Hearing and Vision Screening Program for newborns in Italy

MATERIALS AND METHODS

Data were collected through a nationwide survey conducted in 2018. All maternity wards active in Italy in 2017 were included.

BACKGROUND

The aims of this paper were to present data on the implementation and coverage of simultane-ous Universal Neonatal Hearing and Vision Screening programmes and to evaluate the organization and management of these healthcare procedures in Italy.

CONCLUSIONS

Our results show that implementation of simultaneous hearing and vision screening increased the coverage of both screening tests and is a new multi-disciplinary approach to sensorineural disability. The use of both ABR and TEOAE tests in the hearing screening decreases the number of newborns sent for audiological evaluation, with a notable reduction of costs. The consideration that ocular problems are two to three times more common in deaf and hearing impaired children than their in hearing peers, confirms the importance of establishing guidelines for simultaneous hearing and vision screening, that favors the formation of a multi-disciplinary team (pediatrician, audio-logist, ophthalmologist).

RESULTS

HEARING SCREENING. Overall 427,365 newborns out of 448,386 (95.3%) received the hearing screening test (first level) in 391 out of the 409 maternity hospitals (95.5%), with a national mean referral rate of 3.63% (SD ± 4.58). A statistically significant increase (p<0.034) of newborns sent to audiological examination was found in maternity hospitals with Neonatal Intensive Care Unit (NICU) with "TEOAE only" protocol (9.32% SD ± 7.57), compared to those with "TEOAE/AABR" (3.0% SD ± 3.29). VISION SCREENING. Overall 335,262 newborns out of 448,386 (74.7%) received vision screening (Red Reflex test) for vision impairment in 302 out of 409 maternity hospitals (73.8%), before nursery discharge. The mean referral rate, recorded in only 22 maternity hospitals out of 302 (7.2%), was 0.48% with a rate of lost to follow up of 0.75 %.

Comfort rules for face masks among healthcare workers during COVID-19 spread

Background

The outbreak of Coronavirus disease 2019 (COVID-19) made imperative the use of protective devices as a source control tool. As there is no definite antiviral treatment and effective vaccine, the only efficient means of protecting and mitigating infectious contagion has been the use of personal protective equipment, especially by healthcare workers. However, masks affect the humidification process of inhaled air, possibly leading to a basal inflammatory state of the upper airways.

Study design

This is a single-center observational study conducted at the University Hospital of Catania from April 1, 2020, to June 31, 2020.

Methods

We analyzed the role of protective masks on the elimination of upper airways complaints in healthcare workers of the University Hospital of Catania. We evaluated 277 subjects through a self-administered 17 item questionnaire based on respiratory, work performance and health-related quality of life domains.

Results

A higher prevalence of nasal and ocular symptoms, perceived reduced work performance, difficulty in concentrating, and sleep disorders were found. After two weeks adhering to a list of good practices that we recommended, significant reversibility of the symptoms investigated and work performance enhancement were observed.

Conclusions

Despite clinical complaints related to personal protective equipment, effective amelioration through usage rules is easily obtained. Given the essential use of protective masks, healthcare workers have to adhere to appropriate work and safety prevention rules.

Evolution of Italian Universal Newborn Hearing Screening Programs

BACKGROUND

The aim of this study was to evaluate the state of implementation of the Universal Newborn Hearing Screening Programs in Italy and to determine the effect that an ad hoc legislation may have on the percentage of infants screened for detection of hearing impairment in nurseries.

MATERIAL AND METHODS

Italian Newborn Hearing Screening data were obtained during four national surveys (years 2003, 2006, 2008, and 2011). The screening rates obtained by the Regions which adopted or did not adopt a legislation to increase the newborns' coverage were compared.

RESULTS

In 2011, the average coverage rate was 78.3%, but in 12 out of 20 Regions it exceeded 95%. Coverage rate was greater in Regions that implemented an ad hoc legislation compared to Regions that did not. As a matter of fact, Regions which passed the legislation screened more than 95% of infants, whereas Regions without legislation reported a mean screening rate of nearly 67% of newborns.

CONCLUSION

Current results seem to confirm that a specific legislation might have a decisive effect on the increase of rate of coverage of newborn hearing screenings.

[Permanent childhood hearing impairment: universal newborn hearing screening, PCHI management]

The most recent advances in technology and scientific knowledge have allowed better outcomes in permanent childhood hearing impairment (PCHI) than in the past period. The Universal Newborn Hearing Screening with OtoAcoustic Emissions provides an early identification/habilitation program for hearing impaired children, giving them immediate access to intervention when needed. The aim of this paper was to treat the organization and management of health care procedures for PCHI in Italy, which are not well coordinated with respect to other European Countries. Pediatrician and neonatologists appear to be especially engaged in these aspects.

Universal newborn hearing screening programs in Italy: survey of year 2006

CONCLUSION

Our results suggest a rapid diffusion of newborn hearing screening programs in Italy and indicate that three conditions seem to play a crucial role in the implementation of Universal Newborn Hearing Screening (UNHS) programs: the size (>800 births/year) and location (metropolitan urban areas) of the hospital, and the presence of an audiologist in the UNHS coordinating team.

OBJECTIVES

The aim of this paper is to provide data on the degree of implementation and coverage of UNHS programs in Italy.

MATERIALS AND METHODS

Data were collected through a Screening Survey Questionnaire that was sent to all birthing hospitals active in Italy in 2006 and was filled in by the chief of the hospital or by the UNHS program coordinator.

RESULTS

In Italy UNHS coverage had undergone a steep increase from 29.3% in 2003 (156,048 newborns screened) to 48.4% in 2006 (262,103 screened). The majority of UNHS programs were implemented in the two most economically developed areas, i.e. in the north-west area (79.5%, 108,200 of 136,109 births), and in the north-east area (57.2%, 52,727 of 92,133 births), while a limited diffusion still remains in some areas, typically in the islands (11.3%, 7158 of 63,460 births).

Early hearing detection and intervention in children with prelingual deafness, effects on language development

AIM

The purpose of this study was to assess, the cognitive and receptive language abilities in children with prelingual hearing impairment, in relation to the age of enrollment in the intervention program and examine the related variables.

METHODS

Seventy children with congenital prelingual deafness were divided into 2 groups based on their age at the start of the intervention program: 17 children enrolled between 0-12 months of age, 53 children enrolled after the age of 12 months. The age of intervention is defined as the identification and confirmation of hearing loss, adaptation of hearing aids, and enrollment in the program of special education at the Orthophonological Institute of Rome. Assessments were carried out at 5 years of age. The receptive language abilities were measured using the Peabody picture vocabulary test (PPVT), while the cognitive abilities used the Raven standard progressive matrices test. The material was administered by staff skilled in assessing children with hearing loss. The assessment of language score tests (PPVT and Raven progressive matrix test) of samples of children with hearing loss was compared with normal standardized scores of hearing peers at 5 years of age. Mean group differences were compared using t-tests. The results were considered statistically significant for a P-value less than or equal to 0.05.

RESULTS

A progressive decline in the mean PPVT score with increasing ages of enrollment was present. The mean receptive language score of the children enrolled within the first 12 months was significantly better (P<0.001) compared to those over 13 months. The nonverbal IQ, determined by Raven's standard progressive matrices, showed no statistically significant differences in IQ scores (P = 0.083) between children with early and late age of enrollment. Our data revealed that language abilities are significantly affected by the degree of hearing loss (P<0.001 Children with very severe hearing loss, find it more difficult to achieve adequate language abilities than children with moderate and severe hearing.

CONCLUSION

According to previous studies on the matter, our data suggest that identification of hearing loss at early age associated with early hearing aid fitting, and enrollment in early intervention within the first 12 months of age, may help to obtain good results in the receptive language skills performance. The early identification of prelingual hearing loss at birth through the neonatal screening must therefore be, , considered the primary step for accessing a quality intervention.

[Societal cost of pre-lingual deafness]

Congenital hearing loss still remain an important medical and social problem for the delayed language development. Object of this study is to provide an updated and close estimate of the economic burden involved in pre-lingual hearing loss. Data were provided by the Ministry of Health data bank, the Ministry of Education national data bank, the National Institute of Social Insurance national data bank and the Italian Central Statistics Institute. The information was collected by means of a specially provided Societal Cost Questionnaire (SCQ). Direct medical costs, direct non-medical costs and indirect welfare costs involved in deafness were included in the cost estimate. Was enrolled in the study a sample of subjects with pre-lingual deafness, with a mean bilateral neuro-sensorial hearing impairment equal to 60 dB or more for 500, 1,000 and 2,000 Hz frequency tones in the better ear detected in neonatal age, had prevented speech from developing. The statistical assessment was performed according to an actuarial approach, considering the estimated life expectancy at birth, based on updated population data from census 2001. Based on life expectancy, the lifetime mean cost assessed for a subject affected by profound pre-lingual deafness turned out to be equal to Euro 737,994.76 for a male and Euro 755,404.02 for a female. Unlike other disabling affections, deafness weighs significantly more on the social system than on the health system. As a matter of fact, the direct medical costs, such as audiological diagnosis, hearing aids, etc., only account for 3.8% of the societal cost, whereas education, rehabilitation and welfare costs reach 96.2% of the total. Finally, our results suggest that societal costs can only be reduced by zeroing in on promotion and broadening of effective prevention strategies. The appropriate public health measures (such as the universal newborn hearing screening) set up and implemented in several European and non-European countries proved effective and reduced the handicap degree resulting from deafness. The investment in prevention will be widely paid.

Prevalence of prelingual deafness in Italy

Neonatal hearing loss is the most frequent sensorial congenital defect in newborns. No data are available on worldwide prevalence of congenital deafness. World Health Organization (WHO) data indicate 1-4 cases per 1000 individuals, with a considerable increase in developing countries. A prevalence exceeding 1 per 1000 however, indicates a serious public health problem calling for urgent attention. Aim of the study was the evaluate the prevalence of prelingual deafness in the Italian population and determine the socio-demographic characteristics of the condition. Data were provided by the National Institute of Social Insurance (INPS) and the Italian Central Statistics Institute (ISTAT) and were collected in 18 out of the 20 Italian regions (98.2% of total population). All subjects recognized as deaf-mute by a special medical committee were included. According to law No. 509/1988, they had to present a mean bilateral sensorineural-hearing impairment, detected in neonatal age, which caused the damage in speech development and equal to 60 dB or more for 500-, 1000- and 2000-Hz frequency tones in the better ear. Prevalence rates were calculated according to region and age bracket using updated population data from census 2001. Statistical analyses were performed using the SPSS statistical software package. A total of 40,887 cases of prelingual profound sensorineural hearing loss > or =60 dB were detected in Italy in 2003, for a total prevalence rate of 0.72 per 1000. The hearing impairment prevalence differs according to sex. The overall prevalence is 0.78 per 1000 for males and 0.69 per 1000 for females (p < 0.001). The hearing impairment prevalence differs according to region of residence (p < 0.001). The geographic distribution of prelingual deafness was found to be: North 15,644 cases (0.63 per 1000), Central Italy 7111 cases (0.64 per 1000), South and Islands 18,132 (0.87 per 1000). The prelingual hearing loss is highly prevalent in South Italy (Basilicata, Calabria and Sicily). For the southern regions of Italy, the rate observed in the 50-64 and >64 age groups reached 1.27 and 1.15, respectively. This phenomenon may have been due, in part, to the epidemic incidence of maternal rubella which occurred in the 40's and 50's (in Italy, the rubella vaccination was only recommended starting from 1972), and, in part, to the habit of contracting consanguineous marriages. Data from the Vatican Archives on 520,492 consanguineous marriages, for which dispensation was requested in the period 1911-1964, indicate that in the years 1935-1939, in small villages in South Italy (Basilicata, Calabria, Sicily) consanguineous marriages accounted for over 40% of marriages.

Actinomycosis of submandibular gland: an unusual presentation

An unusual presentation of oro-facial actinomycosis, mimicking the clinical appearance of a malignant lesion is reported. The patient, a 74-year-old female, presented with a right submandibular mass, which slowly grew in size over a period of about 2 months, and a modest dysphagia. A painless cervical mass was palpable over the submandibular region. The rhino-pharyngo-laryngeal region, explored by flexible fiberoptic examination, was normal. At ultrasonography, a 2x2 cm infiltrating dyshomogeneous mass, involving the right submandibular gland, was visible. No connection with adjacent organs was found. There was no associated cervical lymphoadenopathy. Ultrasound-guided fine-needle aspiration cytology, performed on lesion, revealed no evidence of malignancy. The presence of characteristic colonies of actinomyces infection was found. The patient was treated initially with tetracycline chloridrate 100 mg: 1 tablet every 12 hours for 7 weeks, but a repeat ultrasonography showed no resolution. A further fine-needle aspiration cytology showed no actinomyces infection in the specimen. The patient was treated with methylprednisolone, 20 mg every 24 hours, for 5 days. After steroid treatment, the patient has been well and, upon repeat ultrasonography, total resolution of the submandibular lesion was confirmed. In conclusion, the clinical presentation of cervicofacial actinomycosis is variable and may mimic a malignant lesion or chronic granulomatous infections. Diagnostic and therapeutic findings are discussed.