Pesquisaje auditivo universal en recién nacidos de provincia Guantánamo, 2020-2021 / Triagem auditiva universal em recém-nascidos na província de Guantánamo, 2020-2021 / Universal newborn hearing screening in Guantanamo province, 2020-2021

RESUMEN Introducción: El pesquisaje auditivo neonatal es la evaluación que permite detectar o sospechar pérdidas auditivas, abordándose mediante un plan de habilitación o rehabilitación. Objetivo: Determinar la cobertura del pesquisaje auditivo universal en la provincia de Guantánamo, en el contexto epidemiológico de la COVID-19, durante el periodo marzo 2020 a marzo 2021. Método: Se realizó un estudio descriptivo, retrospectivo y de corte transversal. El universo estuvo constituido por 5 999 recién nacidos vivos. Las variables estudiadas fueron: sexo, recién nacidos con y sin factores de riesgo, y las emisiones otoacústicas, cuyos resultados permitieron la evaluación de cobertura. Se definió el indicador estándar (95 %) y el tiempo en que se realizó las primeras emisiones otoacústicas. Se estableció como indicador el porcentaje de recién nacidos pesquisados antes de un mes de vida. Resultados: De los 5 999 nacimientos, el 51,7 % correspondió al sexo masculino y el 48,3 perteneció al sexo femenino. Al 100 % de los recién nacidos sin factores de riesgo (5 838) se les realizó la primera exploración, mientras que a aquellos con factores de riesgo (151) no se les pudo realizar al 0,2 % (10). La pesquisa de los recién nacidos sin factores ocurrió entre 1 y 3 días de nacidos. Nunca se realizaron pesquisas después de los 30 días de nacido en los que presentaron factores de riesgo. La cobertura fue de 99,8 % y el índice de referencia de 0,2 %. Conclusiones: El Programa de Pesquisaje Auditivo Universal en la provincia de Guantánamo en el contexto de la COVID-19 muestra cumplimiento en el indicador de cobertura.

ABSTRACT Introduction: Universal neonatal hearing screening is a test that enables to identify or suspect hearing loss, performed via habilitation or rehabilitation plan. Objective: Determine the coverage of universal hearing screening in the epidemiological context of COVID-19 in Guantánamo province, during the period of march 2020 to march 2021. Method: A descriptive, retrospective cross-sectional study was carried out. A total of 5 999 newborns (as Universe) were involved in the study. Variables used were as follow: sex, newborns with or without risk factors, and otoacoustic emissions, which outcomes allowed for the evaluation of universal hearing screening coverage. The standard indicator (95%) and the time at which the first otoacoustic emissions were made were defined. The percentage of newborns detected before one month of life was established as indicator. Results: The 51.1% of the 5 999 newborns were male and 48.3% were female. The 100% of newborns (5 838) without risk factors underwent to the first examination, meanwhile, among those with risk factors (151 newborns) 0.2% (10) could not be tested. Screening of newborns without factors occurred between 1 and 3 days after birth. Screening was never performed after 30 days of birth in those who presented risk factors. Coverage was 99.8% and the reference rate was 0.2%. Conclusions: Universal Hearing Screening Program application in the context of COVID-19 pandemic in Guantanamo province shows a fulfillment in the coverage indicator.

RESUMO Introdução: A triagem auditiva neonatal é a avaliação para detectar ou suspeitar de perda auditiva, que é abordada por um plano de habilitação ou reabilitação. Objetivo: Determinar a cobertura da triagem auditiva universal na província de Guantánamo, no contexto epidemiológico da COVID-19, durante o período de março de 2020 a março de 2021. Método: Foi realizado um estudo descritivo, retrospectivo, transversal. O universo consistia de 5 999 recém-nascidos vivos. As variáveis estudadas foram: sexo, recém-nascidos com e sem fatores de risco, e emissões otoacústicas, cujos resultados permitiram a avaliação da cobertura. O indicador padrão (95%) e o momento em que as primeiras emissões otoacústicas foram feitas foram definidos. O indicador foi definido como a porcentagem de recém-nascidos examinados antes de um mês de idade. Resultados: Dos 5 999 nascimentos, 51,7% eram homens e 48,3% eram mulheres. 100% dos bebês sem fatores de risco (5.838) foram examinados pela primeira vez, enquanto aqueles com fatores de risco (151) não puderam ser rastreados por 0,2% (10). A triagem de recém-nascidos sem fatores de risco ocorreu entre 1 e 3 dias após o nascimento. A triagem nunca foi realizada após 30 dias de nascimento naqueles com fatores de risco. A cobertura foi de 99,8% e a taxa de base foi de 0,2%. Conclusões: O Programa Universal de Triagem Auditiva na província de Guantánamo no contexto da COVID-19 mostra a conformidade com o indicador de cobertura.

Prevalencia de hipoacusia en una población escolar con síndrome de Down de Bogotá, Colombia / Prevalence of hearing loss in a population of schoolchildren with Down syndrome from Bogotá, Colombia

Introducción: Los niños con síndrome de Down presentan mayor prevalencia de alteraciones de la capacidad auditiva, secundaria a variaciones anatómicas y fisiológicas. En Colombia, no se realiza tamizaje auditivo universal, y no hay datos sobre la prevalencia de hipoacusia en esta población. El propósito de este estudio fue determinar la frecuencia y tipo de estas alteraciones en nuestra población por medio de evaluación audiológica.Pacientes y métodos: Se realizó un estudio de corte trasversal en dos instituciones especializadas en el acompañamiento y terapia de familias de niños con síndrome de Down en Bogotá D. C., Colombia. Entre octubre de 2017 y septiembre de 2018, se realizó audiometría comportamental y/o tonal e impedanciometría en 40 y en 37 niños respectivamente. Los sujetos asistían a las instituciones dos veces por semana y estaban integrados en diferentes grados escolares hasta quinto de primaria. Se estimó la prevalencia y se describieron las características, antecedentes clínicos e hitos del desarrollo del lenguaje. Resultados: Se obtuvo una muestra de 40 niños (22 mujeres) con edades entre 6 y 18 años (media: 11,23). Se encontró antecedente de otitis en 19 sujetos e hipoacusia de leve a moderada en 17 niños, predominantemente, conductiva. Hubo retraso en hitos del desarrollo del lenguaje, en apariencia, no asociado a hipoacusia.Conclusiones: En una muestra de niños con síndrome de Down en Bogotá, se encontró una alta prevalencia de hipoacusia, consistente con resultados de estudios previos. Estos datos resaltan la necesidad de un control estricto de la capacidad auditiva basado en parámetros y guías estandarizadas.

Introduction: Children with Down syndrome have a higher prevalence of hearing disorders, secondary to anatomical and physiological variations. No universal hearing screening is implemented in Colombia, so there are no data available on the prevalence of hearing loss in this population. The objective of this study was to determine the frequency and type of such disorders in this population based on hearing tests.Patients and methods: This was a cross-sectional study conducted at two institutions specialized in accompanying and supporting the families of children with Down syndrome in Bogotá, D.C., Colombia. Between October 2017 and September 2018, a behavioral and/or pure-tone audiometry and an impedance audiometry were done in 40 and 37 children respectively. Subjects attended the institutions twice a week and were integrated at school, up to fifth grade. Prevalence was estimated and characteristics, clinical history, and language developmental milestones were described.Results: The sample was made up of 40 children (22 girls) aged 6-18 years (mean: 11.23). A history of otitis was found in 19 children and of mild to moderate hearing loss, in 17, predominately conductive. A delay in language developmental milestones was observed, apparently not associated with hearing loss. Conclusions: A sample of children with Down syndrome from Bogotá showed a high prevalence of hearing loss, consistent with the results of previous studies. These data stress the need for a strict control of hearing status based on standardized parameters and guidelines.

Feasibility of two staged newborn hearing screening and identification of risk factors for hearing loss other than those included in high risk registry (HRR) given by joint committee on infant hearing (JCIH).

Background: Hearing impairment in neonates is a hidden disability, which is usually detected around 2 years of age. Crucial speech and language development begins during first six months of life. Undetected hearing loss present from an early age can impede acquisition of speech language, communication, cognitive and social-emotional development of a child. Across the globe, there is an evolving consensus that all infants should be screened for hearing impairment and appropriate interventions should be instituted in those found to have the problem by six months of age. Most developed countries have introduced mandatory screening and interventional programme with strategies appropriate for their public health concerns. Unfortunately, in developing countries, due to the paucity of resources, infant hearing screening programme has not been introduced as national programme. There have been very few large scale hearing screening studies done in India, to know the feasibility of universal hearing screening or high risk neonate hearing screening. The present study is taken to fill in the lacune in this aspect. Aims & Objective: To study the feasibility of using two staged Transient Evoked Otoacoustic Emissions (TEOAE) followed by confirmation with Auditory Brainstem Response (ABR) in hearing screening of newborns along with an attempt to identify additional risk factors, other than those included in “High Risk Registry (HRR)” given by Joint Committee on Infant Hearing (JCIH) in 2007. Material and Methods: A prospective observational study of hearing impairment screening was conducted on 800 newborns, who were screened with two staged Transient Evoked Otoacoustic Emissions TEOAE, using handheld TEOAE device, followed by confirmation with Auditory Brainstem Response (ABR). The study was done in Command Hospital Air Force, Bangalore, during Jan 2010 to May 2011, where in all new born, born during the study period were screened, which included 757 healthy neonates and remaining 43 high risk neonates as per HRR of JCIH 2007. Additional risk factors that could affect the hearing in the normal neonates was also studied. Results: At the end of the two TEOAE tests, 15 (1.8%) neonates of the 800 cohort screened were suspected of hearing impairment and referred for ABR test. Sensorineural hearing loss was confirmed by ABR in 5 (0.6%) of those 15 referred, with a 1.2% false positive rate at the end of 2nd TEOAE. 2 of the hearing impaired infants belonged to “at risk group” neonates with remaining 3 not having any risk factor as per “High Risk Registry (HRR)” of Joint Committee on Infant Hearing (JCIH). This study showed the presence of medical conditions like maternal Urinary Tract Infection (UTI), Gestational Diabetes Mellitus (GDM) or maternal Diabetes Mellitus (DM) and Pregnancy Induced Hypertension (PIH) along with the well-known risk factors of HRR in the infants with hearing loss. But a strong association between these maternal conditions and hearing impairment could not be established due to small sample size, warranting a detailed study of these other possible risk factor. Conclusion: This study has shown that two–stage hearing screening with TEOAE & ABR is a feasible method that can be successfully implemented for newborn hearing screening, for early detection of hearing impaired, on a large scale, in hospital, to achieve the high quality standard of screening programs. 3 of the 5 hearing impaired detected in the study had no known risk factor for hearing loss, advocating universal hearing screening and an extensive efforts are required to find additional risk factors that can be included in the HRR of JCIH so as to make high risk screening more effective.