基层地区新生儿医院内两步听力筛查模式探讨

A study of the two-step hearing screening method of newborns in primary-setting hospital

目的探讨基层地区医院内两步听力筛查模式的有效性。方法选择2008年11月至2010年4月出生于安阳市妇幼保健院、并接受瞬态诱发性耳声发射筛查的新生儿,医院内第一次初筛单耳或双耳未通过的新生儿于出院前进行第二次初筛或生后42天进行复筛。记录听力筛查时间及双耳筛查结果,按完成听力筛查的时间将新生儿分组,分析通过率与筛查时间的关系、医院内一次初筛和两次初筛后总的通过率,以及医院内第二次初筛与42天复筛两组人群的通过率。结果 (1)完成听力第一次初筛的新生儿共10060例,总体通过率49.1%(4944/10060),通过率随出生后筛查时间的延迟而提高。(2)未通过第一次初筛的新生儿中30.0%(1535/5116)出院前接受第二次初筛,通过率78.4%(1204/1535),两次初筛后总体通过率61.1%(6148/10060),与一次初筛通过率(49.1%)差异有统计学意义(χ2=291.3,P<0.001)。(3)未通过医院内听力初筛的婴儿中39.1%(1531/3912)于42天接受复筛,通过率92.7%(1420/1531),与医院内第二次初筛通过率(78.4%)差异有统计学意义(χ2=127.3,P<0.001)。结论新生儿听力筛查时间是影响通过率的关键因素,随着出生后筛查时间的延迟,初筛通过率逐步提高;医院内两步筛查可提高初筛通过率,但医院内第二次初筛通过率低于42天复筛通过率。

Objective To study the efficacy of the two-step hearing screening method of newborns in primary-setting hospital. Methods Neonates born at Anyang Maternal and Children＇s Hospital from December 2008 to March 2010 were included into the study. Transient eyoked otoacoustic emissions （TEOAEs） were used as the hearing screening test in all these neonates within 2 -3 days after birth. Those who didn＇t pass unilaterally or bilaterally in the initial test to undergo the second screening test before discharge or at 42-day. Screening results and the time of screening were recorded. The neonates were assigned into different groups according to the time of test. Statistics were analyzed including the following aspects： The relationship between the passing rate and the time of the test; The relationship between the fist-time passing rate and the overall passing rate; The relationship between the second-time passing rate and the passing rate at 42-day. Results （ 1 ） Tatal of 10 600 neonates wentthrough the first hearing screening test, and the passing rate were increased （improved） as the neonates grew（thrived）. The passing rate was 49. 1% （4944/10 060）in the first test. （2） Of newborns failed in the first test, 30. 0% （1535/5116）took the second screening test before discharge, and the passing rate was 78.4% （1204/1535）. The overall passing rate after two-step screening test was 61.1% （6148/10 060, which was higher than the that of the first test alone （X2 = 291.3, P 〈 0. 001 ）. （3） Of newborns failed in the two-step screening test before discharge, 39. 1% （1531/3912） obtained （underwent） rescreening at 42-day, and the passing rate was 92. 7% （ 1420/1531 ）which was higher than the passing rate of the second screening test before discharge （X2 = 127. 3 ,P 〈0. 001 ）. Conclusions The timing of the screening test was the key factor affecting the passing rate in newborns, and the passing rate would increase as the neonates grew. The two-step hearing screening test before discharge resulted in higher passing rate, but the passing rate of the second-time screening in the hospital was lower than at d2-day.