DPOAE序贯AABR筛查模式在新生儿听力初筛中的应用

Application of Sequential Protocol Using DPOAE and AABR in Universal Newborn Hearing Screening

目的探讨新生儿出生48小时内应用畸变产物耳声发射(distortion product otoacoustic emissions,DPOAE)序贯自动听性脑干反应(automated auditory brainstem response,AABR)筛查模式进行听力初筛的有效性。方法筛查对象为1800例新生儿,出生后48小时内采用DPOAE序贯AABR模式(简称序贯模式)进行听力筛查,即先采用DPOAE听力初筛,未通过者立刻进行AABR筛查,若AABR通过,则为序贯模式初筛通过;同时,DPOAE初筛未通过者,在出生48小时至7天内进行第二次DPOAE筛查;序贯筛查未通过者或者二次DPOAE筛查未通过者均转入42天复筛,复筛未通过者3月龄内转入诊断程序;对比序贯筛查和二次DPOAE筛查的假阳性率及确诊听力损失患儿的差异。结果新生儿出生48小时内序贯模式筛查的假阳性率5.3%(95/1794),二次DPOAE筛查假阳性率6.2%(112/1794),差异无统计学意义(P=0.224>0.05);且两种听力筛查模式最终均确诊了同样的6例听力损失患儿。结论DPOAE序贯AABR听力初筛模式的假阳性率及假阴性结果与二次DPOAE初筛模式相似,且可将初筛时间提前,可作为新生儿听力初筛有效可选方案之一。

Objective To explore the effectiveness of sequential protocol using DPOAE and AABR in newborn hearing screening within 48 hours after birth.Methods A total of 1800 newborns were screened for hearing using DPOAE.For those who failed,they were referred for AABR within 48 hours(sequential protocol mode),and also were rescreened using DPOAE after 48 hours to 7 days(DPOAE rescreening mode).Those who failed screening were referred for rescreening in 42 days and diagnosis in 3 months.The quality was examined by comparing the false positive rate and the final diagnosed hearing loss population between different screening modes.Results The false positive rate of DPOAE sequential AABR screening was 5.3%(95/1794)within 48 hours after birth,and the false positive rate of DPOAE rescreening was 6.2(112/1794)after 48 hours.The difference was not statistically significant(P=0.224).These two modes eventually diagnosed the same 6 patients with hearing loss.Conclusion The sequential protocol using DPOAE and AABR can advance the initial screening time without increasing the false positives and false negatives.It can be used as one of the effective options for newborn hearing initial screening.