新生儿听视同步筛查的临床模式

Simultaneous screening program for newborns hearing and ocular diseases

目的探索新生儿听力、眼病同步筛查的可行性和临床模式;了解新生儿听力下降及眼病的发病情况。方法在母婴同室应用瞬态诱发耳声发射,新生儿重症监护病房采用两阶段筛查技术进行新生儿听力筛查;同步进行新生儿眼病筛查。听力复筛未通过者,生后3个月进入诊断程序并进行跟踪随访和定期的听力学评估;眼病筛查疑似病例及时转诊到专业眼科进一步确诊。结果自2002年10月1日至2005年4月30日在济南市妇幼保健院共出生16 800例新生儿,对其中的15 398例(91.7%)新生儿进行了听力、眼病同步筛查。新生儿听力损失在同步筛查儿中的检出率:双耳0.312%(48/15 398),单耳0.227%(35/15 398);有4例单耳或双耳先天性感音神经性聋伴发眼病或眼部阳性体征:1例极重度感音神经性聋(双)、听神经病伴双眼先天性完全性白内障,1例轻度感音神经性聋(双)伴发左眼永存瞳孔膜,1例轻度感音神经性聋(双)伴双眼底静脉扩张,1例右耳轻度感音神经性聋伴双眼永存玻璃体动脉。在15 398例统计取样的新生儿中,共检出先天性眼病或眼部阳性体征13种2211例。结论新生儿期听力损失和眼病或眼部阳性体征在临床中并不少见。新生儿听视同步筛查在听力下降以及眼病监测和防治中是可行的,亦是有效的。

Objective To explore the model and the feasibility of newborn hearing and ocular disease simultaneous screening program and to study the birth prevalence of newborn hearing loss and newborn ocular diseases. Methods The universal newborn hearing screening（UNHS） was performed using transient otoacoustic emission （TEOAE） in well baby nursery and by a two-stage TEOAE and auto auditory brainstem response （AABR） protocol in neonatal intensive care unit （NICU）. The UNHS was simultaneous done with newborn ocular disease screening program. The examination technical method was following： the response to light, external inspection of the eyes and lids, pupil examination, red reflex examination, fundscope examination after pupil dilation for referral （for all newborn in NICU）. The infants who were referred by two-stage hearing screening and/or had high-risk factors of hearing loss received following-up and routine audiological evaluation and personalized intervention from 6 months to 3 years of age. The cases had positive sign and（or） abnormal results of the ocular disease screening were referred for further examination by pediatric ophthalmologists. Results A total of 16 800 children born in Jinan Maternal and Child Hospital from October 1, 2002 to April 30, 2005. Of these infants, 15 398 cases （ 91.7% ） had access to the simultaneous screening program for hearing and ocular diseases. The incidence of congenital sensorineural hearing loss（SNHL） among infants who did UNHS was 0. 312% （48/15 398 ）in bilateral and 0. 227% （35/15 398 ） in unilateral ;Of the 4 cases of congenital SNHL complicated with newborn ocular diseases： 1 profound SNHL （bilateral）, auditory neuropathy with congenital cataract （bilateral）, 1 mild SNHL （bilateral） with membrana pupillaris perseverans （left）and 1 mild SNHL （bilateral） with retina vein dilatation （ bilateral ）, 1 mild SNHL （ right ） with persistent hyaloid artery （ bilateral ）. In all 15 398 newborns, 15 neonates with congenital cataract were detected （22 eyes, 0. 10% ）. Twenty seven neonates with less than 1500 g birth weight admitted to NICU, retinopathy of prematurity was detected in 3 neonates （6 eyes）. Conclusion Hearing loss and ocular diseases was not rare in neonatal and infancy. Newborn hearing and ocular disease simultaneous screening program was not only feasible but also effective in detecting hearing loss and （or） ocular disorders. Early intervention was important for the prevention or treatment of neonatal hearing loss and （or） ocular diseases, such as newborn hearing loss with congenital cataract, retinopathy of prematurity and so on.