一种新的新生儿听力筛查模式探讨:42天初筛

A New Model for Newborn Hearing Screening—First Screening on 42nd day

目的在医院分娩率较低地区，探讨采用出生后42天左右进行初筛的可行性，为难以在出生后48～72dx时进行听力初筛的地区寻求一种可行的听力筛查方法，并可作为新生儿听力筛查（以下简称新筛）项目切人儿童保健体系的起始点。方法采用畸变产物耳声发射（distortionproductotoacousticemissions，DPOAE）和听性脑干反应（auditorybrainstemresponse，ABR），比较3507例（男1898／女1609）出生后20～94天（43．06＋4．123）婴儿（以下简称婴儿组），和2325例（男1199／女1126）1-42天（3．53~1．339）新生儿（以下简称新生儿组）的听力筛查结果，主要指标包括初筛通过率、初筛未通过率、复筛率、复筛通过率、复筛未通过率、转诊率、确诊率。结果（1）初筛通过率：新生儿组83．4％（1940／2325），婴儿组92．9％（3257／3507），x。=128．151，P=O．000；（2）初筛未通过率：新生儿组16．6％，婴儿组7．1％，x。=128．151，P=O．000；（3）复筛率：新生儿组77．9％（300，385），婴儿组84．8％（212，250），x。=4．591，P=O．032；（4）复筛通过率：新生儿组85．7％（257／300），婴儿组71．7％（152／212），x。=15．062，P=O．000；（5）复筛未通过率：新生儿组14．3％，婴儿组28．3％，~2=15．062，P=O．000；（6）转诊率：新生儿组和婴儿组均为100％；（7）确诊率：新生儿组18．6％（8／43），婴儿组68．33％（41／60），x。=21．080，P=O．000。结论听力初筛放在出生后42天左右进行，有较高的初筛通过率、复筛率和确诊率，具有一定的可行性，可以考虑将其作为新筛切入儿童保健体系的起始点。

Objection To identify a new screening model for rural areas with low hospital delivery rate and to identify an appropriate junction to incorporate newborn hearing screening into the child care system. Methods One group of 1 to 42 days （mean = 3.53＋1.339）old neonates （n=2325, M/F = 1199/1126） and one group of 20-94 days （mean = 43.06＋4.123 ） old infants （n= 3507, M/F = 1898/1609 ）were screened using DPOAEs . For those who failed the test screening, a sec- ond DPOAE screening was conducted in two weeks. If failed again, they were tested by ABR. The rate of passing and failure in the first and second screenings, of seconding screening, of referrals and of successful diagnosis were compared between the two groups. Results （ 1 ） First screening pass rate： was 83.4% （ 1940/2325 ） in neonates and 92.9% （3257/3507） in infants （X2=128.151, P=0.000）; （2）First screening failure rate was 16.6% in neonates and 7.1% in infants （X~=128.151, P=0.000）; （3）Rate of second screening was 77.9%（300/385）in neonates and 84.8%（212/250）in infants （X~=4.591, P=0.032）; （4） Second screening pass rate was 85.7%（257/300） in neonates and 71.7%（152/212） in infants （X2=15.062, P=O.000）; （5） Second screening failure rate was 14.3% in neonates and 28.3% in infants （X2=15.062, P=0.000）; （6）Referral rate was 100% in both groups; （7）rate of diagnosis was 18.6% （8/43）in neonates and 68.33% （41/60） in infants （X2=21.080, P=0.000）. Conclusion Postponing initial hearing screening to 42-day appears to be associated with higher first screening pass rate, second screening rate and increased diagnosis accuracy.