Hayes D
Department of Pediatrics, University of Colorado Health Sciences Center, USA.
Pediatr Clin North Am. 1999 Feb;46(1):89-94. doi: 10.1016/s0031-3955(05)70083-3.
Published reports of several statewide and hospital-based systems for universal newborn hearing screening demonstrate that successful large-scale programs that appropriately identify infants with hearing loss in the earliest months of life can be developed. These programs are characterized by nursery-based screening rates of 95% or higher, referral rates of 6% or less, and reasonable per-infant costs. Less data are available regarding the outcome of these screening programs in ensuring confirmation of hearing loss by 3 months of age and initiation of intervention by 6 months of age. The results of the MDNC survey provide important information on the status of newborn hearing screening, audiologic assessment, and intervention services in 16 states. The survey reveals that hospitals have initiated universal newborn hearing screening programs using appropriate technology but that confirmation of hearing loss, fitting of amplification, and enrollment in early intervention are often delayed beyond the JCIH recommendations. Several factors might contribute to late confirmation of hearing loss and delayed amplification and intervention. First, as shown in the Colorado report, lack of a mandatory statewide system for tracking and reporting may delay transition of infants and families from screening to diagnosis, and diagnosis to intervention. In addition, many states lack a centralized system for reporting confirmed hearing loss. Successful statewide programs for universal newborn hearing screening, audiologic diagnosis, and early intervention depend on data-reporting strategies that facilitate transition of infants and families through a system of care. Second, lack of understanding about the urgent need for intervention in the earliest months of life may hinder referral to early intervention programs. Recent data from Colorado's universal newborn hearing screening program reveals that infants who are deaf or who have hearing losses achieve significantly better language development outcomes if intervention begins before age 6 months than infants whose intervention begins after 6 months of age. Hopefully, as these data become more widely available, the compelling need for early intervention will facilitate transition into these services. Although universal newborn hearing screening programs are increasing rapidly, states have not yet developed the coordinated systems for linking universal newborn hearing screening programs to audiologic diagnostic services and audiologic diagnostic services to early intervention programs. Key issues impeding development of these systems may be lack of tracking and reporting systems, lack of standardized guidelines for screening, diagnostic audiologic assessment, hearing aid fitting for very young infants, and lack of understanding about the compelling need for intervention in the earliest months of life. Development of complete systems of care must become a priority for universal newborn hearing screening to provide its ultimate benefit.
几份关于全州范围和医院层面的新生儿听力普遍筛查系统的公开报告表明，可以制定成功的大规模项目，在婴儿生命的最初几个月内恰当地识别出听力损失的婴儿。这些项目的特点是在新生儿病房的筛查率达到95%或更高，转诊率为6%或更低，且每个婴儿的成本合理。关于这些筛查项目在确保3个月龄时确诊听力损失以及6个月龄时开始干预方面的结果，可用数据较少。MDNC调查的结果提供了有关16个州新生儿听力筛查、听力评估和干预服务状况的重要信息。该调查显示，医院已使用适当技术启动了新生儿听力普遍筛查项目，但听力损失的确诊、助听器验配以及早期干预的登记往往延迟，超出了美国儿科学会听力联合委员会（JCIH）的建议。有几个因素可能导致听力损失确诊延迟以及助听器验配和干预延迟。首先，如科罗拉多州的报告所示，缺乏强制性的全州范围跟踪和报告系统可能会延迟婴儿及其家庭从筛查到诊断、再从诊断到干预的过渡。此外，许多州缺乏一个集中的系统来报告确诊的听力损失。成功的全州范围新生儿听力普遍筛查、听力诊断和早期干预项目依赖于数据报告策略，这些策略有助于婴儿及其家庭通过护理系统进行过渡。其次，对生命最初几个月内进行干预的迫切需求缺乏了解，可能会阻碍转介至早期干预项目。科罗拉多州新生儿听力普遍筛查项目的最新数据显示，与干预在6个月龄之后开始的婴儿相比，耳聋或有听力损失的婴儿如果在6个月龄之前开始干预，其语言发育结果会显著更好。希望随着这些数据得到更广泛的传播，对早期干预的迫切需求将促进向这些服务的过渡。尽管新生儿听力普遍筛查项目正在迅速增加，但各州尚未建立起将新生儿听力普遍筛查项目与听力诊断服务以及听力诊断服务与早期干预项目相联系的协调系统。阻碍这些系统发展的关键问题可能是缺乏跟踪和报告系统、缺乏筛查、诊断性听力评估、为非常年幼婴儿验配助听器的标准化指南，以及对生命最初几个月内进行干预的迫切需求缺乏了解。要使新生儿听力普遍筛查发挥其最终效益，建立完整的护理系统必须成为优先事项。
