Universal Neonatal Hearing Screening: An Experience at Tertiary Care Hospital

Background Hearing loss among neonates is one of the important health issue in pediatric population which may remain unnoticed until the child reaches a certain age. The importance of universal early screening, diagnosis and intervention in reducing the negative impact of congenital hearing loss has been described all over the world. Objective To observe the outcome of hearing screening by Automated Auditory Brainstem Response (AABR) in newborns delivered in Dhulikhel Hospital and neonates admitted in an intensive care unit (NICU) of Dhulikhel Hospital. Method A prospective study was done in neonates who were born at Dhulikhel Hospital, Kathmandu University Hospital from February 15th, 2017 to October 30th, 2019. AABR was used for their hearing assessment within 24 hours of birth and again at about 6 weeks of age in those neonates who failed the initial test. All the neonates admitted in NICU were studied regarding the risk factors based on Joint committee on Infant Hearing. Those who failed the test for the second time were referred for detailed audiological diagnostic work up. Result The screening rate was 92.6% of the total deliveries. A total of 5517 neonates comprising of 2800 males and 2717 females were screened from total deliveries of 5956 neonates in the study period. Among them, NICU (sick) babies were 422 (7.7%) and well babies were 5095 (92.3%). Out of them, 1675 failed the test in the first screening and 374 failed in the second screening. So, the total number of referred babies in second screening was 6.7% (374) out of 5517 screened. Amongst them, well babies were 6.59% (336), out of 5095 screened and sick babies were 9% (38) out of 422 screened. Low birth weight and prematurity were found to be the commonest risk factor present among them, followed by the use of ototoxic medications, hyperbilirubinemia and prolonged use of mechanical ventilation. Conclusion Automated Auditory Brainstem Response (AABR) is a very useful tool for hearing screening which should preferably be done in all the neonates where possible. It should be done within one month of life and those with confirmed hearing loss should receive early appropriate intervention for better hearing in future.

THE PROFILE OF CHILDREN WITH CONGENITAL RUBELLA SYDROME SUFFERING FROM HEARING DISORDERS IN DR SOETOMO GENERAL HOSPITAL, SURABAYA

Background: Congenital Rubella Syndrome (CRS) is an infection that can cause hearing loss which is commonly found in infants in Indonesia. The hearing screening of otoacoustic emission (OAE) and automated auditory brainstem response (AABR) is essential as an early screening to prevent speech and language development disorders which may reduce the social function of the patient in the future. Objective: To analyse the profile of children with CRS who suffer from hearing loss in Dr. Soetomo General Hospital, Surabaya in 2015-2017. Material and Method: This research employed a descriptive retrospective study by collecting 118 secondary data from the medical records. Result. CRS was mostly found in 0-3 months age group (76 patients), and was dominated by males (62 patients). The most common signs and symptoms were congenital heart disease (49 patients), followed by hearing loss (37 patients). The serological results were mostly dominated by negative IgM and positive IgG (40 patients). The most dominant results of hearing screening test were OAE and AABR bilateral refer (45 patients). Conclusion. The result of the CRS study is different, and depends on which country the research is conducted.

THE PROFILE OF CHILDREN WITH CONGENITAL RUBELLA SYNDROME SUFFERING FROM HEARING DISORDERS IN DR. SOETOMO GENERAL ACADEMIC HOSPITAL, SURABAYA, INDONESIA

Background: Congenital Rubella Syndrome (CRS) is an infection that can cause hearing loss which is commonly found in infants in Indonesia. The hearing screening of otoacoustic emission (OAE) and automated auditory brainstem response (AABR) is essential as an early screening to prevent speech and language development disorders which may reduce the social function of the patient in the future. Objective: To analyze the profile of children with CRS who suffer from hearing loss in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia in 2015-2017. Materials and Methods: This research employed a descriptive retrospective study by collecting 118 secondary data from the medical records. Results: CRS was mostly found in 0-3 months age group (76 patients), and was dominated by males (62 patients). The most common signs and symptoms were congenital heart disease (49 patients), followed by hearing loss (37 patients). The serological results were mostly dominated by negative IgM and positive IgG (40 patients). The most dominant results of hearing screening test were OAE and AABR bilateral refer (45 patients). Conclusion: The profile of children with CRS suffering from hearing loss is various, depending on which country the research is conducted.

Universal newborn hearing screening: the Belgian experience

Issue Worldwide 466 million people suffer from hearing loss (HL), of whom 34 million children. Early detection of HL in newborns through screening and subsequent intervention significantly improve their developmental and psychosocial outcome. The WHA adopted a resolution on prevention of deafness and HL (2017), urging the member states 'to develop, implement and monitor screening programs for early identification of ear diseases'. Population based newborn hearing screening (PNHS) by automated otoacoustic emission (AOAE) and/or automated auditory brainstem response (AABR) is considered good practice. Description of the Problem Flanders (FL): PNHS by AABR at the age of 2-3 weeks (pass/refer), repeated in case of 'refer'. At 2x 'refer', referral to a tertiary hearing center. French speaking community (FSC): newborns with risk factors for congenital HL are immediately referred to ENT. Others undergo AOAE at day 2-3 (pass/refer with retest in case of 'refer'). At 2x 'refer', referral to ENT for AABR. German speaking community: no data available. Results Coverage rate: FL (birth cohort 2014): 96-98%. FSC (birth cohort 2016): 94.9% of newborns without risk factors had a 1st test. 8.7% of newborns with risk factors didn't have any test. Detection rate/1000 tested newborns FL: 2.1 newborns with congenital HL. FSC: 2.33 newborns with HL (0.30 perceptive/0.36 permanently conductive/0.75 temporary conductive/0.1 conductive NOS/0.06 mixed type/0.77 NOS). Lessons Belgium has at least 2 quality PNHS programs. Due to program differences (different tests/age of testing/registration/financing) in depth comparative analysis on their performance, outcome and cost effectiveness is currently lacking (future perspective). Key messages PNHS is common in high income countries, but is not yet integrated worldwide. In the light of the 2017 WHA resolution Belgium might inspire regions and countries starting up PNHS. An in depth comparative analysis of the current Belgian PNHS programs is needed.

Comparison Results of Automated Auditory Brainstem Response and Brainstem Evoked Response Audiometry for Hearing Loss Detection in High-risk Infants

BACKGROUND: Brainstem evoked response audiometry (BERA) is not widely used for hearing screening because it is considered less practical; however, it is often used for diagnostics. Since the founding of automated auditory brainstem response (AABR), it often uses because it is more practical, has a high sensitivity and specificity in early detection of hearing loss (HL) in high-risk infants. AIM: The objective of the study was to determine the differences results of AABR and BERA for HL detection in high-risk infants at neonatal intensive care unit (NICU). METHODS: The study was conducted from November 2014 to September 2015 with consecutive sampling. The subjects were high-risk infants treated in the NICU room of the Neonatology Division at Dr. Soetomo General Hospital Surabaya and examined using AABR or BERA to determine the existence of HL. RESULTS: BERA results obtained normal (negative) as many as 28 ears (73.68%) and not normal (positive) as many as 10 ears (26.32%). AABR results obtained pass (negative) as many as 23 ears (60.53%) and refer (positive) as many as 15 ears (39.47%). Detection of HL in high-risk infants in NICU with AABR obtained 40% of sensitivity and 60.71% of specificity, 26.67% of positive prediction (NPP), 73.91% of negative predictive value (NPN), 55.26% of accuracy, 39.29% of false positive error rate, and 60% of false negative error rate. The comparative test of Wilcoxon signed-rank between the results of AABR and BER obtained p = 0.236. CONCLUSIONS: There was no difference between AABR and BERA results for HL detection in high-risk infants at NICU.

Comparison between click and CE-CHIRP® stimuli in neonatal hearing screening

Objective: To compare the application time of the Automated Auditory Brainstem Response (A-ABR) between the click and CE-Chirp® stimuli. Methods: Forty-six newborns were evaluated without risk indicators for hearing loss and presenting transient evoked otoacoustic emissions (TEOAE). The A-ABR was performed with Interacoustics® Titan equipment in a hospital, with the click and CE-Chirp® stimuli at the same time. Descriptive statistical analyses and inferential statistics analyses (Student's t-test calculation for mean comparisons among independent samples) were used for the variables age, gender, examination time, laterality and test stimulus used. Results: Of the 46 neonates in the sample, 23 were male and 23 female. The mean age of the sample was 23.1 days. The mean procedure time using the Click stimulus was 85.9 seconds for the right ear and 86.1 seconds for the left ear, whereas for the use of the CE-Chirp® stimulus the results obtained for the right and left ear were28.4 seconds and 27.9 seconds, respectively. There was a statistically significant difference between the mean times obtained through the CE-Chirp® and Click stimuli for both ears (p=0.000). There was no statistically significant difference in the comparison between the right and left ears or between females and males. Conclusion: It was found that the mean duration of the A-ABR procedure using the CE- Chirp® stimulus is three times lower than with the Click stimulus.

DETECTION OF HEARING IMPAIRMENT ASSOCIATED WITH POSITIVE RUBELLA ANTIBODY TEST IN NEONATAL INTENSIVE CARE UNIT DR. SOETOMO HOPSITAL

Hearing loss in newborns or congenital deafness can be caused by the development of parts of the auditory system. Congenital deafness is often associated with infections such as toxoplasmosis, rubella, cytomegalovirus (CMV), and herpes (TORCH). Deafness is very difficult to find early. Examination of inspection methods that are easy and fast. Efforts to conduct early detection are determined through the Newborn Hearing Screening (NHS) program. Otoacoustic Emission (OAE) and Automated Auditory Brainstem Response (AABR) checks are raw materials for early detection. Congenital deafness often occurs with pregnancy infections with viruses such as rubella. Rubella infection during pregnancy, especially during the first trimester often causes Congenital Rubella Syndrome (CRS). Rubella infection is often double with other causes, namely Toxoplasama, CMV and Herpes. Serological examination can be done by examining Rubella IgG and IgM antibodies. Examination of rubella infection with serological anti Rubella IgG and IgM and examination of auditory function with OAE and AABR examination, with results Of the 45 NICU patients at Dr. Soetomo Hospital found 35 (77.7%) patients with positive Rubella serological tests. The number of patients with a single positive serological test was 12 (34.2%) patients and the Double rubella TORCH serological test was 23 (65.7%) patients. From the results of the study 35 patients were at high risk of disturbance and the results of the analysis there were no significant serological differences in Rubella positive with hearing loss (p = 0.087). Hearing loss in NICU infants has a high risk of factors causing Rubella infection and other related causes. Most Rubella Positive serological tests were found Ig G, which can be due to maternal factors. Serology test need to be repeated for confirmation under surveillance program. The constrained is how to follow up the patient s and define the next laboratory test after 6 months. The efforts need to be strengthend in surveillance programs.