The Effect of Universal Newborn Hearing Screening on Spoken Language after Cochlear Implantation.

BACKGROUND: The universal newborn hearing screening (UNHS) was fully implemented across New Zealand by 2010 to improve outcomes for children with prelingual deafness. A previous audit undertaken by our center, the Southern Cochlear Implant Programme (SCIP), demonstrated that UNHS has significantly reduced the time to referral and surgery for cochlear implants in these children. AIMS: This study aims to evaluate the relationship between earlier implantation and language development, the time taken to achieve age-appropriate language, and the effect of socioeconomic status on language skills. METHODS: This is a retrospective cohort study comparing prelingual children with severe to profound bilateral hearing loss who underwent cochlear implantation in SCIP before and after the introduction of the UNHS. The language outcomes were assessed using the Preschool Language Scale and/or the Peabody Picture Vocabulary Test. For the purpose of our study, the standard scores of these tests were expressed as global language scores (GLS). GLSs between 85 and 115 are considered within normal range for age. The socioeconomic status was categorized based on the New Zealand Index of Deprivation (NZDep). RESULTS: Children in the post-UNHS group (46/95 children) were referred to SCIP and received CI at a significantly earlier age (mean = 7 vs 20 mo, p = 8.95E-10, and mean = 13 vs. 24.7 mo, p = 1.43E-07). At 2 years postimplantation, the GLS was significantly higher in the post-UNHS group (mean scores = 93.3 vs. 79.1, p = 0.0213). The scores remained statistically higher in the post-UNHS group when assessed at 3 and 4 years postimplantation. At 2, 3, and 4 years postimplantation, there is a significant linear decrease in GLS with increasing age at cochlear implantation. We found no correlation between NZDep and GLS. CONCLUSION: Children identified through UNHS have the advantage of earlier diagnosis, earlier hearing intervention, and longer duration with the implants, and they can achieve age-appropriate spoken language after 2 years of implantation.

International prospective observational study of upper gastrointestinal haemorrhage: Does weekend admission affect outcome?

INTRODUCTION: Out of hours admissions have higher mortality for many conditions but upper gastrointestinal haemorrhage studies have produced variable outcomes. METHODS: Prospective study of 12 months consecutive admissions of upper gastrointestinal haemorrhage from four international high volume centres. Admission period (weekdays, weeknights or weekends), demographics, haemodynamic parameters, laboratory results, endoscopy findings, further procedures and 30-day mortality were recorded. Five upper gastrointestinal haemorrhage risk scores were calculated. RESULTS: 2118 patients, 60% male, median age 66 years were studied. Compared with patients presenting on weekdays, patients presenting at weekends had no significant differences in comorbidity, pulse, systolic BP, risk scores, frequency of peptic ulcers or varices. Those presenting on weekdays had lower haemoglobin (p = 0.007) and were more likely to have a normal endoscopy (p < 0.01). Time to endoscopy was less for weeknight presentation (p = 0.001). Sixty-seven per cent of those presenting on weekdays, 75% on weeknights and 60% at weekends had endoscopy within 24 h. Transfusion requirements, need for endoscopic therapy or surgery/embolization, rebleeding rates (6.1%) and mortality (7.2%) did not differ with presentation time. CONCLUSION: This multi-centre international study in large centres found no difference in demographics, comorbidity or haemodynamic stability and no increase in mortality for patients presenting with upper gastrointestinal haemorrhage out of hours.

Clinical phenotype and outcome of hepatitis E virus-associated neuralgic amyotrophy.

OBJECTIVE: To determine the clinical phenotype and outcome in hepatitis E virus-associated neuralgic amyotrophy (HEV-NA). METHODS: Cases of NA were identified in 11 centers from 7 European countries, with retrospective analysis of demographics, clinical/laboratory findings, and treatment and outcome. Cases of HEV-NA were compared with NA cases without evidence of HEV infection. RESULTS: Fifty-seven cases of HEV-NA and 61 NA cases without HEV were studied. Fifty-six of 57 HEV-NA cases were anti-HEV IgM positive; 53/57 were IgG positive. In 38 cases, HEV RNA was recovered from the serum and in 1 from the CSF (all genotype 3). Fifty-one of 57 HEV-NA cases were anicteric; median alanine aminotransferase 259 IU/L (range 12-2,961 IU/L); in 6 cases, liver function tests were normal. HEV-NA cases were more likely to have bilateral involvement (80.0% vs 8.6%, p < 0.001), damage outside the brachial plexus (58.5% vs 10.5%, p < 0.01), including phrenic nerve and lumbosacral plexus injury (25.0% vs 3.5%, p = 0.01, and 26.4% vs 7.0%, p = 0.001), reduced reflexes (p = 0.03), sensory symptoms (p = 0.04) with more extensive damage to the brachial plexus. There was no difference in outcome between the 2 groups at 12 months. CONCLUSIONS: Patients with HEV-NA are usually anicteric and have a distinct clinical phenotype, with predominately bilateral asymmetrical involvement of, and more extensive damage to, the brachial plexus. Involvement outside the brachial plexus is more common in HEV-NA. The relationship between HEV and NA is likely to be causal, but is easily overlooked. Patients presenting with NA should be tested for HEV, irrespective of liver function test results. Prospective treatment/outcome studies of HEV-NA are warranted.