河北省石家庄地区新生儿听力筛查的临床实践

Clinical practice of neonatal hearing screening in Shijiazhuang area of Hebei Province

目的：探索河北省新生儿听力筛查的临床方法，了解河北省新生儿听力损失的发病状况，以便制定适合河北省新生儿听力筛查的实施方案，提出听力损失的婴幼儿的早期干预措施。方法：应用畸变诱发性耳声发射（DPOAE）对4229例出生后2-4天的新生儿进行听力筛查（初筛），未通过者于生后6周复筛，对复筛未通过者，于生后3个月左右采用多频稳态听觉诱发反应（ASSR）测听技术进行听力学诊断。对有听损失高危因素者下6个月-3岁之间每半年监测1次听力变化。结果：自2003年10月-2005年11月，两家医院可供听力筛查的新生儿数为4552侧，实际接受初筛查4229例，新生儿初筛查为92．9％；初筛通过3685例，需复筛的共544例，实际复筛人数516例，通过477例，门诊复筛率为94．85％。复筛未通过例数39例。确诊新生儿先天性听力损失23例。由本组资料显示新生儿先天性听力损失在筛查儿中的发病率为5．44‰（单耳和双耳）。单耳听力损失在筛查儿中的发病率为3．08‰，双耳听力损失在筛查儿中的发病率为2．36‰。初筛的阳性率为12．86％。假阳性率为12．38％，两步筛查后的阳性率为0．92％，假阳性率为0．38％。本组未发现假阴性病例。结论：通过应用畸变产物诱发耳声发射技术（DPOAE）、ASSR对新生儿进行听力筛查以及听力学诊断，可早期发现有听力损失的新生儿，及早提出医学意见，并早期进行干预治疗。

Objective： To conduct a follow up study of these newborns who failed the hearing screening in Hebei Province in order to to validate the appropriate clinical testing protocol in newborn hearing screening and to propose ace universal hearing screening and early intervention program based on the findings. Methods： Distortion product otoacoustic emission （DPOAE） was used to screen the hearing in 4 229 newborns 2 -4 days after birth. Those who failed the initial screening underwent another DPOAE screening 6 week later. Aditory steady state evoked response （ASSR） was used for the assessment of the hearing of those who failed the second screening at an interval of every 6 months from 3 months to 3 years old. Results： From July 2001 to November 2003, among 4 552 newborns, 4 229 received the initial hearing screening; accounting for 92. 9% and 3 685 passed it at a rate of 87. 13%. The false - positive rate was 12. 38% in the initial screening. For the two screenings the failing rates were 0. 92 and no false - negative cases were found. After the 2 - stage screening 23 infants were diagnosed with hearing loss. Tho prevalence of one ear hearing loss was 3. 08‰, and a prevalence of hilateral hearing loss was 2. 36‰. Conclusion： Hearing screening and audiological follow -up employing both DPOAE and ASSR are useful to identify infants with hearing loss as early as possible so as to provide appropriate intervention.