de Kock Tersia, Swanepoel DeWet, Hall James W
Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa.
Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa; Ear Sciences Centre, School of Surgery, The University of Western Australia, Australia; Ear Science Institute Australia, Subiaco, Western Australia, Australia.
Int J Pediatr Otorhinolaryngol. 2016 May;84:124-31. doi: 10.1016/j.ijporl.2016.02.031. Epub 2016 Mar 5.
Postnatal visits at community-based midwife obstetric units (MOUs) have been proposed as an alternative primary healthcare screening platform in South Africa. This study evaluated the outcomes of distortion product otoacoustic emissions (DPOAEs) and automated auditory brainstem response (AABR) screening conducted by a dedicated non-professional screener at a community-based MOU in the Western Cape, South Africa.
Universal newborn hearing screening (UNHS) at a community-based MOU was evaluated over a 16-month period. A dedicated non-professional screener was trained to follow a two-stage screening protocol targeting bilateral hearing loss. A two group comparative design was used alternating AABR (Maico MB11 BERAphone™()) and DPOAE (Bio-logic AuDX I) technology on a daily basis. Infants referring the initial screen received a follow-up appointment in two days' time and were rescreened with the same technology used at their first screen. Those referring the second stage were booked for diagnostic assessments.
7452 infants were screened including 47.9% (n=3573) with DPOAE and 52.1% (n=3879) with AABR technology. Mean age at first stage screen was 6.1 days. The initial bilateral referral rate was significantly lower for AABR (4.6%) compared to DPOAE (7.0%) and dropped to 0.3% and 0.7% respectively following the second stage screenings. First rescreen and initial diagnostic follow-up rates of 90% and 92.3% were obtained for the DPOAE group and 86.6% and 90% for the AABR group. Follow-up rates showed no significant difference between technology groups. Diagnostic assessment revealed a higher prevalence rate for bilateral SNHL among the AABR group (1/1000) compared to the DPOAE group (0.3/1000). Screening technology had no significant influence on daily screening capacity (23 AABR/day; 24 DPOAE/day).
Postnatal visits at community-based MOUs create a useful platform for hearing screening and follow-up. AABR technology with negligible disposable costs provides opportunity for AABR screening to be utilised in community-based programmes. AABR screening offers lower initial referral rates and a higher true positive rate compared to DPOAE.
在南非，已提议将社区助产士产科单位（MOUs）的产后访视作为一种替代性的初级医疗保健筛查平台。本研究评估了由一名专门的非专业筛查人员在南非西开普省一个社区MOUs进行的畸变产物耳声发射（DPOAEs）和自动听性脑干反应（AABR）筛查的结果。
对一个社区MOUs在16个月期间的新生儿听力普遍筛查（UNHS）进行了评估。一名专门的非专业筛查人员接受培训，遵循针对双侧听力损失的两阶段筛查方案。采用两组比较设计，每天交替使用AABR（Maico MB11 BERAphone™()）和DPOAE（Bio-logic AuDX I）技术。初次筛查未通过的婴儿在两天后接受随访预约，并用初次筛查时使用的相同技术进行重新筛查。那些进入第二阶段筛查的婴儿被安排进行诊断评估。
共筛查了7452名婴儿，其中3573名（47.9%）使用DPOAE技术，3879名（52.1%）使用AABR技术。第一阶段筛查的平均年龄为6.1天。与DPOAE（7.0%）相比，AABR的初次双侧转诊率显著较低（4.6%），在第二阶段筛查后分别降至0.3%和0.7%。DPOAE组的首次重新筛查率和初次诊断随访率分别为90%和92.3%，AABR组为86.6%和90%。各技术组的随访率无显著差异。诊断评估显示，AABR组双侧感音神经性听力损失（SNHL）的患病率（1/1000）高于DPOAE组（0.3/1000）。筛查技术对每日筛查能力无显著影响（AABR每天23例；DPOAE每天24例）。
社区MOUs的产后访视为听力筛查和随访创造了一个有用的平台。一次性成本可忽略不计的AABR技术为在社区项目中使用AABR筛查提供了机会。与DPOAE相比，AABR筛查的初次转诊率较低，真阳性率较高。
