2017~2019年广东省新生儿听力初筛、复筛、随访现况及影响因素

Newborn Hearing Screening in Guangdong Province:Status and Influencing Factors of Initial Screening,Rescreening and Follow-up

目的调查广东省新生儿听力筛查的现状,并探讨复筛、随访的影响因素。方法对来自广东省各市的195家相关医疗机构中195例从事新生儿听力筛查的工作人员进行2017年至2019年新生儿听力筛查初筛率、复筛率、失筛原因、失访率及对目标人群随访情况的问卷调查,并结合2017年至2019年广东省新生儿听力筛查年度报表及相关文献资料,分析2017年至2019年广东省新生儿听力筛查、复筛、随访现况以及可能影响因素。结果2017年广东省全省初筛率为89.36%,其中初筛率最低的地区为粤东地区(64.61%),2018年初筛率为92.10%,2019年为94.20%;77.44%(151/195)的受调查机构新生儿复筛率大于50%,12.82%(25/195)的机构复筛率在30%~50%之间,9.74%(19/195)机构复筛率小于30%。对复筛率的可能影响因素进行Spearman等级相关检验,医院所在地区(珠三角地区赋值为1,粤西地区赋值为2,粤北地区赋值为3,粤东地区赋值为4)与复筛率呈显著负相关(r=-0.28,P<0.05),医院等级与复筛率呈显著正相关(r=0.49,P<0.05),失筛原因从高到低依次为家属对听力筛查的认识不足、认为不需要复筛(43.08%,84/195)、联系方式错误(26.67%,52/195)、经济因素(16.92%,33/195)、交通不便(11.79%,23/195)、因为传统观念拒绝验证新生儿可能存在疾病(1.54%,3/195)。73.85%(144/195)的受调查机构定期对未通过复筛的新生儿或听力筛查通过但有听力损失高危因素的新生儿进行随访,对随访的可能影响因素进行Spearman等级相关检验,医院所处地区与目标人群随访呈显著负相关(r=-0.224,P<0.05),医院等级与目标人群随访呈显著正相关(r=0.49,P<0.05)。定期随访的144家受调查机构失访率均低于10%。结论2017年至2019年广东省新生儿听力初筛率连年升高,初筛率地区分布两极化的现象有所改善,但粤东地区初筛率仍较低;复筛率仍未能达80%,仅珠三角地区可达89%,但粤北、粤东部分地区未能达标;影响复筛率的因素除联系方式错误外,主要为对新生儿听力筛查未充分认知和经济因素;广东省新生儿听力筛查随访覆盖率较高,失访率较低,但各地区医院的随访工作开展不平衡,基层医院的随访工作还有待加强。

Objective To investigate the current status of newborn hearing screening and the influencing factors of rescreening and follow-up in Guangdong province.Methods In 2019,a questionnaire survey was conducted on the initial screening rate,rescreening rate,causes of loss of screening,loss to follow-up rate and follow-up situation of the target population of newborn hearing screening from 2017 to 2019 in 195 medical institutions from various cities in Guangdong province.Combined with the annual report of the newborn hearing screening in Guangdong province from 2017 to 2019 and related literature data,the progress of the initial screening and the current status of rescreening and follow-up,explore the influencing factors were investigoded.Results In 2017,the initial screening rate of Guangdong province was 89.36%,of which the region with the lowest screening rate was eastern Guangdong(64.61%).The initial screening rate of Guangdong province reached 92.10%in 2018,and 94.20%in 2019.77.44%(151/195)of the surveyed institutions'rescreening rate was more than 50%,12.82%(25/195)was between 30%and 50%,and 9.74%(19/195)was less than 30%.The possible influencing factors of rescreening rate were tested by Spearman rank correlation test①Hospital location when establishing the database,the values of Pearl River Delta,western Guangdong,northern Guangdong and eastern Guangdong were 1,2,3 and 4,respectively,r=-0.28,P<0.05,showing a significant negative correlation.②Hospital grade r=0.49,P<0.05,showing a significant positive correlation.According to the results of the questionnaire,the number of votes for the cause of loss to rescreening was from high to low as the lack of understanding of hearing screening,indicating that there was no need for rescreening 43.08%(84/195),contact error 26.67%(52/195),economic factors 16.92%(33/195),transportation inconvenience 11.79%(23/195),or refused to verify that there may be diseases in newborns due to traditional beliefs 1.54%(3/195).73.85%(144/195)of the surveyed institutions regularly followed up the target population,that was,newborns who failed rescreening or newborns with normal hearing screening but with high risk factors for hearing loss.The possible influencing factors of regular follow-up were tested by Spearman rank correlation test.When establishing the database,the value of regular follow-up was 1,and that of non-regular follow-up was 0.The results showed that①Hospital location r=-0.224,P<0.05,showing a significant negative correlation.②Hospital grade r=0.49,P<0.05,showing a significant positive correlation.The loss of follow-up rate of 144 institutions surveyed on a regular basis was less than 10%.Conclusion From 2017 to 2019,the overall initial screening rate of newborn hearing screening in Guangdong province had increased year after year,and the polarization of the regional distribution of initial screening rate has been improved,but the initial screening rate in eastern Guangdong was still low.The overall rescreening rate in Guangdong province was still not up to 80%,and only the Pearl River Delta region reached.However,some areas in northern and eastern Guangdong fail to meet the standards,and the regional differences in rescreening rates were quite different.Apart from the fact that the accurate reasons for loss to rescreening were not known due to incorrect contact information,the main reason for loss to rescreening was the lack of adequate cognition and economic factors.The follow-up coverage rate of newborn hearing screening in Guangdong province was high,and the loss to follow-up rate was low,but the follow-up situation of primary hospital needs to be strengthened,and the follow-up development of hospitals in different regions is not balanced.