天津市新生儿听力筛查及信息化建设

Neonatal hearing screening and its information system development in Tianjin

目的通过对新生儿听力筛查及信息化管理,早期发现和诊断先天性听力损失,及时干预。方法新生儿出生3～5d采用畸变产物耳声发射(distoetion product otoacoustic emissions,DPOAE)进行初筛;42d用DPOAE和自动判别听性脑干反应(auto auditory brainstem response,AABR)进行复筛;3个月和6个月分别用听性脑干反应(auditory brainstem responses,ABR)、多频稳态反应(auditory steady state response,ASSR)和声导抗检查进行两次诊断;有听力障碍的患儿适时干预措施,并定期复查和随访。结果 2009～2010年在天津市出生活产婴儿106547人,104224例生后3d开始进行听力测试,全市建立了新生儿听力筛查信息化网络管理。初筛率为97.82%;初筛时正常新生儿未通过率为9.12%(9075/99484),高危儿为23.65%(1121/4740),高危儿未通过率明显高于正常新生儿(χ2=1.082,P<0.01);42d复筛率为53.44%;3个月接受第一次诊断的有362例;6个月接受诊断的有117例,其中100例(161耳)有不同程度听力损失,中重度和极重度听力障碍患儿在6个月确诊后进行干预。结论①通过建立新生儿听力筛查信息网络化管理系统,初筛率达97%以上;②42d新生儿听力复筛采用DPOAE和AABR检测技术联合应用,减少了漏筛和漏诊;③高危新生儿初筛阳性率为23.65%,明显高于正常新生儿。

OBJECTIVE To identify newborn＇s hearing loss and initiate intervention in time through neonatal screening and information system.METHODS Initial screening is done with distortion product otoacoustic emissions（DPOAE）,3-5 days after birth.Re-screening is on the 42nd day after birth with DPOAE and auto auditory brainstem response（AABR）.Diagnostic examinations are at 3 months and 6 months old by auditory brainstem responses（ABR）,auditory steady state responses（ASSR）,and acoustic impedance audiometry methods.Infants with hearing loss are intervened and followed up.RESULTS From 2009 to 2010,104224 newborns received hearing screening among the 106547 live borns,with the initial screening rate of 97.82%.The high risk infants＇ rate that did not pass the initial screening is significantly higher than the normal infants（χ 2 =1.082,P 0.01）.Re-screening rate at 42 days is 53.44%.362 infants got the first diagnostic examination at 3 months;117 infants got the second one at 6 months,100 of them（161 ears）were diagnosed with different degrees of hearing loss.Middle and severe hearing impaired infants were intervened after 6 months of age.CONCLUSION 1.A good neonatal hearing screening information system has been developed in Tianjin,covered all obstetric hospitals.The initial screening rate reached 97%.2.DPOAE and AABR are applied in re-screening in order to ensure the accurate and compressive hearing evaluation.3.The high risk infants＇ positive rate is 23.65%,obviously higher than that of the normal newborns＇.