Carew P, Mensah F K, Rance G, Flynn T, Poulakis Z, Wake M
Murdoch Childrens Research Institute, Parkville, Australia.
The University of Melbourne, Parkville, Australia.
Child Care Health Dev. 2018 Jan;44(1):71-82. doi: 10.1111/cch.12477. Epub 2017 Jun 14.
Universal newborn hearing screening (UNHS) targets moderate or greater hearing loss. However, UNHS also frequently detects children with mild loss that results in many receiving early treatment. The benefits of this approach are not yet established. We aimed to (i) compare language and psychosocial outcomes between four hearing loss detection systems for children aged 5-8 years with congenital mild-moderate hearing loss; (ii) determine whether age of detection predicts outcomes; and (iii) compare outcomes between children identified via well-established UNHS and the general population.
Linear regression adjusted for potential confounding factors was used throughout. Via a quasi-experimental design, language and psychosocial outcomes were compared across four population-based Australian systems of hearing loss detection: opportunistic detection, born 1991-1993, n = 50; universal risk factor referral, born 2003-2005, n = 34; newly established UNHS, born 2003-2005, n = 41; and well-established UNHS, born 2007-2010, n = 21. In pooled analyses, we examined whether age of detection predicted outcomes. Outcomes were similarly compared between the current well-established UNHS system and typically developing children in the Early Language in Victoria Study, born 2003, n = 1217.
Age at diagnosis and hearing aid fitting fell steadily across the four systems. For moderate losses, mean expressive language (P for trend .05) and receptive vocabulary (P for trend .06) improved across the four systems, but benefit was not obvious for mild losses. In pooled analyses, diagnosis before age six months predicted better language outcomes for moderate losses. Children with mild-moderate losses exposed to well-established UNHS continue to experience expressive language scores well below children in the general population (adjusted mean difference -8.9 points, 95% CI -14.7 to -3.1).
Treatment arising from UNHS appears to be clearly benefitting children with moderate hearing losses. However, rigorous trials are needed to quantify benefits, versus costs and potential harms, of early aiding of children with mild losses.
新生儿听力普遍筛查（UNHS）的目标是筛查出中度及以上听力损失。然而，UNHS也经常检测出轻度听力损失的儿童，这导致许多儿童接受了早期治疗。这种方法的益处尚未得到证实。我们旨在：（i）比较5至8岁先天性轻中度听力损失儿童的四种听力损失检测系统在语言和心理社会方面的结局；（ii）确定检测年龄是否能预测结局；（iii）比较通过成熟的UNHS识别出的儿童与一般人群的结局。
自始至终使用对潜在混杂因素进行调整的线性回归。通过准实验设计，对澳大利亚四个基于人群的听力损失检测系统的语言和心理社会结局进行比较：机会性检测，1991年至1993年出生，n = 50；普遍危险因素转诊，2003年至2005年出生，n = 34；新建立UNHS，2003年至2005年出生，n = 41；成熟的UNHS，2007年至2010年出生，n = 21。在汇总分析中，我们研究了检测年龄是否能预测结局。在当前成熟的UNHS系统与维多利亚早期语言研究中2003年出生的典型发育儿童（n = 1217）之间，也对结局进行了类似比较。
在这四个系统中，诊断年龄和佩戴助听器的年龄稳步下降。对于中度听力损失，在这四个系统中，平均表达性语言（趋势P值为0.05）和接受性词汇（趋势P值为0.06）有所改善，但对于轻度听力损失，益处并不明显。在汇总分析中，6个月前诊断对于中度听力损失能预测更好的语言结局。暴露于成熟的UNHS的轻中度听力损失儿童的表达性语言得分仍远低于一般人群中的儿童（调整后平均差异为-8.9分，95%可信区间为-1 .7至-3.1）。
UNHS带来的治疗似乎明显使中度听力损失儿童受益。然而，需要进行严格试验以量化对轻度听力损失儿童早期干预的益处、成本和潜在危害。
