正常和重症监护病房新生儿听力筛查结果分析

An Analysis of Newborn Hearing Screening Results in Obstetrics and Neonatal Intensive Care Units

目的分析正常和重症监护室(NICU)新生儿听力筛查的结果,了解其初、复筛率及听力损失检出率。方法应用DPOAE对2009年1月1日～2010年12月29日出生的正常和NICU新生儿进行听力筛查,正常新生儿于生后2～5天初筛,NICU新生儿在病情稳定后进行初筛;初筛未通过者于42天行DPOAE复筛,复筛仍未通过者于3月龄行ABR和/或ASSR检查。结果正常新生儿3 778例,接受筛查3 668例,初筛率97.09%(3 668/3 778),初筛未通过342例(9.32%,342/3 668),复筛144例(42.11%,144/342),复筛未通过40例(27.78%,40/144),转诊25例,最终确诊先天性听力损失7例(1.91‰,7/3 668)。NICU新生儿2 665例,全部接受初筛,初筛率100%,初筛未通过330例(12.38%,330/2 665),复筛46例(13.94%,46/330),复筛未通过8例(17.39%,8/46),实际转诊6例,最终确诊先天性听力损失2例(0.75‰,2/2 665),其中1例为缺血缺氧性脑病,另1例为新生儿窒息。两组听力损失检出率1.42‰(9/6 333),其中中度6例,重度2例,极重度1例;单耳3例,双耳6例。结论本组正常和NICU新生儿听力筛查复筛率明显低于推荐标准,NICU新生儿听力损失的检出率低于其它地区。

Objective To analyze the results of newborn hearing screening in obstetrics and neonatal intensive care unit （NICU）. Methods Distortion product otoacoustic emission （DPOAE） was used to undertake initial screening to the newborns between 2-5 days at our hospital and the initial screening to the newborns at the neonatal intensive care unit after conditions were stabilized. Those who failed to pass the initial screening received rescreening on the 42nd day. For the newborn failed in the rescreening, they would be transferred to provincial hospitals for au- ditory brainstem response （ABR） and/or auditory steady--state responses （ASSR） examination when they were 3 months old. Results 3 668 newborn out of 3 778 in the obstetrics department received hearing screening. The initial screening rate was 97. 09% （3 668/3 778）. 342 cases failed in their initial screening, with the positive rate of 9.32%0 （342/3 668）; 342 received a rescreening but actually 144 cases were undertaken the rescreening with the rescreening rate at 42.11% （144/342）. 40 cases failed in a repetitive screening, with the positive rate of 27. 7 % （40/ 144）. Referral 25 cases, eventually diagnosed congenital hearing loss in 7 cases 1.91%0（7/3 668）, 2 665 cases of newborn at NICU received initial hearing screening with an initial screening rate of 100%, of whom 330 cases failed in the initial hearing screening, with a positive rate of 12.3% （330/2 665）. 330 cases for a repetitive screening with only 46 cases received actual screening, and the screening rate was 13.94% （46/330）. 8 cases failed in a rescreening, with a positive rate of 7.39 % （8/46）. The actual referral in 6,eventually diagnosed congenital hearing loss in 2 cases 0.75%（2/2 665）,of whom, one newborn suffered hypoxic ischemic eneephalopathy, and the other case suffered severe neonatal asphyxia, ahogether 9 cases have hearing loss in the two groups, with total hearing loss rate of 1.42%o（9/6 333）. 6 had mild hearing loss, 2 severe and 1 profound. 3 cases occurred in the single ear while 6 in the both ears. Conclusion The rescreening rate of the two groups was lower than the recommended standard and the final diagnosis rare in NICU was lower than in other areas.