Sininger Yvonne S, Martinez Amy, Eisenberg Laurie, Christensen Elizabeth, Grimes Alison, Hu Jasmine
Division of Head and Neck Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA 90095-1624, USA.
J Am Acad Audiol. 2009 Jan;20(1):49-57. doi: 10.3766/jaaa.20.1.5.
Newborn Hearing Screening (NHS) programs aim to reduce the age of identification and intervention of infants with hearing loss. It is generally accepted that NHS programs achieve that outcome, but few studies have compared children who were screened to those not screened in the same study and during the same time period. This study takes advantage of the emerging screening programs in California to compare children based on screening status on age at intervention milestones.
The purpose of this studywas to compare the outcomes of cohorts of children with hearing loss, some screened for hearing loss at birth and others not screened. Specifically, the measures compared are the benchmarks suggested by the Joint Committee on Infant hearing for determining the quality of screening programs.
Records from 64 children with bilateral permanent hearing loss who were enrolled in a study of communication outcomes served as data for this study. Of these children, 47 were screened with 39 failing and 8 passing, and 17 were not screened.
This study was observational and involved no planned intervention.
Outcome benchmarks included age at diagnosis of hearing loss, age at fitting of amplification, and age at enrollment in early intervention. Delays between diagnosis and fitting or enrollment were also calculated. Hearing screening status of the children included screened with fail outcome, screened with pass outcome, and not screened. Analysis included simple descriptive statistics, and t-tests were used to compare outcomes by groups: screened/not screened, screened pass/screened failed, and passed/not screened.
Children with hearing loss who had been screened as newborns were diagnosed with hearing loss 24.62 months earlier, fitted with hearing aids 23.51 months earlier, and enrolled in early intervention 19.98 months earlier than those infants who were not screened. Screening status did not influence delays in fitting of amplification or enrollment in intervention following diagnosis. Eight of the infants with hearing loss (12.5%) passed the NHS, and the ages at benchmarks of those children were slightly but not significantly earlier than infants who had not been screened.
The age at achievement of benchmarks such as diagnosis, fitting of amplification, and enrollment in early intervention in children who were screened for hearing loss is on target with stated goals provided by the Academy of Pediatrics and the Joint Committee on Infant Hearing. In addition, children who are not screened for hearing loss continue to show dramatic delays in achievement of benchmarks by as much as 24 months. Evaluating achievement of benchmarks during the start-up period of NHS programs allowed a direct evaluation of ability of these screening programs to meet stated goals. This demonstrates, unequivocally, that the NHS process itself is responsible for improvements in age at diagnosis, hearing aid fitting, and enrollment in intervention.
新生儿听力筛查（NHS）项目旨在降低听力损失婴儿的确诊和干预年龄。人们普遍认为NHS项目实现了这一目标，但很少有研究在同一研究和同一时间段内比较接受筛查的儿童与未接受筛查的儿童。本研究利用加利福尼亚州新兴的筛查项目，根据干预里程碑年龄时的筛查状态对儿童进行比较。
本研究的目的是比较听力损失儿童队列的结果，其中一些儿童在出生时接受了听力损失筛查，另一些则未接受筛查。具体而言，所比较的指标是婴儿听力联合委员会建议的用于确定筛查项目质量的基准。
64名双侧永久性听力损失儿童的记录被纳入一项沟通结果研究，作为本研究的数据。在这些儿童中，47名接受了筛查，其中39名未通过，8名通过；17名未接受筛查。
本研究为观察性研究，未进行计划干预。
结果基准包括听力损失诊断年龄、佩戴助听器年龄和开始早期干预的年龄。还计算了诊断与佩戴助听器或开始干预之间的延迟。儿童的听力筛查状态包括筛查未通过、筛查通过和未筛查。分析包括简单描述性统计，t检验用于按组比较结果：筛查/未筛查、筛查通过/筛查未通过、通过/未筛查。
与未接受筛查的婴儿相比，新生儿期接受筛查的听力损失儿童听力损失诊断时间提前24.62个月，佩戴助听器时间提前23.51个月，开始早期干预时间提前19.98个月。筛查状态不影响诊断后佩戴助听器或开始干预的延迟。8名听力损失婴儿（12.5%）通过了NHS，这些儿童达到基准的年龄比未接受筛查的婴儿略早，但差异不显著。
接受听力损失筛查的儿童在达到诊断、佩戴助听器和开始早期干预等基准方面的年龄符合美国儿科学会和婴儿听力联合委员会设定的目标。此外，未接受听力损失筛查的儿童在达到基准方面仍有多达24个月的显著延迟。在NHS项目启动阶段评估基准的达成情况，可以直接评估这些筛查项目实现既定目标的能力。这明确表明，NHS流程本身是诊断年龄、助听器佩戴和干预开始年龄改善的原因。
