Neonatal Hearing Screening in Wallonia-Brussels Federation: Organisation and Results
Explore the organisation and results of neonatal hearing screening in the Wallonia-Brussels Federation, highlighting the importance of early intervention for permanent childhood hearing loss. Learn about the protocol, evolution since implementation, risk factors, and data collection methods.
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ROYAL BELGIAN SOCIETY FOR EAR, NOSE AND THROAT, HEAD AND NECK SURGERY ANNUAL REPORT: NEONATAL HEARING SCREENING Organisation and results of neonatal hearing screening in the Wallonia-Brussels Federation B n dicte Vos UNHS Coordinator 16 November 2013 Centre d Epid miologie P rinatale CEpiP asbl
Context Permanent childhood hearing loss: Public health concern Prevalence (significant bilateral HL)* Well-baby nursery population: 1-3 NICU population: 2-4% Consequences Cognition, socio-emotional development appropriate intervention before 6 months of age International recommendations Universal newborn hearing screening (UNHS) 2 *American Academy of Pediatrics, 1999; ANAES, 1999
Context Wallonia-Brussels Federation: Before 2006: No coordinated UNHS November 2006: Protocol released (organisation of the program) Maternity hospitals in Brussels & Wallonia Participation: voluntary basis Objective: To present the organisation and results of the UNHS program (FWB) and its evolution since implementation (2007-2011) 3
Protocol Organisation: only guidelines Hospitals: free to design its own approach $ in 2011 * AOAE: automated otoacoustic emissions 4
Organisation Organisation: only guidelines Hospitals: free to design its own approach Different patterns : - Screeners: from maternity ward or ENT ward (nurses, midwives, audiologists, ) - Days: from 2 to 7 days a week Screeners an days are related 7/7 days: do not decrease untested or lost to follow up children 5
Risk factors in the UNHS-FWB Risk factors related to the peri- and postnatal period - Apgar score of 0-6 at 5 minutes - Gestational age < 36 weeks and/or low birth weight (< 1500 gr.) - NICU admission 5 days - Exposure to ototoxic medications - Hyperbilirubinaemia at level requiring exchange transfusion - Assisted ventilation lasting 24 hours - Head or neck anomalies and by extension each syndrome known to include a HL - Neurological or endocrine disease the prenatal period - Family history of hereditary HL - Consanguinity (1stdegree) - In-utero infection : cytomegalovirus toxoplasmosis herpes rubella syphilis - Poisoning (alcohol, drugs) by the mother during pregnancy 6
Data collection Paper : Collected by 3 neonatal screening c. - AOAE: backside of the PKU form - ABR (or AOAE after discharge): specific forms Computer : Coordinating agency Internet connection 7
Recall system Untested - abnormal results recalled for outpatient testing paper transmission: Hospitals contact the parents, 3 times computer transmission Coordinating agency sends 2 letters to the parents (day 15 & 30); 1 letter to the hospital (day 45) 8
Funding Screening FWB hospital: 5 /child Parents hospital: 10 /child; Reimbursed by most social security organisations Diagnosis: Federal Sickness Fund Data collection: FWB Devices & users training: Hospitals 9
Data analysis Inclusion criterion: Implementation of the UNHS program in the hospital Dates of birth: 1/1/2007 31/12/2011 Comparison of the results By year of birth ( date of the test) 10
Participation to the program Hospitals: 1/1/2007: 23 hospitals during 2007: +19 end of 2011: 43 all hospitals of the FWB, except 3 Newborns (participating hospitals): 60000 2007-2011: 239722 newborns 40000 20000 0 2007 2008 2009 2010 2011 11
Eligible population 3.0 2.5 Percentage 2.0 >58% Kind & Gezin "Outside" Refusal 1.5 1.0 0.5 0.0 2007 2008 2009 2010 2011 2007-2008: +22% 60000 50000 2009-2011: stabilisation 40000 30000 1 risk fact. UNHS Population 20000 No risk fact. 10000 0 12
Risk factors for HL 10.0 8.0 Percentage 6.0 Proportion of RF: 2007-2011: globally, 6.9% doubled between 2007-2011 1 risk factor(s) 4.0 2.0 0.0 - data quality (communication of the information) Effect of the training (pediatricians)? - Literature: 8-10% 13
Screening group Coverage rate: 1sttest 100.0 Untested 95.0 90.0 1st screening test coverage: < 90% < 95% decrease in 2011: due to an absence of transmission of the results ( tests not performed) 85.0 80.0 75.0 Percentage 70.0 Coverage test 1 65.0 60.0 Recommandation: > 95 % 55.0 50.0 45.0 40.0 2007 2008 2009 Years 2010 2011 14
Screening group Pass results: 2ndtest 100.0 2nd test needed 95.0 90.0 85.0 Results of the 1st screening test: 85% 88% Learning curve? 80.0 75.0 Percentage 70.0 Pass results test1 65.0 60.0 55.0 50.0 45.0 40.0 2007 2008 2009 Years 2010 2011 15
Screening group Coverage rate & pass results : 2ndtest 100.0 95.0 90.0 85.0 80.0 75.0 Percentage 70.0 Coverage test 2 Referred for audiological assessment: 2.4% 65.0 Pass results test2 60.0 55.0 50.0 45.0 40.0 2007 2008 2009 Years 2010 2011 16
Screening group Coverage rate: follow up 100.0 Coverage of the follow up (newborns referred to ENT): 45% 70% 95.0 90.0 85.0 Lack in data transmission? (= lost to documentation) 80.0 Recommendation: >95% 75.0 Percentage 70.0 Coverage follow up 65.0 60.0 55.0 50.0 45.0 40.0 2007 2008 2009 Years 2010 2011 17
Newborns with 1 RF 8.0 Percentage 6.0 4.0 Untested 2.0 0.0 2007 2008 2009 2010 2011 2007-2009: 2010-2011: improvement no systematic data transmission? 18
Hearing status Hearing status, by year of birth (2007-2011) and by presence or not of risk factor(s) 100.0 95.0 90.0 Percentage Hearing loss Untested 85.0 Lost to follow up Prevalence HL (2007-2011): 1.46 Prevalence HL (2007-2011): 26.33 Normal hearing 80.0 75.0 2007 2008 Without risk factor 2009 2010 2011 2007 2008 2009 2010 2011 1 risk factor(s) 19
Hearing impairments Unilateral & Bilateral n 743 124 3 197 26 171 222 Unilateral Bilateral (n=233397) n n 3.18 0.53 0.01 0.84 0.11 0.73 0.95 357 41 1.53 0.18 0.00 0.45 0.06 0.43 0.41 386 83 1.65 0.36 0.01 0.39 0.05 0.30 0.54 Perceptive Auditory neuropathy Conductive (temporary) Conductive (permanent) Conductive (unspecified) Hearing loss - Unspecified 0 3 105 14 101 96 92 12 70 126 Data quality: has to be improved 20
Conclusion Comparison to other programs Coverage rates Lost to follow up Prevalence of HL Data quality Data from rehabilitation services: Missing global evaluation of the program is impossible 21
Thank you for your attention This program is funded by the F d ration Wallonie-Bruxelles and supported by a scientific working group composed by Drs N. Deggouj, P. Deltenre, L. Demanez, A. Doyen, P. Eymael, A-L. Mansbach, N. Melice Scientific promoteur: Dr A. Leveque B n dicte Vos - UNHS coordinator Centre de r f rence pour le Programme de d pistage n onatal de la surdit Centre d Epid miologie P rinatale CEpiP asbl 22
UNHS-FWB has existed for 5 years Main difficulties in the implementation: beginning Remaining difficulties: Early discharge of the infant Increase of paperwork workload Lack of identification of high risk newborns Lack of transmission of the results Computer data transmission: Technical difficulties, but better transmission of the results 24
