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A Model for a Universal Newborn Hearing Screening in Lombardy

Pierangelo Sarchi on behalf of: Pastorino G., Sergi P., Mosca F., Sarchi P., Redaelli T., Arpesella M., Cesarani A. A Model for a Universal Newborn Hearing Screening in Lombardy. University of Milan. University of Pavia. 11th Annual Maternal and Child Health Epidemiology Conference

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A Model for a Universal Newborn Hearing Screening in Lombardy

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  1. Pierangelo Sarchi on behalf of: Pastorino G., Sergi P., Mosca F., Sarchi P., Redaelli T., Arpesella M., Cesarani A. A Model for aUniversal Newborn Hearing Screening in Lombardy University of Milan University of Pavia 11th Annual Maternal and Child Health Epidemiology Conference December 9th, 2005, Miami Beach, FL

  2. Lombardy • 9.5 million inhabitants • 93 thousand newborn years • UNHS is not compulsory

  3. Hearing impairment • Infants diagnosed by 6 months of age have significantly better speech, language and cognitive outcomes than infants diagnosed later. • Without an early screening hearing impairment can be diagnosed at about 30 months

  4. “Fondazione Policlinico, Mangiagalli, Regina Elena”Milan • reference center for maternal infantile disease in Lombardy • 6500 newborns/year • 47 % of the hospital patients come from outside the City of Milan.

  5. “Fondazione Policlinico, Mangiagalli, Regina Elena” Patient Demographics source: Patiens admissioni in Lombardy 2004, Regione Lombardia 2005

  6. Objectives of the Study • To determine the prevalence of newborns with hearing impairment in the reference center for maternal infantile disease, in Lombardy • to encourage other hospitals in Lombardy to adopt our model of UNHS

  7. Objectives of the Study • to implement a universal newborn hearing screening program to identify infants with hearing loss by three months of age in Lombardy • to verify in the middle term the effectiveness of early screening in improving speech and language skills of infants

  8. Timetable • hearing screening planned in 1995 • hearing screening introduced in 1997 • From 06.01.1997 to 06.30.200544,996 newborns were screened

  9. Methods According to the JCIH protocol, newborn infants were separated in Risk and No-Risk: • The Risk newborns were subjected to audiometric test AABR: every newborn referred was evaluated by conventional ABR with threshold identification. • The No-Risk newborns were subjected to TEOAE test: those who failed were evaluated with the AABR test. The newborns who failed again were evaluated by conventional ABR with threshold identification within three months.

  10. Indicators associated with audiologic risk • birth weight <= 1500 g • cranio-facial abnormalities • chromosomal anomalies / syndrome • family history • Mechanical ventilation lasting 5 days or more • Apgar scores of 0 to 4 at 1 minute or 0 to 6 at 5 minutes • Infectious disease: such as Bacterial meningitis, in utero infection cytomegalovirus, rubella, syphilis, herpes, and toxoplasmosis • hyperbilirubinaemia >20 mg/dl or exchange transfusion • ototoxic drugs JCHI 1994, adjusted

  11. Risk before discharge AABR pass refer ABR

  12. No-Risk Before discharge - 1th STEP TEOAE PASS REFER AABR PASS REFER After discharge (two weeks) - 2nd STEP TEOAE PASS REFER AABR PASS REFER 3th STEP ABR-threshold

  13. From 06.01.1997 to 06.30.2005 • 45,183 newborns • 44,996 infants screened (>95%) • 93.4% of them were screened before being discharged • 6.6% were examined by 30 days old

  14. Risk Results • From 06.01.1997 to 06.30.2005 1578(>99%) newborns at risk were screened • 99% screened before the discharge from hospital • 1% examined in the next two months • 6.4% result refer at AABR • the loss at the follow-up was <1%

  15. No-Risk Results • From 06.01.1997 to 06.30.2005 43,418 (>95%) newborns No-Risk were screened • 93.4 % screened before the discharge from hospital • 6.6% examined in the next thirty days • 1.7% result refer at 1th step • 0.4% refer with diagnostic evaluation (ABR) • the loss at the follow-up was of 101(13.6%) infants.

  16. Hearing Impairment Prevalence of bilateral hearing impairment ( =>40 dBnHL) was 0.15% : • 2.9% in the Risk newborns • 0.05 % in the No-Risk newborns Prevalence of monolateral hearing impairment was 0.14% : • 2.9 % among Risk • 0.04 %. in No-Risk

  17. Conclusions • The prevalence of newborns with hearing impairement in our hospital is in accord with international data. • The organization of the screening is such to reduce the discomfort of the family.

  18. Public Health Implications • Our model of UNHS reaches the goal of early diagnosis. • This model was adopted in 6 hospitals and will be adopted by other Hospitals in Lombardy coordinated by the Mangiagalli’s team at no cost for families

  19. Thank-You E-mail: psarchi@gmail.com

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