Dauman René, Roussey Michel, Belot Véronique, Denoyelle Françoise, Roman Stéphane, Gavilan-Cellié Isabelle, Ruzza-Surroca Isabelle, Calmels Marie-Noëlle, Lina-Granade Geneviève, Houssin Elise, Charlemagne Agnès, Garabedian Noël
CHU de Bordeaux, Université de Bordeaux, Service ORL, Unité médicale d'Audiologie, 33076 Bordeaux, France.
Int J Pediatr Otorhinolaryngol. 2009 Mar;73(3):457-65. doi: 10.1016/j.ijporl.2008.12.001. Epub 2009 Jan 10.
The focus of this report is hearing screening of newborns transferred from the regular nursery to a specialized area. The purpose of the study undertaken was: (1) to determine whether screening coverage in this population was achieved; (2) to establish whether the linkage between neonatal screening and the diagnostic follow-up was carried out correctly; (3) to better determine the incidence of permanent childhood hearing impairment (PCHI) in this at-risk population.
Six population centres averaging 12,000 births annually participated (Bordeaux, Lille, Paris, Marseille, Toulouse and Lyon). Automated auditory brainstem response (AABR) (Natus ALGO 3i) screening was performed in two stages: i.e. infants with initial "positive" results were screened a second time using the same technique. Of the 117,103 babies born during the study period, 4972 neonates were "transferred" and comprised the population for this report (4.2% of the total births).
Screening results for 4972 "transferred" neonates were compared with those of non-transferred neonates (N=112,131). Screening coverage of eligible infants was significantly lower (75.4%) in "transferred" neonates (3750 infants screened) compared to 97.5% coverage of non-transferred neonates (109,349 infants screened). The rate of positive results after the first stage AABR was higher in the "transferred" population (11.1%) than in the non-transferred population (6.5%). Of the 415 "transferred" newborns with initial positive screens, 91.3% were rechecked as stipulated in the project protocol. The second pre-discharge AABR ascertained that in half of the cases auditory function had normalized in the day. Of the 183 "transferred" infants whose result remained suspect at the conclusion of both stages of the neonatal screen (4.9% of the tested population), only 70.5% returned to the audiology centre for diagnostic follow-up. The incidence of bilateral PCHI was markedly higher (4/1000) in "transferred" infants than in the non-transferred population (1.08/1000).
The difficulty of obtaining universal screening coverage in "transferred" infants was, unfortunately, verified in this prospective, multicentre study. Further, the diversity of our "transferred" population was not much greater than that revealed by careful analysis of published hearing screening studies in neonatal intensive care unit (NICU) infants. The influence of risk factors and their more or less complex combinations is apparent.
本报告重点关注从常规新生儿病房转至专门区域的新生儿听力筛查情况。本研究的目的是：（1）确定该人群的筛查覆盖率是否达标；（2）确定新生儿筛查与诊断后续流程之间的联系是否正确执行；（3）更好地确定该高危人群中儿童永久性听力障碍（PCHI）的发病率。
六个平均每年有12000例分娩的人口中心参与了研究（波尔多、里尔、巴黎、马赛、图卢兹和里昂）。采用自动听性脑干反应（AABR）（Natus ALGO 3i）进行两阶段筛查：即对初次筛查结果为“阳性”的婴儿，使用相同技术进行二次筛查。在研究期间出生的117103名婴儿中，4972名新生儿被“转运”，构成了本报告的研究对象（占总出生人数的4.2%）。
将4972名“转运”新生儿的筛查结果与未转运新生儿（N = 112131）的结果进行比较。“转运”新生儿（3750名婴儿接受筛查）中符合条件婴儿的筛查覆盖率（75.4%）显著低于未转运新生儿（109349名婴儿接受筛查）的97.5%覆盖率。“转运组”第一阶段AABR筛查后阳性结果的比例（11.1%）高于未转运组（6.5%）。在415名初次筛查呈阳性的“转运”新生儿中，91.3%按照项目方案规定进行了复查。第二次出院前AABR检查确定，在一半的病例中，当天听觉功能已恢复正常。在新生儿筛查两阶段结束时结果仍存疑的183名“转运”婴儿中（占受检人群的4.9%），只有70.5%返回听力中心进行诊断随访。“转运”婴儿双侧PCHI的发病率（4/1000）明显高于未转运人群（1.08/1000）。
遗憾的是，在这项前瞻性多中心研究中证实了在“转运”婴儿中实现普遍筛查覆盖率存在困难。此外，我们“转运”人群的多样性并不比仔细分析已发表的新生儿重症监护病房（NICU）婴儿听力筛查研究中所揭示的多样性大多少。风险因素及其或多或少复杂组合的影响是显而易见的。
