Respostas falso-positivas na triagem auditiva neonatal universal: possíveis causas

Children's Hearing Health Panorama in the Unified Health System in the state of Sergipe

PURPOSE

To describe the panorama of children's hearing health in the Unified Health System of the state of Sergipe.

METHODS

A quantitative and retrospective study consisting of four steps: 1) Search the National Registry of Health Establishments of institutions affiliated to the Health Unic System in the state of Sergipe that perform obstetric services and hearing health services; 2) Collecting Neonatal Hearing Screening (NHS) coverage data through DATASUS (from 2012 to 2020); 3) Data collection from medical records of institutions with obstetrics and that perform NHS; and 4) Interview with the guardians of children undergoing auditory rehabilitation. The results were summarized using descriptive statistics (absolute and relative frequency, measures of central tendency, and dispersion).

RESULTS

Only one out of the 29 establishments with obstetrics performs NHS. Two of the Hearing Health Reference Centers (HHRC) are qualified for cochlear implants and two Specialized Centers are qualified for Rehabilitation. From 2012 to 2020, NHS coverage in the state was less than 40%, and when performed in the maternity ward, there were no referrals for Brainstem Auditory Evoked Response (BERA) and audiological diagnosis. The HHRC showed considerable coverage and a lower evasion rate to perform BERA, with a diagnosis rate of 4.8%. The mean time from the NHS to rehabilitation was longer than recommended.

CONCLUSION

NHS coverage must be increased, adjusting the hearing health network to articulate the different levels of care, and reducing the time for identification, diagnosis, and start of rehabilitation.

Hearing of neonates without risk indicators for hearing loss and use of antimalarial drugs during pregnancy: a historical cohort study in the Northern Region of Brazil

INTRODUCTION

Studies have demonstrated the ototoxic effects of antimalarial drugs in individuals who receive these drugs, but little is known regarding the toxicity of these drugs in the newborn auditory system when administered to the mother receive the drug during pregnancy.

OBJECTIVE

To verify the incidence of hearing loss in neonates who have no other associated risk indicators, born to mothers treated for malaria during pregnancy.

METHODS

A retrospective, quantitative cohort study was developed at Hospital de Base Dr. Ary Pinheiro and Clínica Limiar, both located in the municipality of Porto Velho (Rondônia). The sample consisted of 527 newborns divided into two groups: exposed to antimalarials drugs during pregnancy group (n = 32) and non-exposed group (n = 495). Data collection took place from September 2014 to December 2015, through an interview with the mothers and/or guardians of the newborn, through the newborns' and the mothers' records, and the neonatal hearing screening database of the above-mentioned institutions.

RESULTS

All the neonates in the exposed group, assessed through the recording of transient otoacoustic emissions associated with the automated brainstem auditory evoked potential test, underwent neonatal hearing screening in the first examination. Among the newborns in the non-exposed group, 30 showed failure and were retested. Of these, one continued to fail and was referred for diagnosis, in whom the results showed to be within the normal range. Among the neonates of the exposed group, infection with Plasmodium vivax was the most frequent, and was similarly distributed among the gestational trimesters, and chloroquine was the most commonly used antimalarial drug treatment more often given during the third trimester; these findings did not show any influence on the audiological findings of the studied neonates.

CONCLUSION

The present study did not identify any cases of hearing loss in neonates born to mothers who used antimalarial drugs during gestation.

Avaliação do programa de triagem auditiva neonatal da Clínica Escola do Univag

RESUMO Objetivo: verificar se a porcentagem de recém-nascidos que falharam na triagem auditiva do serviço da Clínica Escola do Centro Universitário de Várzea Grande está dentro do determinado pelos indicadores de qualidade dos serviços de Triagem Auditiva Neonatal. Método: estudo retrospectivo, no qual foram analisados os resultados dos exames de Emissões Otoacústicas Transientes realizados no período de Outubro de 2013 a Agosto de 2014, em um serviço gratuito de triagem auditiva neonatal opcional do setor privado de uma universidade da cidade de Várzea Grande-Mato Grosso, Brasil. Compuseram a amostra 251 participantes, subdivididos em dois grupos: grupo de baixo risco composto por 210 participantes, sendo 100 do gênero feminino e 110 do masculino e; grupo de alto risco composto por 41 participantes, sendo 17 do gênero feminino e 24 do masculino. Resultados: foram analisados os resultados da triagem auditiva obtidas com o teste das Emissões Otoacústicas Transientes sendo que no grupo de baixo risco 39,52% passaram, 4,76% falharam e 55,71% não compareceram ao serviço para finalização da triagem. Já no grupo de alto risco, 48,78% passaram, 14,63% falharam e 36,59% não compareceram ao serviço para finalização da triagem, conforme demonstrado nas Tabelas 1 e 2. Conclusão: a porcentagem de indivíduos que falharam na triagem auditiva neonatal pelo serviço avaliado está acima do preconizado pela literatura.

The Effect of Mode of Delivery and Hospital Type on Newborn Hearing Screening Results Using Otoacoustic Emissions: Based on Screening Age

It is well known that false positive on newborn hearing screening increases cost and maternal anxiety and worry. We aimed to evaluate the influence of mode of delivery (cesarean, vaginal) and hospital type (private, public) on false positives first screening test based on screening age. Identification and control of these factors can reduce the rate of false positives. Overall, 2784 infants were evaluated by otoacoustic emissions test. Hearing screening test was performed before hospital discharge. Finally, rate of the false-positive between both delivery group and hospital types were compared on the basis of screening age. False-positive results are obtained when a condition is not present, but the test results indicate that it is present. False positive rate in the first screening test in vaginal delivery was significantly higher than cesarean delivery and rate of significantly decreased with screening age. This reduction was observed only in cesarean delivery. Also the rate of false positives in public hospital is 2.2 fold higher than private hospital (P = 0.000) and with increase in screening age, the rate of False positive is significantly reduced in private hospitals while this decrease is not observed in public hospital. Screening test be retarded as much as possible in cesarean group and private hospital and be conducted just prior to hospital discharge also in public hospital, screening test are done in a separate room. In this way, false positive can be reduced by about six times and the cost and concerns imposed by the rate of false positives minimized.

Intensive care unit: results of the Newborn Hearing Screening

Introduction

Procedures for extending the life of newborns are closely related to potential causes of hearing loss, justifying the identification and understanding of risk factors for this deficiency.

Objective

To characterize the population, analyze the frequency of risk factors for hearing loss, and assess the audiological status of infants attended in a Newborn Hearing Screening program (NHS).

Methods

This was a retrospective study that analyzed medical records of 140 patients from a neonatal intensive care unit, identifying the frequency of risk factors for hearing loss and audiological status, utilizing transient otoacoustic emissions and brainstem auditory evoked potential (BAEP).

Results

Prematurity was present in 78.87% of cases; 45% of the infants were underweight and 73% received ototoxic medication. Audiologically, 11.42% failed the NHS, and 5% of cases failed retest; of these, one had results compatible with hearing loss on BAEP.

Conclusion

A higher rate of low birth weight, and prematurity was observed in infants who underwent screening and had an audiological diagnosis by the third month of life. Only one newborn presented a change in audiological status. The authors emphasize the importance of auditory monitoring for all infants, considering this as a high-risk sample for hearing loss.

Neonatal hearing screening in a low-risk maternity in São Paulo state

INTRODUCTION

The literature indicates that neonatal hearing screening should be universal, so a description of programs that adopt this recommendation is relevant.

OBJECTIVE

To describe the results of newborn hearing screening and the profile of mothers and newborns attended to in a low-risk maternity setting, and to correlate the characteristics of this population with the results of transient evoked otoacoustic emissions.

METHODS

A contemporary cross-sectional cohort study. The sample consisted of 670 infants and the procedures performed were audiological history, transient-evoked otoacoustic emissions (TEOAE), distortion product-evoked otoacoustic emissions (DPEOAE), and automated-brainstem auditory evoked potential (ABSAEP).

RESULTS

The rate of success in this program was 98.5%, the failure rate was 0.62%, and that of non-attendance to finalize the diagnostic process, 0.93%. When correlating the variables studied with the results of transient evoked otoacoustic emissions, there was a significant negative correlation only for age of infant.

CONCLUSION

The program of this maternity hospital was effective and complies with national and international recommendations. The population consisted of young mothers with few pregnancy complications and healthy infants. The only variable that influenced transient evoked otoacoustic emission results, after hospital discharge, was the age at which infants were evaluated.

The importance of retesting the hearing screening as an indicator of the real early hearing disorder

Introduction

Early diagnosis of hearing loss minimizes its impact on child development. We studied factors that influence the effectiveness of screening programs.

Objective

To investigate the relationship between gender, weight at birth, gestational age, risk factors for hearing loss, venue for newborn hearing screening and “pass” and “fail” results in the retest.

Methods

Prospective cohort study was carried out in a tertiary referral hospital. The screening was performed in 565 newborns through transient evoked otoacoustic emissions in three admission units before hospital discharge and retest in the outpatient clinic. Gender, weight at birth, gestational age, presence of risk indicators for hearing loss and venue for newborn hearing screening were considered.

Results

Full-term infants comprised 86% of the cases, preterm 14%, and risk factors for hearing loss were identified in 11%. Considering the 165 newborns retested, only the venue for screening, Intermediate Care Unit, was related to “fail” result in the retest.

Conclusions

Gender, weight at birth, gestational age and presence of risk factors for hearing loss were not related to “pass” and/or “fail” results in the retest. The screening performed in intermediate care units increases the chance of continued “fail” result in the Transient Otoacoustic Evoked Emissions test.

Triagem auditiva neonatal com emissão otoacústica transiente utilizando estímulo de banda estreita

OBJETIVO: avaliar a sensibilidade e a especificidade de um equipamento automático de Emissão Otoacustica Evocada Transiente que utiliza um estímulo de banda estreita, Narrow. MÉTODOS: foi analisado o resultado da Triagem Auditiva Neonatal de 300 neonatos. A Emissão Otoacústica Evocada Transiente foi realizada com um equipamento portátil automático, com o estímulo de banda estreita - Narrow. Todos os neonatos foram submetidos ao Potencial Evocado Auditivo de Tronco Encefálico com o estímulo clique, duração 100μs como padrão-ouro. RESULTADOS: o percentual de "passa" na Triagem Auditiva Neonatal foi de 90,7%. Considerando os resultados do padrão-ouro, foi observado uma taxa de falso-positivo de 9%. A sensibilidade e especificidade encontradas foram de 100% e 92%, respectivamente. CONCLUSÃO: o estímulo de banda estreita - Narrow mostrou-se eficaz para ser utilizado nos programa de Triagem Auditiva Neonatal Universal.

Quality indicators in a newborn hearing screening service

INTRODUCTION

Newborn hearing screening (NHS) programs are implemented across the globe to detect early hearing impairment. In order to meet this objective, the quality of these programs should be monitored using internationally recognized indicators.

OBJECTIVE

To evaluate a newborn hearing screening service (NHSS) using international quality indicators.

METHODS

A retrospective cohort study on the NHSS of Minas Gerais was conducted, analyzing the services performed between 2010 and 2011. Results were analyzed according to criteria from the American Academy of Pediatrics and the Joint Committee on Infant Hearing.

RESULTS

This study assessed 6987 children. The proportions of cases that were referred for a retest, that followed through with retest, and that were referred for diagnosis were 8.0%, 71.9%, and 2.1%, respectively. The proportion of assessed newborn children in the first 30 days of life in this study was 65%. The median age of those children who failed both the NHS and the retest was significantly higher than the other children. The chance of a child with a hearing impairment risk indicator to fail the NHS was 2.4 times higher than of those without a risk indicator.

CONCLUSION

NHSS achieved three of four evaluated indicators. Despite this, it is still necessary to perform NHS earlier and to ensure that the subsequent steps are followed.

[Assessment of levels of otoacoustic emission response in neonates with perinatal asphyxia]

Objective:

To evaluate the effects of perinatal asphyxia on the level of the response to transient otoacoustic emissions in infants.

Methods:

Otoacoustic emissions in 154 neonates were performed: 54 infants who suffered asphyxia at birth, measured by Apgar score and medical diagnosis, and 100 infants without risk were compared. Scores less than 4 in the first minute and/or less than 6 in the fifth minute were considered as "low Apgar". Statistical analysis of the data was performed using the Kruskal, Wilcoxon, and Mann-Whitney nonparametric tests.

Results:

Lower levels of response were observed in transient otoacoustic emission in the group that suffered perinatal asphyxia, with significant values for the frequencies 2,000, 3,000, and 4,000 Hz in the right ear, and 2,000 and 4,000 Hz in the left ear.

Conclusions:

The analysis of the intrinsic characteristics of the otoacoustic emissions evidenced low performance of outer hair cells in neonates who had perinatal asphyxia, which may affect the development of listening skills in this population.

Triagem auditiva neonatal: índice de passa/falha com relação a sexo, tipo de parto e tempo de vida

OBJETIVO: verificar em recém-nascidos (RNs) sem risco de perda auditiva o índice de passa/falha na Triagem Auditiva Neonatal Universal (TANU), relacionando-o com o sexo, o tipo de parto e o tempo de vida. MÉTODO: caracteriza-se como um estudo quantitativo, retrospectivo, transversal e de grupo, inserido na atenção secundária à saúde do hospital universitário onde foram analisados 1.526 prontuários de RNs, com analisador de Emissões Otoacústicas Transientes (EOAT) modelo Otoport Lite. Adotou-se como critério de inclusão RNs de ambos os sexos, nascidos a termo. Foram excluídos da pesquisa 355 RNs que apresentaram um dos indicadores de risco associados à perda auditiva, ou ainda se alguns dos dados coletados pela pesquisa estivessem incompletos. A amostra estudada foi de 1.171 prontuários. RESULTADOS: 88,3% dos RNs passaram na primeira triagem. Não foram encontrados achados significantes em relação ao índice de falha e aos fatores sexo e tipo de parto. Os RNs que realizaram a triagem até 28 horas após o nascimento falharam mais frequentemente, enquanto os com mais de 32 horas de vida passaram mais frequentemente na primeira triagem. CONCLUSÃO: o estudo demonstrou que houve um momento mais adequado para a realização da primeira triagem após 32 horas de vida.

Índice de retorno ao reteste em um programa de triagem auditiva neonatal

OBJETIVO: investigar o nível de consciência dos pais em relação à importância da triagem auditiva neonatal, bem como verificar os motivos do não comparecimento ao retorno agendado após a primeira avaliação. MÉTODO: a casuística foi constituída por 31 mães e/ou responsáveis dos recém-nascidos da unidade neonatal do Hospital Universitário de Maringá, os quais não compareceram ao reteste agendado após a alta hospitalar. RESULTADOS: os motivos apresentados pelas mães e/ou responsáveis para o não comparecimento ao retorno agendado envolveram atitudes que puderam sinalizar pouca importância atribuída às questões relacionadas à audição e a Triagem Auditiva Neonatal, pois sugiram motivos irrelevantes como o esquecimento do retorno, mãe pensou que o bebê não deixaria ser submetido ao exame e a perda de horário para nova avaliação. Tal fato, provavelmente reflete a falta de conscientização por parte das mães dos recém-nascidos quanto à importância da Triagem Auditiva Neonatal. CONCLUSÃO: existe a necessidade de aumentar a conscientização geral em relação à Triagem Auditiva Neonatal, por parte dos familiares e dos profissionais que atuam diretamente com os recém-nascidos, os quais contribuirão para a agilidade do processo diagnóstico, garantindo melhores perspectiva ao futuro de crianças portadoras de deficiência auditiva.

Time after birth in relation to failure rate in newborn hearing screening

OBJECTIVE

To verify and correlate the rate of failure in the newborn hearing screening in relation to the time of life of the newborn when the procedure is carried out.

METHODS

The study focused on babies born on a maternity, from October/2010 to March/2011. Newborns possessing one or more risk indicators for auditory impairment as described by the JCIH, 2007 or with time of life longer than 60 h were excluded. An automated transient evoked otoacoustic emission equipment was used. The "pass" criterion adopted was: signal to noise ratio greater than 6dB and a minimum signal level of -5dbNPS in at least three frequencies. Babies were divided in three groups: GI: fewer than 24 h old, GII: between 24 and 36 h, and GIII: more than 36 h.

RESULTS

890 babies were included, 52% male and 48% female. Of all newborns, 70% passed the test and 30% failed. Regarding gender, 30% female and 31% male failed the test. 35% of the newborns were in GI, 53% in GII and 12% in GIII. Comparing the three groups simultaneously, we conclude that there is evidence of differences between them (P value <0.001). When compared two by two, we conclude that the distributions of GII and GIII may be considered the same (P=0.443), but both are different from GI (P<0.001). We noticed that in GII and GIII, the proportion of patients who presented de "pass" result is much higher than that of patients who presented this result in GI. The result of logistic regression shows that with the passing of each hour after birth, a newborn's chance of failing the test decreases by 5%.

CONCLUSION

We have concluded that the failure rate in the newborn hearing screening was much higher in the newborns screened within 24 h from birth, deviating statistically from the newborns screened between 24 and 36 h. There was no statistically significant difference between the latter two time brackets.

Triagem auditiva neonatal: das alterações auditivas à análise molecular

OBJETIVO: verificar a prevalência da deficiência auditiva em um programa de triagem auditiva neonatal e investigar mutações do gene GJB2 naqueles com suspeita de deficiência auditiva. MÉTODO: foi realizado estudo longitudinal com 908 RN a termo, pós-termo e pré-termo que foram submetidos à realização da triagem auditiva por meio do teste de Emissão Otoacústica Evocada por Estímulo Transiente (EOA-T) e reflexo cócleo-palpebral (RCP). Para os recém-nascidos, em que houve falha na triagem auditiva em uma ou ambas as orelhas, eram encaminhados para uma segunda avaliação. No reteste, quando o teste de EOA-T resultasse em não passa em uma ou ambas as orelhas, a criança era encaminhada para avaliação e conduta otorrinolaringológica. Após realização do Potencial Evocado Auditivo de Tronco Encefálico (PEATE) a equipe de avaliadores decidia se deveria encaminhar a criança para investigação da mutação. Quando havia suspeita de deficiência auditiva era colhido 3 mL de sangue venoso periférico para a pesquisa de mutação do gene da conexina 26. RESULTADOS: foi constatado a presença de deficiência auditiva condutiva em 2 recém-nascidos (0,22%) e neurossensorial em 1 (0,11%). Na criança com deficiência auditiva neurossensorial foi detectada a presença da mutação 35delG. CONCLUSÃO: a avaliação audiológica em conjunto com exames moleculares das principais mutações do gene GJB2 em recém-nascidos com suspeita da deficiência auditiva contribuiu para a rapidez do diagnóstico audiológico, visando uma intervenção precoce, aconselhamento genético e prognóstico educacional da criança.