大规模新生儿听力筛查与早期干预效果的评估

Universal newborn hearing screening and effect of early intervention

目的探讨大范围实施新生儿听力普遍筛查（UNHS）的可行性，以及对筛查出的听力障碍新生儿进行早期诊断和早期干预的效果。方法分析2002年1月~2005年12月上海市实施新生儿听力普遍筛查的情况，包括筛查人数、初筛率、初筛和复筛阳性率、确诊人数以及听力障碍程度的分布。筛查技术采用筛查型畸变产物耳声发射（DPOAE）法，于出生后3 d内和42 d内分别进行初筛和复筛，对复筛未通过者三个月内转至上海市儿童听力障碍诊治中心予以确诊。确诊后的婴幼儿六个月内进行干预，并进行跟踪随访和评估，比较干预和未干预组之间的差异。结果2002~2005年筛查总人数分别为56191、82662、86940、121460例，初筛率分别为83.38%、93.93%、94.01%和98.03%，初筛阳性率分别为12.53%、11.41%、12.00%和11.92%；复筛率分别为63.92%、63.47%、71.50%和70.04%，复筛阳性率分别为10.40%、13.48%、11.00%和10.74%，最后确诊人数分别为125、128、129、433例。由此得出上海市新生儿听力障碍的发生率为2.35‰（815/347 253）。确诊患儿中双侧中度以上听力损失319例（39.14%，319/815），截止2005年6月随访资料完整者194例，其中中度以上进行系统干预者34例，因经济原因等未行干预者31例，两组语言及认知发育相差显著（P〈0.05），接受干预组语言和认知发育接近正常儿童水平。结论在较大范围内实施政府统一协调和学科合作的UNHS可以取得较为满意的结果，对确诊患儿进行早期干预效果确切。

Objective To explore the feasibility of universal newborn hearing screening （ UNHS）, and to evaluate the effect of early intervention on newborns with hearing loss. Methods A retrospective study of the newborn hearing screening in Shanghai from January 2002 to December 2005 was carried out. The total number of newborns, the coverage rate, the positive rate of first screening and repeated screening, the number with definite diagnosis, and the distribution of hearing-impaired newborns according to degree of hearing loss were analyzed. The screening was performed by using distortion product otoacoustic emission （DPOAE）. First screening and repeated screening were carried out within 3 days and 42 days after birth, and those who failed the repeated screening were diagnosed at the Shanghai Children＇s Hearing and Speech Center within the age of three months. Children with a definite diagnosis were given intervention within 6 months. Follow-up and evaluation were performed from 6 months to 3 years of age, and comparison were made between the intervention group and non-intervention group. Results The number of newborns screened was 56 191 （2002） , 82 662 （2003） , 86 940 （2004） and 121 460 （2005） , respectively. The coverage rate of first screening was 83.38% , 93.93% , 94.01% and 98.03% , and the positive rate was 12.53% , 11.41% , 12.00% and 11.92% , respectively. The coverage rate of repeated screening rate was 63.92% , 63.47% , 71.50% and 70.04% , and the positive rate was 10.40% , 13.48% , 11.0% and 10.74% , respectively. The number of newborns with a definite diagnosis was 125, 128, 129 and 433, respectively. The prevelence of hearing loss in UNHS was 2.35 （815/347 253）. The number of newborns with moderate or more severe bilateral hearing loss was 319 （39.14% , 319/815）, among whom 194 had been followed up and 34 had received intervention up till June 2005. Thirty-one had not received intervention out of economic reasons. The devel- opment of speech and cognition was significantly different between the two groups （P 〈 0.05）, with the development of children in the intervention group well performed almost like the normals. Conclusion It is feasible and effective to conduct UNHS with the help of government and related parties. The early intervention will definitely benefit those with hearing loss.