Evaluation of the newborn hearing screening program in the University of Santo Tomas Hospital based on the joint committee on infant hearing 2019 position statement on quality indicators for screening and confirmation of hearing loss

Objective@#To evaluate the newborn hearing screening program in the University of Santo Tomas Hospital based on the quality indicators set by the Joint Committee on Infant Hearing (JCIH) 2019 position statement.@*Methods@#Design: Cross-sectional study Setting: Tertiary Private Training Hospital Participants: All newborns delivered in 2019 at the University of Santo Tomas (UST) Hospital were considered for inclusion@*Results@#The UST Hospital had 778 newborns in 2019, of which 687 (88.3%) completed newborn hearing screening by 1 month of age. There were 81 (10.4%) who failed initial hospitalbased screening and required outpatient re-screening while 11 (1.4%) of those who failed initial screening also failed subsequent rescreening. Forty-five (5.7%) newborns failed initial screening and subsequently passed re-screening. None of the eleven (0/11) patients completed comprehensive audiologic evaluation thus, patients necessitating referral for intervention were not identified. There were a total of 67 (8.6%) dropouts throughout the hearing evaluation process. Fifteen (15) infants were not screened due to unavailability of trained personnel at time of referral, four (4) infants were advised third screening while two (2) were advised observation instead of proceeding to confirmatory test.@*Conclusion@#The University of Santo Tomas Hospital newborn hearing screening program has yet to reach the quality indicators set by the Joint Committee on Infant Hearing 2019 for screening and confirmation of hearing loss. Among identified areas for improvement are the availability of trained personnel, insufficient means to ensure compliance, reluctance to pursue further testing and practices among healthcare providers.

Pilot implementation of a computer-based training course on newborn hearing screening and teleaudiology among primary healthcare providers in low resource settings

Objective@#Newborn hearing screening (NHS) in the Philippines has been mandated by law since 2009. However, lack of awareness and knowledge about NHS remains a challenge, especially among healthcare providers. This paper describes the pilot implementation of a computer-based training (CBT) course on NHS and teleaudiology among primary healthcare providers (PHCPs) in rural Philippines. @*Methods@#A four-module web-based training course on newborn hearing screening and teleaudiology in an online learning management system (LMS) was field-tested among PHCPs from eight rural communities in the Philippines. Participants were given four weeks to complete the course. @*Results@#Forty-two PHCPs participated in the CBT. Thirty-four (81%) completed the whole course (mean attrition rate of 4.8% per module) at a mean duration of 10.2 days. Baseline data shows that participants had no NHS training, although the majority (83%) had information and communications technology (ICT) training. Comparison of preand post-test mean scores showed a 24.0% (p<0.001) significant increase in the post-test in all four modules. Passing rates (i.e., score ≥70%) from pre- to post-test increased by 54.6% (range: 38-80% increase). Usability of the CBT was rated high with a mean score of 4.32 out of 5 (range: 4.13 to 4.47), covering all eight parameters. Participants expressed general satisfaction and a positive attitude on CBT to improve knowledge on NHS and teleaudiology. @*Conclusion@#Even in low resource settings where gaps in ICT infrastructure exist, eLearning can be used as an alternative approach to increase awareness and support training of healthcare providers on newborn hearing screening.

Design of a blended learning course for training community healthcare providers on ehealth-enabled newborn hearing screening

Objectives@#We present in this article the design and evaluation of a blended learning approach for training community healthcare providers in performing newborn hearing screening (NHS).@*Methods@#We developed a blended learning course for training community healthcare providers on eHealth-enabled NHS, following Bloom’s revised taxonomy of educational objectives. The training involved three components: computer-based training (CBT), face-to-face (FTF) training, and on-site coaching. We used surveys and post-training interviews following Level 1 Kirkpatrick’s training evaluation model to get initial feedback on the training program. @*Results@#Thirty-one community healthcare providers from five rural health units and a private hearing screening center, with a mean age of 42.2 ± 12.0 years, participated in the pilot. 93.5% of the participants agreed that the program content met stated objectives and was relevant to their practice. The length of the course was perceived to be adequate. Overall satisfaction with the program was rated at 8.5 ± 0.9 (with ten as the highest). The majority expressed that the CBT and FTF course were satisfactory at 93.5% and 100%, respectively. All participants agreed that the course enhanced their knowledge of newborn hearing screening and telehealth. Positive reviews were received from participants on the use of CBT to improve theoretical knowledge before FTF training. Participants declared that FTF training and on-site coaching helped improved NHS skills and implementation. @*Conclusion@#Competent community healthcare providers are critical to strengthening the performance of the health system, and advances in the education and technology sectors offer promising potential in upskilling local healthcare providers. The increasing access of Filipino healthcare providers to improved information and communications technology (ICT) is a significant catalyst for pedagogical innovation, like the use of blended learning in the continuous professional development of health practitioners. As ICTs gradually penetrate the health sector, the challenge we now face is not whether but how we can use innovations in education strategies to benefit healthcare providers.

Evaluation of the design and development of the HeLe newborn hearing screening tele-audiology systems for the Philippines

Introduction@#There is increasing interest in innovation development and management in the Philippines, especially in the last decade. In the advocacy for universal hearing health, the HeLe, “Hearing for Life’’ Research Program was implemented. HeLe developed novel telehealth technologies and field tested a proof-of-concept service delivery model to improve provision of newborn hearing screening and intervention services in the Philippines. @*Objective@#As the HeLe research period concludes, this appraisal was organized to document and assess the health information technology systems of the HeLe. @*Methods@#The evaluation follows the elements of the Centers for Disease Control and Prevention (CDC) guidelines for evaluation of public health surveillance systems. It centers on the status of the eHealth-based components of the HeLe NHS interventions: HeLe NHS module in the Community Health Information Tracking System (CHITS) electronic medical records system, the Tele-Audiology module in National Telehealth System (NTS), and the HeLe NHS registry. The evaluation is based on interviews of key HeLe research staff and documentation review. @*Results@#The HeLe system has a stable, SQL-Server-based architecture. It is a secure, web-based system with clean separation of back-end database and front-end Web, using Secure Socket Layer (SSL) technology. Standardization of data via mapping ensures reliable, comparable measures. HeLe demonstrates that NHS data collected by the HeLe NHS device can be sent to, stored in, and extracted from the CHITS electronic medical record system and exchanged across platforms. Where actual patient and NHS data were available, this HeLe system is validated to be efficacious to capture and seamlessly exchange data across various eHealth platforms. These eHealth technologies are described to be at Technology Readiness Level 5, “technologies are validated in a relevant environment”. The HeLe program, however, needs to address completeness in documentation as a standard practice, if only to ensure better management of risks introduced by novel eHealth systems in patient care. The CDC public health surveillance checklist used for this assessment is useful in identifying gaps in research management for the HeLe inventors. It is recommended to be incorporated to be standard and implemented early in the next iteration of the HeLe research. @*Conclusions@#Overall, the HeLe technologies, in this initial stage of research, have achieved the purpose for which they were developed. As a novel technologybased NHS system, HeLe is a potentially powerful tool to assist in monitoring newborn hearing disease caseloads by community-based primary care clinics, NHS facilities, and hospitals that provide definitive medical services. As other health systems strengthening reforms take root in the Philippines, secure exchange of data electronically across the country would depend on sound technologies, including those used in hearing health. This paper can be instructive to the emerging research community in the eHealth and biomedical development space especially in resource-challenged settings. Likewise, lessons can reinforce institutional support from research agencies, clinicians, and state/county or subnational health departments for policy and resource mobilization to better manage those identified with congenital hearing loss.

A comparison of the human voice (“Baah”) test and the automated auditory brainstem response in detecting neonates with hearing loss in a community setting

Objective@#To assess the usage of the “Baah” Test compared to the AABR (Automated Auditory Brainstem Response) in detecting hearing loss of neonates in the community setting. @*Methods@#This is a retrospective cross-sectional study. The targeted sample population are infants less than a month old who underwent screening at a testing facility in Malolos, Bulacan spanning the years 2011 and 2012. @*Results@#A total of 201 infants were included in the study, with a mean age of 10.77 days with a standard deviation of 7.79. The ratio of males to females was almost equal at 1:1.01. For infants who passed hearing screening on at least one ear, 96% (193 infants) correlated with the results of “Baah” testing. For those with bilateral refer results on AABR, 4 out of the 6 correlated with the “Baah” Test. @*Conclusion@#There is potential in using the “Baah” Test as a tool for hearing loss assessment of infants in situations wherein the usual hearing screening tests are inaccessible. It makes use of little resources, and though it does have its limitations in assessing for unilateral hearing loss (as the test cannot test ears in isolation), it would be able to identify infants likely to have bilateral hearing loss.

Accuracy and use of the reflexive behavioral (“Baah”) test and risk factor questionnaire for hearing screening in infants six months old and below

Objective@#To determine the accuracy, sensitivity, specificity, positive predictive values, and use of the Reflexive Behavioral “Baah” Test and NHSRC Level 1 and Level 2 Questionnaires in detecting hearing impairment in rural health communities. @*Methods@#This was a prospective cross-sectional study conducted at the rural health unit of five municipalities. Infants less than six months old were screened for hearing impairments using the OAE device (standard), the Reflexive Behavioral “Baah” test, and the NHSRC Level 1 and Level 2 Questionnaires. The “Baah” test and the filling out of the NHSRC Level 1 and 2 Questionnaires were done by trained health workers while OAE was done by an audiologist. @*Results@#A total of 103 babies, with a mean age of 41.9 days at the time of testing and a male to female ratio of 1.02:1 (52 males and 51 females) were tested. A hearing impairment prevalence of 4.9% (5 out of 103) was noted. The “Baah” test showed to have a sensitivity of 60%, specificity of 97.96% and an accuracy rate of 96.12%. The NHSRC Level 1 and Level 2 Questionnaires showed sensitivity, specificity, and accuracy rate of 40%, 67.35% and 66.02%, respectively for the former and 40%, 85.71% and 83.50%, respectively for the latter. Analysis of the complimentary use of the NHSRC Level 1 and Level 2 Questionnaires with the “Baah” test also showed no significant improvement to using the “Baah” test as a stand-alone screening tool with sensitivity, specificity, and accuracy of 60%, 67.35% and 66.99%, respectively for the “Baah” test and Level 1 Questionnaire, and 60%, 83.67% and 82.52%, respectively for the “Baah” test and Level 2 Questionnaire. @*Conclusion@#The Reflexive Behavioral “Baah” test is a potentially accurate, sensitive, specific, and acceptable standalone hearing screening test to identify infants with higher risk of hearing impairment in the rural health community setting. On the other hand, the use of the NHSRC Questionnaires as a stand-alone or complementary tool for “Baah” is unnecessary as it results to more false positive and false negative results.

Implementation of Universal Newborn Hearing Screening in the Philippines: A survey of registered newborn hearing centers

Background@#Universal newborn hearing screening is mandated in the Philippines through the Universal Newborn Hearing Screening and Intervention Act of 2009 (RA 9709). Newborn hearing screening (NBHS) centers are required to perform screening tests, compile and submit data on screened newborns, and advise parents on the subsequent steps after NBHS.@*Objective@#The study aimed to conduct a survey of the implementation of the Universal Newborn Hearing Screening and Intervention Program (UNHSIP) in the different regions of the country; and assess the information technology (IT) capabilities of hearing centers.@*Methods@#Fifty-one NBHS centers across twelve regions were surveyed through on-site inspections in 2016. Data was gathered on the centers’ testing capability, staffing, access to specialists, use of local protocols, connectivity, and IT capabilities. @*Results@#All surveyed centers followed the recommended protocols of the Manual of Operations of the Universal Newborn Hearing Screening and Intervention Act of 2009 (RA 9709). Among the 12 regions visited, only five (41.67%) had Category C centers with confirmatory testing and early amplification services as recommended. Majority of facilities (96.1%) were staffed by trained and certified personnel. A small percentage had access to subspecialists such as clinical audiologists (39.2%) and speech-language pathologists (23.5%). All facilities had computer access, but only 58.8% had internet access. Majority (94.1%) of the centers visited were not using the recommended data submission methods, specifically the use of registry cards and the online registry. Only 27.5% of centers had data on newborns who underwent confirmatory testing or early intervention. @*Conclusion@#Facilities were found to be compliant to NBHS screening protocols and majority complied with certification requirements for staff; but were found to be non-compliant with use of registry cards or the online registry. Majority of centers were able to contact the parents of neonates who did not pass newborn screening, but had no system to track outcomes. Lack of confirmatory and early intervention services in identified areas emphasize the need for development of regional centers. It is recommended that measures to improve the utilization of the online registry are taken.

Eficacia del «Programa de tamizaje auditivo neonatal universal¼ de la Caja Costarricense del Seguro Social en la detección de sordera en niñas y niños, entre 2016 y 2018 / Effectiveness of «Universal Newborn Hearing Screening program¼ of Caja Costarricense del Seguro Social, in detecting deafness in children, from 2016 to 2018

Resumen Introducción: el tamizaje auditivo es un método de detección y su propósito es intervenir de forma temprana para reducir las consecuencias negativas de una eventual afección auditiva en el desarrollo integral del infante. Costa Rica ha implementado en el sistema de salud público un programa de tamizaje auditivo neonatal universal, donde se examina todo niño o niña antes del primer mes de vida. Aunque se han percibido múltiples beneficios, es importante demostrar con evidencia científica si cumple sus objetivos. Metodología: se analizó la eficacia del «Programa de tamizaje auditivo neonatal universal» (TANU) de la Caja Costarricense de Seguro Social, a partir de la información registrada de 37 656 infantes evaluados entre los años 2016 y 2018, mediante el contraste empírico con las técnicas descriptivas de distribución de frecuencias de variables, y las pruebas inferenciales chi cuadrado y análisis de varianza (ANOVA). Resultados: en cuanto a la edad al momento del examen, el 71 % de la muestra tenía entre 0 y 3 días. Su desempeño a través del tiempo y la extensión a distintos centros de salud ha sido satisfactorio, así mismo, la cantidad de infantes valorados ha sido hasta del 98 % de la población. Conclusiones: el programa TANU es eficaz en la mayoría de aspectos analizados, destaca la identificación de factores de riesgo y la detección temprana de afecciones auditivas, sin embargo, se proponen mejoras en relación con el manejo de la información.

Abstract Introduction: Hearing screening is a detection method, its objective is to provide an early intervention that allows reducing the negative consequences of an eventual hearing impairment, in the integral development of the infant. Costa Rica has implemented a universal neonatal hearing screening program in the public health system, where the hearing of every child born in the country is examined before the first month of life. Although multiple benefits have been perceived, it is important to demonstrate with scientific evidence if it accomplishes its objectives. Methodology: the effectiveness of the Universal Newborn Hearing Screening Program in Costa Rica was analyzed, based on the information recorded from 37,656 children evaluated since 2016 to 2018, through empirical contrast using both descriptive techniques: frequency distribution of variables, as well as the use of inferential tests: chi square and analysis of variance (ANOVA). Results: 71 % of the sample was between 0 and 3 days old at the moment of being examined. Its performance over time and extension to different health centers has been satisfactory, likewise, the number of infants evaluated has been up to 98 % of the population. Conclusions: the TANU program is effective in most of the aspects analyzed, the identification of risk factors and the early detection of hearing disorders are outstanding, however, improvements are proposed in relation to the handling of information.

Implementation of newborn hearing screening in Rizal, Philippines, and Northern California: Lessons learned

Objective@#The universal newborn hearing screening program has been implemented in the Philippines for the past ten years. However, screening rates in the country are still low. The current study aimed to describe the universal newborn hearing screening program (UNHSP) delivery system in Rizal, Philippines, and Northern California. @*Methods@#The study utilized a case study research design using data triangulation of FGD, KII, and document review to characterize and compare the implementation of the Universal Newborn Hearing Screening Program in Rizal Province and Northern California. @*Results@#Several differences were found in the protocols for newborn hearing screening in Rizal, Philippines, and Northern California, including centralization of the program, availability of surveillance data, screening protocols, and tracking system. @*Conclusion@#There is an immense need to disseminate universal newborn hearing screening among healthcare practitioners and create a system to monitor and evaluate real-time data.

Outcomes of online adaptation of the universal newborn hearing screening certification

Objective@#An adaptation of the newborn hearing screening personnel certification course to an online platform started development in June 2020. It was then implemented in July 2020. The current study aimed to evaluate the initial implementation of the online adaptation of the universal newborn hearing screening certification course among participants. @*Methods@#Through a concurrent mixed-methods research design, the study triangulated program outcomes, course evaluation, and key informant interviews of participants from July to November 2020 to evaluate the initial implementation of the course. @*Results@#The certification course participants had an overall positive experience with the initial implementation of the online adaptation. Only a minority of participants expressed their dissatisfaction with the course evaluation form. Moreover, the key informant interviews showed more detailed areas of improvement. @*Conclusion@#Despite the course's high ratings and administrative strengths, the use and features of Canvas as a learning management system were needed for participants to maximize the course. Furthermore, improvements in the presentation of the lectures and increasing the interactivity and engagement of the learning materials were recommendations in the refinement of the online course.

Development and pilot implementation of the online certification of universal newborn hearing screening personnel

@#<p style="text-align: justify;"><strong>Objective.</strong> The current paper aimed to discuss developing the online newborn hearing screening certification course and revisions made from pre-pandemic face-to-face strategies to the online implementation in response to COVID-19 limitations. Furthermore, it aimed to create recommendations for the refinement of the course.</p><p style="text-align: justify;"><strong>Methods.</strong> The development of the adaptation consisted of document review, focus group discussions among program faculty before and after implementation, which covered the demand for the certification course, opportunities for adaptation, situational limitations, and online implementation advantages and concerns. In addition, a cost-benefit analysis of the online course was done.</p><p style="text-align: justify;"><strong>Results.</strong> The certification course was developed within a month and retained the same learning objectives going into an online implementation. One significant change was the addition of a local experience module which allowed for the participation of regional newborn hearing screening coordinators. More resources were required from both instructors and learners to implement successfully. Due to the asynchronous nature of the online course, the evaluation scheme was adapted accordingly. However, teaching strategies were limited. The pricing of the course was also not optimal.</p><p style="text-align: justify;"><strong>Conclusion.</strong> Although there were merits in adapting the certification course to the online learning platform, there were areas for refinement. These were the alignment of all course modules to learning objectives, the addition of varied teaching methods, and the revision of pricing for the course.</p>

Maternal diabetes: A potential risk factor of congenital hearing loss

@#Objective. The purpose of this study is to identify the incidence rate of 'refer' result in neonates born to diabetic mothers and to determine the association of maternal diabetes and the initial 'refer' result. Methods. This was a retrospective cross-sectional study which included neonates who had hearing screening test using transient-evoked otoacoustic emissions test (TEOAE) on both ears at the Philippine General Hospital Ear unit during three weeks. We obtained the demographic characteristics, presence/absence of maternal diabetes, and OAE results. Results. Among the 150 neonates, ten were born to diabetic mothers, with an age range of 2-8 days old. Forty percent of neonates of diabetic mothers had an initial 'refer' result compared with 7.9% of nondiabetic mothers' neonates. After logistic regression analysis, there is a significant association between maternal diabetes and initial 'refer' result in OAE with a p-value <0.05. If the mother is diagnosed with diabetes (gestational/pre-gestational), the odds of having an initial 'refer' result in the hearing screening is 2x higher. The odds can range from 2-43 times. Conclusion. The incidence rate of an initial 'refer' result in neonates of diabetic mothers is 40%. There is a significant association between maternal diabetes and the initial 'refer' result in the OAE test.

Registro de emisiones otoacústicas transientes basado en microcontroladores de alto rendimiento / Transient Otoacoustic Emissions Register based on High Performance Microcontrollers

La hipoacusia tiene una incidencia notable entre los recién nacidos. Una intervención temprana durante el período de maduración auditiva permite minimizar los efectos en el desarrollo intelectual del infante. Se propone el desarrollo de un Registrador de Emisiones Otoacústicas Transientes como parte de un sistema de cribado neonatal basado en microcontroladores de alto rendimiento. La prueba consiste en aplicar periódicamente un estímulo tipo chasquido para obtener la respuesta coclear. Se promedian las señales adquiridas y se aplica la Transformada Rápida de Fourier. El espectro obtenido es dividido en bandas de media octava para analizar la correlación y la relación señal-ruido. Si estos parámetros son mayores que los umbrales de referencia en la mayoría de las bandas, se considera al paciente apto para el desarrollo normal. El firmware fue implementado sobre el procesador STM32F405 y evaluado con el simulador Baby Isao; obteniéndose una sensibilidad del 87.5 por ciento y una especificidad del 93.75 por ciento(AU)

Hearing loss is highly incident among newborns. Early intervention during the period of auditory maturation allows adequate levels of intellectual development to be achieved. The development of a Transient Otoacoustic Emissions Recorder is proposed as part of a neonatal screening system based on high-performance microcontrollers. The test consists of periodically applying a click stimulus to obtain the cochlear response. The acquired signals are averaged and the Fast Fourier Transform is applied. The spectrum obtained is divided into half-octave bands to assess the correlation as well as the signal-noise ratio. If these parameters are greater than the reference thresholds in most of the bands, the patient is considered suitable for normal cognitive development. The firmware was implemented on the STM32F405 processor and evaluated with the Baby Isao simulator; obtaining a sensitivity of 87.5 percent and a specificity of 93.75 percent(AU)

Acompanhamento audiológico de lactente com risco para sífilis congênita: relato de caso / Audiological follow up of an infant affected by congenital syphilis: case report

Objetivo: descrever o acompanhamento audiológico de uma criança com exame sorológico positivo para sífilis. Caso Clínico: E.G.M.L, com sorologia positiva para sífilis, com dois dias de vida, obteve resultado "falha" na Triagem Auditiva Neonatal, com Emissões Otoacústicas Evocadas Transientes. Encaminada para o ambulatório da Clínica Escola de Fonoaudiologia, da Universidade Estadual da Bahia, retornou com quatro meses, quando realizou reteste das Emissões Otoacústicas Evocadas Transientes, que permaneceram ausentes; também se submeteu à imitanciometria, onde foram obtidas curvas timpanométricas "pico único". A avaliação da condução nervosa com Potencial Evocado Auditivo do Tronco Encefálico do Tronco Encefálico mostrou-se normal na orelha esquerda, com limiares eletrofisiológicos presentes até a intensidade de 50 dB. Porém, houve despertar do sono e não foi possível avaliar a orelha direita. Em nova reavaliação, aos oito meses, a condução nervosa pelo mesmo processo apresentou normalidade na orelha direita. As condições nutricionais de E.G.M.L. eram então críticas, com desnutrição acentuada. O atendimento no âmbito audiológico foi temporariamente suspenso e houve encaminhamento para o setor de fisioterapia e nutrição da Universidade do Estado da Bahia. Discussão: o levantamento de questões audiológicas, em grupos de risco para alterações auditivas, visa à reabilitação e à garantia das condições ideais de comunicação. Neonatos com detecção precoce de alterações auditivas são candidatos ideais à amplificação e reabilitação. Conclusão: crianças com risco para sífilis congênita precisam ser avaliadas na Triagem Auditiva e acompanhadas no seguimento. Entretanto, algumas vezes torna-se difícil conscientizar a família. Essa continuidade é importante para assegurar a integridade dos sentidos e, no caso da audição, para favorecer o desenvolvimento adequado da criança.

Objective: to describe the audiologic follow-up of a child testing positive in the serological test for syphilis. Case: E.G.M.L. has positive syphilis serology and within two days of life presented a Newborn Hearing Screening result considered fail and Transient-evoked Otoacoustic Emissions (TEOAE). She was referred to the outpatient clinic of the Clinical School of Speech-Language Therapy of State University of Bahia (UNEB) to where she returned after four months to submit to a retest of TEOAE which remained absent and an immittance test that presented a single-peaked tympanometric shape. The evaluation of nerve conduction related to Auditory Brainstem Response (ABR) was normal in the left ear presenting thresholds up to 50 dB. However, as she awakened, it was not possible to assess the right ear. However, in a new reassessment, which only occurred when she was at eight months of age, the nerve conduction related to ABR was normal in the right ear. The nutritional status of E.G.M.L at eight months of age was critical, she was severely undernourished. The hearing care service was temporarily suspended, then she was referred to the UNEB physiotherapy and nutrition sector. Discussion: the purpose of the survey on audiological issues among infectious risk groups is to make an early diagnosis of hearing disorders in order to promote rehabilitation and improve communication functions. Neonates with hearing loss at such a young age are the best candidates for amplification and rehabilitation. Conclusion: Children at risk for congenital syphilis need to be evaluated in terms of Hearing Screening and to be monitored, even though it sometimes becomes difficult to convince the family about that. It is important to keep this process in order to assure the integrity of the senses, especially in terms of the audiologic system, and to promote the adequate development of the child.

Baseline knowledge, attitudes, and practices of healthcare practitioners in Rizal Province, Philippines toward Implementing the Universal Newborn Hearing Screening Program

Objective@#The study describes the current knowledge, attitudes, and practices of healthcare practitioners in Rizal province regarding the implementation of the universal newborn hearing screening program (UNHSP).@*Materials and Methods@#A descriptive phenomenologic research design through focus group discussions with pediatric and OBGYN consultants in a government hospital, nurses from private primary and secondary hospitals, midwives from private birthing homes, and rural health workers@*Results@#Attitudes. All participants recognized that they had important roles in implementing the program except the OBGYN consultants as they felt that information about the UNHSP should be provided by pediatricians. Practices. The lack of a screening device, trained personnel, and a referral network were the most common barriers in implementing the program. Knowledge. Most participants lacked specific knowledge about hearing loss and its implications in the UNHSP.@*Conclusion@#Most participants were able to determine the advantages and disadvantages of implementing the UNHSP. However, less than half of the participants admitted to have an established protocol to give access to newborn hearing screening services. Establishment of an information dissemination protocol and materials may be beneficial in the absence of funding for screening devices.

Universal hearing screening in newborns: experience in a tertiary care hospital of Mangalore, Karnataka, India

Background: The aim of the study was to do universal hearing screening of all newborns using otoacoustic emission (OAE), to know the incidence and risk factors of hearing loss in neonates.Methods: This was a prospective observational study done in a tertiary care hospital in Mangalore city in Karnataka. 950 neonates were screened with distortion product otoacoustic emission (DPOAE) during the study period of one year from 2017 to 2018. A repeat test was done at one and a half months of age if the first test failed. Auditory brain stem evoked response (ABER) was performed at 3 months of age if both the tests failed. Babies with hearing loss were referred to ENT specialist for further management. Comparison of the variables was done by student's t test and Chi-square test. P-value <0.05 was considered statistically significant.Results: Out of the 950 newborns screened with DPOAE test, 204 (21.4 %) babies had abnormal screen either in single or both ears. 7 out of 204 (3.43%) babies had abnormal OAE on repeat testing at one and half months. 2 out of 7 babies (0.96 %) had significant hearing loss ABER was performed at 3 months of age.Conclusions: Early identification by screening of hearing loss prevents a significant public health concern. Early recognition and intervention prior to 6 months have a significant positive impact on development.

Diagnostic Clues for Congenital Cytomegalovirus Infection: Association with Newborn Hearing Screening Tests

PURPOSE: To investigate clinical markers for the diagnosis of congenital cytomegalovirus (CMV) infection and determine the correlation between abnormal newborn hearing screening results and asymptomatic congenital CMV infection. METHODS: Medical records of newborns with congenital CMV infection, born at Cheil General Hospital & Women's Healthcare Center from July 2008 to June 2018, were retrospectively reviewed. Infants with congenital CMV infection were classified into “symptomatic,” “asymptomatic,” and “asymptomatic with isolated abnormal automated auditory brainstem response (AABR)” groups. Clinical data were analyzed based on this classification. RESULTS: Among the 59,424 live births, congenital CMV infection was found in 25 neonates, including 19 symptomatic (0.03%) infants, two asymptomatic, and four asymptomatic with isolated abnormal AABR. Diagnostic clues for the identification of congenital CMV infection were intrauterine growth restriction (IUGR), including microcephaly in 10 infants (40.0%), abnormal AABR in four (16.0%), initial complicated signs in four (16.0%), and abnormal findings on brain ultrasonography in three (12.0%). Other less common markers included petechiae, abnormal findings on antenatal ultrasonography, and co-twin with CMV infection. During the recent 10 years, 53,094 of 59,424 newborns (89.3%) had AABR for hearing screening and 493 (0.9%) did not pass. Among them, 477 (96.8%) were screened for CMV, and results were positive for seven (1.5%). Among the seven infants, four had asymptomatic congenital CMV infection. Overall, 0.8% of the newborns with abnormal AABR (four of 477 infants) were diagnosed as having asymptomatic congenital CMV infection. CONCLUSION: The incidence of symptomatic congenital CMV infection was 0.03%, and 0.8% of infants who failed in the newborn hearing screening tests had asymptomatic congenital CMV infection. The most common clinical marker to diagnose congenital CMV infection was IUGR, including microcephaly, and the second isolated marker was abnormal AABR.

A study on the accuracy of pen click test as a hearing screening tool among newborns seen in two tertiary government hospitals

BACKGROUND@#Hearing impairment has a great impact on the functional, social and emotional aspects of a child. Thus, early detection and management is crucial for optimal development of the child. The Newborn Hearing Screening Act was approved in the Philippines to ―institutionalize measures for prevention and early diagnosis of congenital hearing loss among newborns‖. A simple, accurate and readily available hearing screening tool is necessary in less privileged communities.@*OBJECTIVES@#To determine the accuracy of Pen Click Test as compared to otoacoustic emission test as a hearing screening tool among newborns seen in two tertiary government hospitals. The accuracy of Pen Click Test was measured for its sensitivity, specificity, positive and negative predictive value.@*METHODS@#The study is an experimental design consisting of three phases: Phase I is a randomized complete block design; Phase II involves inter-rater and intra-rater variability randomized block design and Phase III is a cross sectional design. The study was done in two government tertiary hospitals. The subjects are term newborns with both ears analyzed independently from each other.@*RESULTS@#Phase I of the study identified Acroball retractable pen as the study stimulus based on its accessibility and its capability to produce high decibel. In phase II, all health workers produced a sound stimulus of more than 70 decibels. Majority of the health workers had no significant difference among each other which means there is minimal deviation from the mean. Phase III showed that pen click test has a high specificity of 98% and a sensitivity of 43%. Based on disease prevalence, the test showed a positive predictive value of 77% and negative predictive value of 93%. Kappa agreement showed moderate result with a Kappa coefficient of 0.54.@*CONCLUSION@#The study showed high specificity in identifying hearing impairment and a positive association of Pen Click test to the standard hearing audiometer. The application of this test in the community may be done as a hearing screening tool. This study provides an accessible, easily reproducible and accurate tool for hearing screening that may be applied in communities without facilities.

Knowledge And Attitude Of Malaysian Healthcare Professionals Towards Newborn Hearing Screening Program

@#Newborn hearing screening program (NHSP) is a standard of care in many countries around the world. Its success to a great extent depends on professionals understanding of the program’s goals and the screening procedures. Hence, this study aimed to investigate the knowledge and attitudes of Malaysian healthcare professionals involved in NHSP. A cross-sectional survey study using a 25 items questionnaire was conducted on a purposive sample of healthcare professionals who worked in 30 Malaysian government hospitals that run NHSP. Four hundred and three questionnaires were distributed, only 138 completed questionnaires were analysed, yielding a response rate of 34.2%. Of the 138 healthcare professionals, 35 (25.4%) were paediatricians, 43 (31.2%) were ear, nose and throat (ENT) specialists, and 60 (43.5%) were nurses. In general, the study revealed that the ENT specialists scored significantly higher that the paediatricians and nurses on both knowledge and attitude. Although the majority of all three healthcare professionals (>75%) viewed NHSP as very important, yet many nurses and paediatricians (>70%) reported received limited information during their training in this area and felt uncomfortable in explaining about the whole hearing screening process to the parents. Despite the positive attitude towards NHSP, 22.5% of the healthcare professionals were not aware of the existence of the program. In conclusion, this study has demonstrated knowledge gap in NHSP among the healthcare professionals, but their positive attitudes could be an indication of a strong interest to learn more about NHSP. Therefore, there is a need to take urgent efforts to improve the knowledge of healthcare professionals on NHSP.

Evaluation of the newborn hearing screening program in The Medical City based on Joint Commission on Infant Hearing (JCIH) 2007 position statement quality indicators

Objective@#The objective of this study is to evaluate the newborn hearing screening program in The Medical City based on the Joint Committee on Infant Hearing (JCIH) 2007 Position Statement Quality Indicators. @*Methods@#Study Design: Cross - Sectional Survey. Setting: Tertiary Private Hospital. Participants: All newborns who underwent newborn hearing screening in The Medical City for the year 2015. @*Results@#Of 2,010 patients delivered in the hospital in year 2015, 1,986 (98.8%) were screened. Among the 59 babies with initial “refer” results, 15 (25.42%) “referred” a second time while 24 (40.68%) “passed” the rescreening. Twenty (33.89%) did not undergo rescreening (10 were classified as dropouts, while another 10 did not undergo rescreening for various reasons. Of those who “referred” during rescreening, only 9 (60%) had further evaluation done with ABR/ASSR. Among these, 4 (26.66%) had hearing loss and proceeded with the appropriate monitoring and management while 5 (33.33%) had normal hearing. @*Conclusion@#The current newborn hearing screening program in the Medical City was able to reach JCIH 2007 quality indicators for screening but not for confirmation of hearing Loss. All patients with hearing loss were managed with early rehabilitation.