Análisis crítico de una década de cribado neonatal de hipoacusia en un hospital comarcal / Results from ten years newborn hearing screening in a secondary hospital

INTRODUCCIÓN: Se evalúa el protocolo de cribado de hipoacusia neonatal en un hospital comarcal. PACIENTES: Análisis en 14.247 recién nacidos en la maternidad del centro desde el año 2002 al 2013 inclusive. MÉTODOS: Protocolo con registro de otoemisiones bilaterales (registro inicial y repetición si falla, al mes de vida) y potenciales auditivos (confirmación). RESULTADOS: Se realizó la prueba antes del alta a 14.015 neonatos (98,3% de la muestra) cumpliendo así los objetivos de cobertura del cribado. En el primer paso resultaron normales el 93,7%, lo que implica una adecuada tasa de paso y no obliga a excesivas repeticiones. La segunda determinación obtiene también buenos resultados, puesto que el 88,9% de los que acuden resultan normales, dejando solo un 0,63% del grupo inicial para valorar con potenciales. Un 10,6% no acude a la cita, lo que constituye el principal problema detectado. En los remitidos a potenciales esta pérdida es mayor, con un 29,5%, a pesar de que la rentabilidad en aquellos pacientes que se exploran con esta técnica es muy alta dado que el 69,4% de ellos presenta unos potenciales alterados. Esta cifra de alterados representa el 0,31% del total de recién nacidos estudiados, cifra similar a la incidencia de sordera congénita. Teniendo en cuenta las pérdidas en seguimiento referidas la incidencia real podría ser mayor. CONCLUSIONES: El programa es muy útil pero necesita un control estricto del seguimiento para evitar pérdidas de pacientes. Para ello es fundamental tener una base de datos dedicada y un coordinador del programa

INTRODUCTION: A critical analysis is performed on the results of a newborn hearing screening program in a regional hospital. PATIENTS: Screening results from 14,247 newborns in our maternity ward from 2002 to 2013. METHODS: Two step recordings of bilateral otoacoustic emissions (initial and repeat, if failed, at about one month of life). Assessment by clinical brainstem responses. RESULTS: The first step was performed on 14,015 newborns (98.3% of the total) reaching the screening objective. The first step pass figures were 93.7%, which implies a good pass rate with a few patients to repeat. The second step is also good because it has a pass rate of 88.9% of newborns examined (only 0.63% of initial group needed brainstem responses assessment), but 10.6% were lost to follow up, and that is a major problem. In newborns, scheduled for brainstem responses, the loss to follow-up is worse, with a figure of 29.5%, despite the high accuracy of this test given that 69.4% of those assessed showed hearing loss. This figure represents a 0.31% of the initial group, and is a similar to that published for congenital hearing loss. Including patients that were lost to follow up this figure could be greater. CONCLUSION: Newborn hearing screening is useful but needs stronger control to avoid the follow up loss. In order to achieve this, it is crucial to have a good database and a screening coordinator

[Results from ten years newborn hearing screening in a secondary hospital]. / Análisis crítico de una década de cribado neonatal de hipoacusia en un hospital comarcal.

INTRODUCTION: A critical analysis is performed on the results of a newborn hearing screening program in a regional hospital. PATIENTS: Screening results from 14,247 newborns in our maternity ward from 2002 to 2013. METHODS: Two step recordings of bilateral otoacoustic emissions (initial and repeat, if failed, at about one month of life). Assessment by clinical brainstem responses. RESULTS: The first step was performed on 14,015 newborns (98.3% of the total) reaching the screening objective. The first step pass figures were 93.7%, which implies a good pass rate with a few patients to repeat. The second step is also good because it has a pass rate of 88.9% of newborns examined (only 0.63% of initial group needed brainstem responses assessment), but 10.6% were lost to follow up, and that is a major problem. In newborns, scheduled for brainstem responses, the loss to follow-up is worse, with a figure of 29.5%, despite the high accuracy of this test given that 69.4% of those assessed showed hearing loss. This figure represents a 0.31% of the initial group, and is a similar to that published for congenital hearing loss. Including patients that were lost to follow up this figure could be greater. CONCLUSION: Newborn hearing screening is useful but needs stronger control to avoid the follow up loss. In order to achieve this, it is crucial to have a good database and a screening coordinator.