With the increasing time and quantity of newborn hearing screening in Zhongshan City, Guangdong Province, how to strengthen the follow-up, diagnostic intervention and rehabilitation management of newborns and infants who failed hearing screening has become a problem faced by hospitals and hearing screening and diagnosis centers. Manual data entry and document management have brought a lot of complicated workload to newborn hearing screening, which is increasingly unsuitable for its management mode. In order to improve the management level and strengthen the quality control of newborn hearing screening in Zhongshan City, from August of 20 1 1 year to now, Zhongshan Hospital of Traditional Chinese Medicine and eleven county hospitals have popularized and applied the network management system of newborn hearing screening in Guangdong Province. This paper analyzes and summarizes the newborn hearing screening before and after the application of the system, and discusses the practicability and advancement of the system.
1, data and methods
1. 1 20 10 Newborns born in obstetrics in eleven town hospitals, such as Zhongshan Hospital of Traditional Chinese Medicine and Xiaolan People's Hospital, since July, of which July 20 10? 2911July Before the application of Guangdong neonatal hearing screening network management system, there were 29,657 newborns (593 14 ears) born in the above hospitals, 2011August? From August 2065438 to August 2002, a total of 3 1 169 newborns (62338 ears) were born in the above hospitals.
1.2 hearing screening and diagnostic procedures all newborns were screened for hearing from 3 days after birth to before discharge (before discharge of NICU high-risk infants), and those who failed the initial screening were re-screened for 42 days. Those who still failed were diagnosed for the first time at 3 months and for the second time at 6 months. Infants diagnosed with hearing impairment receive intervention and rehabilitation treatment at the age of 6 months. Before the application of this system, all data were registered and managed manually. The basic data and input data for registration include: mother's or newborn's name, newborn's sex, age, date of birth, initial screening results, re-screening, high-risk factors, diagnosis, intervention time and mode, detailed address and effective contact telephone number. After the application of this system, the above data are entered through the neonatal hearing screening network management system.
1.3 hearing screening method and application of newborn hearing screening network system
1.3. 1 hearing screening diagnostic instrument Zhongshan hospital of traditional Chinese medicine used algoSi rapid auditory brainstem evoked potential instrument of the United States, and township hospitals used screening otoacoustic emission instrument for routine newborn hearing screening. The audiological diagnosis used NicoletVikingQuest auditory brainstem evoked potential instrument in the United States, VivosonicVivoLinkintegrity multi-frequency steady-state evoked potential instrument in Canada, MADSENCAPELLA full-function otoacoustic emission instrument in Denmark, GSI6 1 pure tone audiometer in the United States and GSITympStar acoustic impedance instrument in the United States.
1.3.2 Guangdong newborn hearing screening network management system functions: ① input or automatically import the basic information of newborns; ② Management of intervention results of hearing screening diagnosis; ③ Automatic tracking SMS management; ④ Classified authority management of screening centers and hospitals; ⑤ Referral and remote consultation management; ⑥ Statistical analysis and reporting function of data.
1.4 statistical methods The hearing screening data before and after using this system were tested by statistical software SPSS 1 1.0.
2. Results
2. 1 The newborn hearing screening network management system was used before and after the initial screening and re-screening. After using this system, the primary screening rate and secondary screening rate are obviously improved, and the primary screening loss rate is obviously decreased, which has statistical significance (P
2.2 Referral, diagnosis and intervention of neonatal hearing screening before and after the use of neonatal hearing screening network system. After using this system, the referral rate, diagnosis rate and intervention rate are obviously improved, and the missed diagnosis rate is obviously reduced, which has statistical significance (P
2.3 The statistical reports, follow-up time and follow-up expenses before and after the use of the neonatal hearing screening network system can only rely on manual statistical monthly reports, quarterly reports and annual reports before using the system. Manual calculation is time-consuming and prone to statistical errors, so it is impossible to monitor in real time. After using this system, the real data of the system dynamic data report can be obtained by clicking the mouse, and the real-time release of the follow-up information of the system reduces the time and cost of telephone notification. Before the application of this system, the basic data were manually registered and entered for 4 minutes/person. After the application of this system, the basic obstetric medical records can be imported directly into the hospital his system, saving 3 minutes/person, saving 4 hours for each statistical report, saving the follow-up cost of 0. 12 yuan/person and the follow-up time of 2 minutes/person.
Step 3 discuss
Neonatal hearing screening is a systematic project, and it is necessary to establish a well-functioning regional network system in order to implement effective management, data storage and processing, and obtain real and effective objective data on this basis. Therefore, it is particularly important to use the newborn hearing screening management system.
The newborn hearing screening network management system has established a communication platform among provincial and municipal health administrative departments, hearing screening diagnosis centers and hearing screening hospitals, which can quickly grasp the newborn hearing screening information, completely record the basic data of newborns and babies, and provide complete data for provincial and municipal health authorities and clinical research; The dynamic data report of the system can be reported accurately at any time, and the real-time monitoring of the network and comprehensive analysis of the data provide a strong basis for the quality control of hearing screening.
The upgraded import function of the system can directly import the basic obstetric medical records, reducing the tedious and time-consuming manual registration management before applying the system. The results of this study show that the time of data entry, registration and statistical statements is saved after using this system, and the subsequent time and expenses are reduced. Compared with the previous manual statistical methods, the statistical function of neonatal disease screening (including hearing screening) significantly reduces the labor intensity and improves the work efficiency.
The results of this study show that after using this system, the neonatal hearing screening rate has been improved, because after using this system, the hearing screening and diagnosis center can monitor the screening hospitals through monthly reports. Except for a few newborns who failed to receive screening due to financial difficulties and were seriously transferred to hospital, most newborns can receive screening, but it is still lower than the initial screening rate of 97.98% in Shanghai, indicating that the hearing screening of newborns in this city needs to be further improved.
After using this system, the lost follow-up rate of primary screening decreased by 65,438 08.58%, the lost follow-up rate of first diagnosis decreased by 65,438 02%, and the lost follow-up rate decreased by 8.7%, which was lower than the results reported by Tang et al. Most of the reasons for losing contact are telephone changes, migrant workers take their children back to their hometown, and a few parents refuse to follow up. The improvement of referral rate and follow-up rate and the reduction of lost follow-up rate depend on the real-time monitoring function of hearing screening system. Through this function, you can search the list of people who should be re-examined within three days every day and notify the information in advance, so that parents can get timely and accurate re-examination information.
No one is responsible for the follow-up of newborn hearing screening in some primary hospitals, which leads to a low referral rate. After using this system, the referral rate increased from 8 1. 1% before use to 93. 1%. The newborn hearing screening hospital is implemented through the double guarantee of double referral forms and system information, and the diagnosis results are reported to the hearing screening hospital in real time through the network system, so that the hospital can track and supervise the infants who have not been diagnosed in the diagnosis center in time, so that the diagnosis center and the hearing screening hospital can share information and resources, thus improving the referral rate and the diagnosis rate.
Before the use of this system, the hearing screening and diagnosis center was only "passive", and it was difficult to make overall management by providing technical guidance to primary hospitals on a regular basis. After using this system, the diagnosis center holds online training on hearing screening technology once every quarter, and the expert consultation platform of the system can make difficult cases get timely diagnosis intervention and rehabilitation guidance through online consultation, thus improving the diagnosis level of the diagnosis center. From the results of this paper, compared with before using the system, the first diagnosis rate increased by 65,438+02%, and the second diagnosis rate increased by 8.7%. In addition, due to the household registration management procedures of the system, the information of hearing-impaired children in this city can be reported to the Disabled Persons' Federation in time, and they can enjoy the subsidy policy of hearing-impaired assistance and rehabilitation of the Disabled Persons' Federation, so that the intervention rate has increased from 85.9% before using the system to 94. 1% after using the system.
The hearing screening system records the release time, diagnosis results and notification follow-up information of the screening in detail. At the same time, after the newborn hearing screening, parents will automatically receive the text message of the screening results and the analysis and explanation of the hearing screening diagnosis results. With the information website, they can log in to the health education column of hearing screening system, which increases parents' understanding of hearing screening and enhances parents' awareness and compliance of hearing screening.
The results of this study show that the popularization and application of neonatal hearing screening network management system in primary hospitals has improved the initial screening rate, re-screening rate, referral rate, diagnosis rate and intervention rate, reduced the loss of follow-up, and the systematic and clear process management has improved the management level of neonatal hearing screening.
Hearing impairment is a common birth defect, and a considerable part of it is caused by not being diagnosed in time at birth and missing the best expectation. Foreign studies show that the incidence of bilateral hearing impairment in normal newborns is about 0. 1%~0.3%, and the incidence of severe to extremely severe hearing impairment is about 0. 1%. There is a lack of complete epidemiological data in China, and the existing research results are similar. There are 800,000 deaf children aged 0-7 in China, and the number is increasing by 30,000 every year. Normal listening is the premise of language learning. Three years after a child is born, especially the first year, is a critical period for language development. If the brain can't get effective sound stimulation because of hearing impairment at this time, it means losing the critical period of language learning, which will seriously affect children's speech, cognition and emotional development, not only affecting individuals and families, but also bringing great burden to society. Due to the lack of language stimulation and the influence of environment, children with severe hearing impairment can't enter the language learning period before 1 1 month, and can't establish normal language learning in the most important and crucial 2-3 years of language development, which will eventually lead to deafness and even lead to psychological and behavioral problems such as language and speech disorders, low social adaptability, attention deficit and learning difficulties. If hearing impairment can be found in newborns or early infants, the language stimulation environment can be reconstructed with the help of sound reinforcement technology, so that language development is not damaged or less damaged. Therefore, newborn hearing screening for all newborns in China is an effective way to find hearing impairment at an early stage and finally make children with congenital hearing impairment deaf and dumb. Otoacousticemission (OAE) means that external acoustic stimulation is introduced into the cochlea through the external auditory canal and the middle ear, and the outer hair cells are stimulated to release energy actively, and then transmitted back to the external ear, which is received by the probe and displayed by the computer. In this paper, distortion product otoacoustic emissions are mainly used to screen the hearing of newborns, and those who fail to pass the two screenings are referred to otolaryngology for further diagnosis and treatment in time, so as to find hearing impairment and intervene early. In addition, in view of the high false positive rate of otoacoustic emission, this paper mainly discusses the factors that affect the passing rate of newborn hearing screening, so as to take corresponding intervention measures in clinical work, seek the best opportunity and scheme to reduce the false positive rate and repeat screening work, reduce parents' doubts and anxiety about false positive results, and improve screening efficiency.
1, data and methods
1. 1 research object
0 1, 324 newborns who were born in Lianyungang First People's Hospital from May 2006 to April 30, 2008 and received the second hearing screening, including 202 males and 22 females 122.
1.2 method
1.2. 1 research methods GSI-70 automatic portable otoacoustic emission instrument produced by Grayson-Stadhle company was used to screen 2236 newborns, and those who failed the initial screening were screened again 42 days after birth. DPOAE uses two tones with different intensities (L 1=65dBspl, L2 = 55 dbspl) 1 and \2 as stimulus sounds, and f 1:\2 = 1.2. The response of outer hair cells inside the cochlea to the test signal is called distortion product, that is, DP; The average noise level in the ear canal is called the noise platform, or NF. The difference between the distortion product (DP) point and the noise platform (NF) point of each frequency is the signal-to-noise ratio. There are three frequencies: 2000Hz, 3000Hz and 4000Hz3. Test method: At least two of the (1)3 reactions are on or above the PASS/RE (Pass/Referral) line, and these two reactions are marked as passing respectively, and the signal-to-noise ratio is greater than 10dB, then the test result is marked as passing. (2) At least two of the three reactions are below the qualified/unqualified line, and these two reactions are recorded as qualified respectively, and then the test results are recorded as qualified. (3) If at least two of the three reactions are respectively marked as noise, the test result will be marked as noise. (4) If a response score is "Pass", a response score is "Reference" and a response score is "Noise", the test result score is "Noise". (5) The test results show ABORT, which does not mean that the test results are passed or referenced, so a new test should be conducted. The test result is displayed on the screening instrument as passing, which means passing; If the results show that both REFER and NOISE fail, then the person who fails must pass two or more tests, and the person who fails in one ear fails. At the same time of screening, a self-made questionnaire was used to investigate 33 factors such as neonatal screening time, birth history, family history, disease history, mother's pregnancy history, parents' occupation and education level, in order to understand the factors affecting the passing rate of neonatal hearing screening.
1.2.2 test method (1) test time: generally 3 days or later, preferably after feeding and changing diapers. (2) Check the body position: check the left ear with the right position, and check the right ear with the left position. (3) test environment: the temperature is appropriate and basically quiet, but sound insulation is not required, and the background noise is
1.2.3 statistical methods SPSS 10.0 statistical software was used for statistical analysis. Chi-square test was used for univariate analysis, and P < 0.05 showed that the difference was statistically significant.
2. Results
2. 1 neonatal hearing screening
From May, 2006 to April, 30, 2008, 2236 newborns were born in Lianyungang First People's Hospital and received distortion product otoacoustic emission hearing screening, including 1 1 74 males, 1062 females and 1874 newborns passed. Of the 362 people who needed the second screening, 324 were actually screened. Among the 324 newborns screened for the second time, there were 202 males and 22 females 122, and 3 newborns10 passed the second screening (95.7%). 14 people failed two screening tests, and 8 men and 6 women were transferred to otolaryngology department for further diagnosis and treatment.
2.2 Analysis of factors affecting the passing rate of hearing screening
Of the 324 newborns screened for the second time, 3 10(95.7%) passed. The screening pass rate of full-term and expired infants was higher than that of premature infants, those who weighed more than 2500g were higher than those who weighed less than 2500g, and healthy newborns were higher than those who had a history of neonatal diseases, with statistical significance (P < 0.05). The other 30 factors, such as gender, examination time, mother's delivery mode, family history, disease history, mother's pregnancy history, parents' occupation and education level, were all P >；. 0.05, the difference was not statistically significant.
Step 3 discuss
At present, there is no uniform regulation at home and abroad on the time of re-examination of newborn hearing, and it is generally required to be examined within 3 months after birth. We issued a "re-examination" notice to parents for newborns who failed the initial screening, requiring those who failed the initial screening to re-examine about 42 days after birth, and the re-examination time should be set at the same time as the time of the children's health care clinic to minimize the missed screening rate.
In our research, we found that the passing rate of screening is related to the gestational age and birth weight of newborns. The failure rate of premature infants and low birth weight infants is higher than that of full-term infants and normal birth weight infants, which may be due to the imperfect development of peripheral auditory organs and central nervous system and poor response to external sound stimuli. Some people use OAE to study the clinical audiology of newborns. It is found that premature infants respond to sounds worse than normal full-term newborns within a period of time after birth, and the response range of OAE is relatively small. In addition, the development of cartilage and external auditory canal of premature and low birth weight infants is more immature, and the pharyngeal orifice and tympanic orifice of eustachian tube are almost horizontal, which also directly affects the derivation of DPOAE [2]. Therefore, the re-screening results show multiple births and gestational age.
The results of this study show that the re-examination pass rate of healthy newborns is significantly higher than that of newborns with a history of neonatal diseases, which suggests that we should pay attention to the hearing screening of sick newborns. It is reported that the incidence of hearing impairment among newborns rescued in intensive care unit is as high as 22.6%, of which 1% is severe. The retrospective study also found that about 50% hearing-impaired children in NICU were rescued after birth.
Listening is one of the important senses of human beings and an indispensable ability in people's daily life. Early hearing loss in infants, even slight, will lead to obvious and permanent dysfunction in physiological and behavioral communication.
The application of otoacoustic emission in newborn hearing screening can find hearing loss early, intervene early, promote language development, and achieve deaf but not dumb. Screening is only a means, and the ultimate goal is to further diagnose the children with screening problems and reduce missed diagnosis, so parents' compliance is very important. This requires us to patiently explain the harm of hearing loss, increase parents' awareness of hearing impairment and improve parents' trust in hearing screening. Correctly evaluate the results of the initial screening without exaggerating the facts, so as to prevent parents from having too much psychological pressure; Parents should pay enough attention to ensure timely review. If the first test result is unqualified, parents should be given a reasonable explanation to avoid panic. Those who fail to pass the re-examination should be referred to otolaryngology for further diagnosis and treatment. The second screening in our hospital lasted for 42 days, 362 people needed to be screened, and 324 people were actually screened. Although parents have been informed that our re-examination is free, 38 people will be screened in the future, accounting for 10.5% of the people who need re-examination. This shows that our publicity work has not been done enough and parents have not paid enough attention to it. How to improve the re-inspection rate? It has been reported that by using the software of "Project Management of Neonatal Congenital Disease Screening" and "Management of High-risk Newborns", the screening results of each examined baby are filed, followed up and the community clinic where the baby lives is notified. Babies who leave the city and return to the countryside shall be notified by county-level health centers under their jurisdiction, and the health department shall designate a special person to be responsible for telephone follow-up to ensure the re-screening rate.
Yoshinaga-Itano and others followed up 150 hearing-impaired children of different degrees and ages. The age of the subjects was 12~36 months, and about 50% of them had hearing impairment before 6 months. During the follow-up period, all subjects' development and language ability were evaluated with appropriate development and language scale. The results show that no matter whether the hearing impairment is mild or severe, as long as it is found before 6 months old and the children's cognitive ability is normal, the children's language ability can basically reach the normal level after intervention. There is no significant difference in language development between children with mild hearing impairment and children with severe hearing impairment. Another similar prospective study in Britain also proved that early detection of hearing impairment is the only important factor to prevent language development disorders in children with hearing impairment. The only relevant factor that affects the final language ability is the time when hearing impairment is found, not the degree of hearing impairment. Therefore, universal newborn hearing screening can find hearing impairment early, which is of great significance to reduce the incidence of deaf-mute children in China and improve the quality of the whole nation.
Low gestational age, low birth weight and neonatal diseases have significant effects on the passing rate of neonatal hearing screening. Universal hearing screening for newborns can find hearing impairment early, which is of great significance to reduce the incidence of deaf-mute children in China and improve the quality of the whole nation.