours-Syndrome-Family history-Craniofacial anomalies-In utero infection
29 days- 2 years-Parental/caregiverconcern-Family history-Syndrome-Postnatal infection-In-utero infection-Hyperbilirubinemia-Neurogenerative disorders-Head trauma
Benefits of Newborn Screening
• IDENTIFICATION
• EARLY INTERVENTION
• REDUCED MORBIDITY
• FAMILY PLANNING
Risk of Newborn Hearing Screening• Parent anxiety (false positive )• Missed diagnosis ( false negative)• Unanticipated outcome - range of reactions - maternal feelings of guilt - financial problem - cultural sensitivity
HOW TO DO ?
• One
• Two step
Hearing Screening Techniques
OAE
AABROAE + AABR
OAE
ABR
Otoacoustic Emmision (OAE)
Measures sound waves produced in the inner ear
PASS
REFER
Automatic Auditory Brainstem Response (AABR)
PASS
REFER
Measures how the hearing nerve responds to sound
TIMING TO TEST
INTERVENTION
< 6 month HA CI
DIAGNOSIS (OAE,AABR/ABR)3 month RISK FACTORS
IDENTIFICATION (OAE)BEFORE DISCHARGE 2 days
BIRTH: Hospital-based Screening
• OAE,AABR,ABR• Re-Screen before discharge :possible• Hearing screen pass : not guarantee (risk
factors ?)• Re-screening if : - any failure / incomplete - unilateral• Parents refuse screening : documentation
Before one month of Age
• Outpatient re-screening : - failed - missed - incomplete• Unilateral failure : audiology evaluation
Early re-screening :- Earlier diagnosis
- Minimizes parental anxiety
Before Three Month of Age Audiology evaluation
DIAGNOSIS If HL is confirmed (Information, amplification & communication)
Before Six months of Age• Continue early intervention : WHY ???• Other evaluations : - genetics - ophthalmology - pediatrics Syndrome ? - neurology - cardiology - nephrology
HTA Hearing Screening
Bayi baru lahir / 2 hr
OAE PASS REFER
1 –3 BULANAuto ABR
atauclick 35 dB
P R
3 bulanOtoskopi
TimpanometriOAE
Auto ABR
P R
ABR Click & Tone B 500 Hzatau ASSR
Timpanometri High Frequeny
Pemantauan • Speech development• AudiologiTiap 3-6 bulan smp (anak bisa bicara) usia 3 th
Habilitasi usia 6 bulan
Tidak perlu tindak lanjut
ALUR SKRINING BAYI BARU LAHIR
ABR Click + CochlearMicrophonicABR Tone B 500 Hz atau ASSRTimpanometri ( refleks akustik)
High Frequency
Faktor Risiko (-)
Neuropati Auditorik
Tuli Sensorineural
Faktor Risiko (+)
Conclusion
☺Screening is part of a system of follow-up, diagnosis, treatment and evaluation.
☺Timely and appropriate intervention have lasting effects on outcomes.
☺ Family involvement : important
THANK YOU