Why is newborn hearing

screening important ?

Semiramis ZizlavskyPre PITO 8, Sept 2,2013 Jakarta

INTRODUCTION• Babies : develop speech and language from

the time they are born. • Listening and interacting with sounds and

voices around them.• Baby is born with hearing loss: speech and

language development can be delayed.• Hearing screening testing : highly accurate.

earlier identification and treatment of infants

- What is newborn hearing screening- Why hearing screening is important ?- Principles of Screening- Target- Risk Factors- Benefit of Hearing Screening- Risk of Newborn Hearing Screening- Timing to test- How to do ?- Important to thinks

What is newborn hearing screening ?

Newborn hearing screening…….. programs are designed to identify hearing loss in infants shortly after birth

• Prevalence ; 2-3 per 1000 newborn will have HL Indonesia : 1-3 per 1000 1/1000 WBN 10/1000 NICU

Why is early identification of hearing loss important

• Hearing loss is the most common birth condition

• Previous methods for detecting hearing loss have been ineffective (behavioral observation)

• Undetected hearing loss can delay speech, language, social and academic

development

Incidence of Congenital Conditions (Per 10,000)

0

5

10

15

20

25

30

35

Hearing loss Clef t lip or palate

Down syndrome

Limb defects Spina bifida Sickle cell anemia

PKU

Num

ber p

er 1

0,00

0

Congenital Condition Type

Screening

Quick

Cheap

Not Invasive

Accurate, reproducible

Principles of Principles of Screening

Target

Universal Hearing

Screening

All Babies

Targeted Hearing

Screening

Risk Factors

RISK FACTORS (JCIH 2000) 0-28 day-NICU > 48 hours-Syndrome-Family history-Craniofacial anomalies-In utero infection

29 days- 2 years-Parental/caregiverconcern-Family history-Syndrome-Postnatal infection-In-utero infection-Hyperbilirubinemia-Neurogenerative disorders-Head trauma

Benefits of Newborn Screening

• IDENTIFICATION

• EARLY INTERVENTION

• REDUCED MORBIDITY

• FAMILY PLANNING

Risk of Newborn Hearing Screening• Parent anxiety (false positive )• Missed diagnosis ( false negative)• Unanticipated outcome - range of reactions - maternal feelings of guilt - financial problem - cultural sensitivity

HOW TO DO ?

• One

• Two step

Hearing Screening Techniques

OAE

AABROAE + AABR

OAE

ABR

Otoacoustic Emmision (OAE)

Measures sound waves produced in the inner ear

PASS

REFER

Automatic Auditory Brainstem Response (AABR)

PASS

REFER

Measures how the hearing nerve responds to sound

TIMING TO TEST

INTERVENTION

< 6 month HA CI

DIAGNOSIS (OAE,AABR/ABR)3 month RISK FACTORS

IDENTIFICATION (OAE)BEFORE DISCHARGE 2 days

BIRTH: Hospital-based Screening

• OAE,AABR,ABR• Re-Screen before discharge :possible• Hearing screen pass : not guarantee (risk

factors ?)• Re-screening if : - any failure / incomplete - unilateral• Parents refuse screening : documentation

Before one month of Age

• Outpatient re-screening : - failed - missed - incomplete• Unilateral failure : audiology evaluation

Early re-screening :- Earlier diagnosis

- Minimizes parental anxiety

Before Three Month of Age Audiology evaluation

DIAGNOSIS If HL is confirmed (Information, amplification & communication)

Before Six months of Age• Continue early intervention : WHY ???• Other evaluations : - genetics - ophthalmology - pediatrics Syndrome ? - neurology - cardiology - nephrology

HTA Hearing Screening

Bayi baru lahir / 2 hr

OAE PASS REFER

1 –3 BULANAuto ABR

atauclick 35 dB

P R

3 bulanOtoskopi

TimpanometriOAE

Auto ABR

P R

ABR Click & Tone B 500 Hzatau ASSR

Timpanometri High Frequeny

Pemantauan • Speech development• AudiologiTiap 3-6 bulan smp (anak bisa bicara) usia 3 th

Habilitasi usia 6 bulan

Tidak perlu tindak lanjut

ALUR SKRINING BAYI BARU LAHIR

ABR Click + CochlearMicrophonicABR Tone B 500 Hz atau ASSRTimpanometri ( refleks akustik)

High Frequency

Faktor Risiko (-)

Neuropati Auditorik

Tuli Sensorineural

Faktor Risiko (+)

Conclusion

☺Screening is part of a system of follow-up, diagnosis, treatment and evaluation.

☺Timely and appropriate intervention have lasting effects on outcomes.

☺ Family involvement : important

THANK YOU