Updating the nationwide methodology for hearing screening of newborns in the Czech Republic.

Screening programs examining neonatal hearing serve to detect hearing defects, as a prerequisite for hearing rehabilitation, communication skills, and the enhancement of speech development. There are two methods through which neonatal hearing screening is carried out - the transiently evoked otoacoustic emissions (TEOAE) or the automatic BERA (AABR, automated auditory brainstem response). Positive screening means the discovery of a hearing defect (permanent hearing loss), and negative screening (normal TEOAE or the AABR results) means the absence of a hearing defect. The procedural aim is to update and adjust the neonatal hearing screening, which is determined by the Bulletin of the Ministry of Health of the Czech Republic No. 7/2012. Neonatal screening is performed at three levels: at neonatological site, at the ENT (phoniatric) rescreening site and at the ENT regional centre. The activities at each level are accurately and concretely identified including the issue of billing the performance to health insurance companies and informed consent to personal data protection (GDPR). The correct functioning of screening for hearing loss is based on the simple organization of the screening, patient examination comfort, medical recovery from it, and its economic viability. The schedule for neonatal hearing screening and rehabilitation recommends the following steps: 1. screening of a newborns hearing on the second or third day after delivery by a neonatological nurse using otoacoustic emissions, alternatively AABR for newborns at risk; 2. hearing rescreening in the third to sixth week of child`s age at the ENT rescreening site; 3. completion of hearing impairment diagnostics within three to sixth months of age at the ENT regional centre. The failure to follow the procedure above is a threat to the hearing and speech development of the child with severe permanent hearing impairment. The collaboration of ENT doctors with neonatologists and paediatricians allows for creating conditions under which the functional nationwide hearing screening of newborns can be established throughout the Czech Republic.

Cerebral function monitoring in neonates with perinatal asphyxia--preliminary results.

INTRODUCTION: This study was based on foreign studies which confirmed the importance of amplitude-integrated electroencefalographic monitoring (aEEG) in the early prediction of the future neurological development of newborn infants with hypoxic syndrome. Our aim was to confirm the correlation between the type of aEEG trace and the level of brain damage in newborn infants in the early hours after the hypoxic event and to introduce this method into routine practice. MATERIAL AND METHODS: With 56 newborn infants having suffered a perinatal hypoxic event (the average umbilical arterial pH was 6.95, the average BE value -17.3) and in 2 newborn infants after early postnatal hypoxia, aEEG monitoring was performed continually. The aEEG records of brain activity obtained were analyzed using the Hellström-Westas classification. The level of hypoxic-ischemic encephalopathy was evaluated according to the Sarnat-Sarnat classification. Assessment of future neurological development is not included in this work. RESULTS: 12 (21%) of the 56 newborn infants did not develop any hypoxic-ischemic encephalopathy, 8 (14%) newborn infants had hypoxic-ischemic encephalopathy (HIE) grade I, 19 (35%) had HIE grade II and 17 (30%) had HIE grade III. The newborn infants without hypoxic-ischemic encephalopathy had normal or slightly abnormal aEEG trace. In the case of newborn infants who had HIE grade I, we recorded a normal or slightly abnormal aEEG trace. In the case of newborn infants who had HIE grade II, we recorded all types of aEEG trace--from normal to seriously pathological. Of the newborn infants who had HIE grade III, all had a pathological aEEG trace of "burst suppression patterns", low voltage pattern or flat trace pattern. The results show that if a newborn infant had a pathological type of aEEG trace in the early hours after a hypoxic event he or she later developed at least HIE grade II. 53% of the newborn infants with a flat aEEG trace later had HIE grade III. CONCLUSION: Cerebral function monitoring is a non-invasive method used for the early assessment of the severity of a hypoxic event. As it could be used in the first few hours after birth, this method could be applied to select patients suitable for therapeutic hypothermia.

Development of gastric emptying in premature infants. Use of the (13)C-octanoic acid breath test.

OBJECTIVE: The non-invasive (13)C-octanoic acid breath test ((13)C-OABT) has recently been used to monitor gastric emptying. We evaluated (13)C-OABT as a method for assessing gastric emptying in relation to the amount of milk ingested in preterm neonates during their first days of life. METHODS: The (13)C-OABT was performed in 16 stable preterm neonates born between weeks 31 and 37 of gestation (mean +/- standard deviation: 34.0 +/- 1.5 wk). Birth weight was 1400 to 2680 g (2076 +/- 350 g); four newborns were small for gestational age. The newborns underwent (13)C-OABT three times according to the amount of (13)C-primed breast milk being fed to them (<7 mL/kg, 7-13 mL/kg, and 10-19 mL/kg per dose). (13)C-primed breast milk (the test meal) was prepared by adding (13)C-octanoic acid to pasteurized breast milk to achieve a concentration of 1 microL of (13)C-octanoic acid/mL of milk. Exhaled air samples were taken through an original nasal mask. Amounts of (13)C and (12)C in the exhaled air samples were measured by mass spectrometry. Results were expressed as delta over baseline and related to the international standard of Pee Dee Belemnite Limestone. To assess the half-life of elimination (t(1/2)E), we modeled the process of elimination with the incomplete gamma-function, which has a convenient form for the empiric plotting of breath test data. We estimated the parameters of the function, f(x) = A x(b) e(-cx), by using the moment method. The curves were determined by the t(1/2)E of (13)CO(2) and characterized by the shape of the elimination curve. The half-time of gastric emptying (t(1/2)GE) was calculated as t(1/2)E reduced by the mean metabolic half-time of octanoic acid. RESULTS: Forty-eight (13)C-OABT results from 16 premature newborns were analyzed. The mean and median of t(1/2)GE calculated from all three tests were 50.3 (+/-29.9) and 43.7 min, respectively. The t(1/2)GE did not change significantly (P = 0.6811) with the administered dose of (13)C-primed breast milk in the stomach. The coefficient of variation among the studied infants was 4.0% to 33.6% (mean, 11.5%). In 12 infants, the characteristic type of elimination curve was the same for all three tests. CONCLUSIONS: In the first hours of gastric feeding, neither the age of the neonate nor the amount of administered (13)C-primed breast milk had any effect on t(1/2)GE. The gastric emptying rate and the evacuation curve shape for individual neonates were similar and independent of milk amount.