current status of hearing screening in the neonatal intensive care unit shana jacobs, b.s. jackson...
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Current Status of Hearing Screening in the Neonatal Intensive Care Unit
Shana Jacobs, B.S.
Jackson Roush, Ph.D.
Division of Speech and Hearing Sciences
University of North Carolina School of Medicine
Chapel Hill, NC
Faculty Disclosure
In the past 12 months, I have not had a significant financial interest or other relationship with the manufacturer(s) of the product(s) or provider(s) of the service(s) that will be discussed in my presentation.
This presentation will (not) include discussion of pharmaceuticals or devices that have not been approved by the FDA or if you will be discussing unapproved or “off-label” uses of pharmaceuticals or devices.
Acknowledgements
Karl White, NCHAM State EHDI Coordinators
Background Incidence of SNHL – Well-babies: 1-2:1000– NICU 10-20:1000
Because of the high incidence of permanent hearing impairment in this population, physiologic screening via ABR has occurred in the NICU since the 1980s
More recently OAEs are also used in the NICU – alone or in a combined ABR/OAE protocol
A growing concern for NICU Infants…
Auditory Neuropathy – Dysynchrony– Abnormal neural function at the level of the
VIIIth nerve/brainstem in the presence of normal outer hair cell function
– Incidence is higher than once thought• 25% of NICU infants according to one recent
study (Berg et al, 2005)
– OAE screening alone will not identify AN/AD
Other Challenges in the NICU
Challenges– Ambient noise levels– Transfer before
screening– Difficulties with
tracking, follow-up– Lack of accurate,
efficient reporting procedures
Nurseries in US Hospitals
Level 1 (basic care of well-babies) Level 2 (moderate risk of serious
complications): N=120 Level 3 (specialty and subspecialty care
including life support): N=760
10-15% of newborn population receive care in Level 2 or 3 nursery (Bhatt, 2001; AAP, 2004)
Purpose of this study
To determine the technologies and protocols used for NICU hearing screening in the U.S.
To identify challenges associated with NICU hearing screening
To obtain an estimate of how many infants are being identified with AN/AD
Methodology Survey Instrument
– Electronically distributed– 13 Questions
• Number of Well-Baby and NICU Infants screened• NICU Screening Methods and Protocols• Number of Babies Identified over the past year with AN/AD
– Anonymous once submitted Distribution
– Emailed to State EHDI Coordinators, January, 2006• Used EHDI listserv to contact 51 coordinators (1 per state)
– Two reminder notices sent Returns as of January 30th
– 23/51 (45%)
Please estimate the % of NICU infants discharged prior to screening over the past year
0-2% discharged before screening: 15 (66%) 3-5% discharged before screening: 1 (4%) 6-10% discharged before screening: 3 (13%) >10% discharged before screening: 1 (4%) Unable to estimate: 3 (13%)
If an infant is not screened in the NICU prior to discharge, what is most likely to
happen?
Primary care physician advised of need for initial screen
Family advised of need for initial screen Referral for audiologic assessment
For the first NICU hearing screening, what
technology is used?
OAE: 2 (9%) ABR: 7 (30%) OAE or ABR: 14 (61%)
In your state, who usually conducts the
first NICU hearing screening?
Nurses Hospital Technicians Audiologists
If re-screening is provided in the NICU for infants who fail the first screen, what technology/protocol is most often used?
• 26% - AABR followed by AABR (6/23)• 9% - OAE followed by ABR (2/23)• 9% - OAE followed by OAE (2/23) • 47% - Could be any of the above (11/23)• 9% - Other 2/23
Please indicate the person who is most likely to perform NICU hearing re-screenings in your state?
Nurses Audiologists Hospital Technicians
How many re-screenings are typically performed prior to a referral for
comprehensive audiology evaluation? 57% - 1 re-screening (13/23) 30% - 2 re-screenings (7/23) 0% - 3 re-screenings (0) 0% - More than 3 (0) 13% - Variability in re-screens (3/23)
What are the most significant obstacles or frustrations associated with infant hearing
screening in the NICU in your state? Narrow window of time from when infant is available for
screening to time of transfer; discharge before screening completed
Difficulty tracking children who are transferred from one facility to another (also transfers between nurseries within same hospital)
Hard to ensure follow-up of all infants who fails screening
Failure of some hospitals to report screening results; lack of coordination, uniformity of reporting
Obstacles and frustration (cont’d)
Medical staff may not appreciate the importance of hearing screening; need to give priority to medical concerns
Lack of uniformity in screening protocols Lack of qualified screening personnel
on weekends Excessive ambient noise levels Lack of audiologist availability for follow-
up
Comparison of Eight States
A B C D E F G H
Total
Screened
86,300 69,000 27,000 124,800 50,000 43,000 26,000 14,000
275 160 26 77 100 60 26 12
3.1 2.3 1 1 2 1.4 1 0.9
8 5 6 4 5 3 2 0
3% 3% 23% 5% 5% 5% 8% 0%
Total SNHL
(# per 1000)
AN-AD
Total SNHL Identified (one or both ears)
N=8 States
Total Screened: 440,100
Permanent HL 1.6/1000 % with AN/AD 5%
Conclusions NICU screening protocols vary widely even within some states Some NICUs are using technologies/protocols that will not
identify AN/AD Prevalence estimates of permanent HL consistent with other
reports Infants with AN/AD approximately 5% of all infants identified
with SNHL (unable to compare NICU vs. well-baby screening) Many state EHDI coordinators report frustration with narrow
window of opportunity for screening before discharge
Future Needs
Improved statewide systems for tracking and follow-up
Greater uniformity in statewide screening protocols Further study and more detailed analysis needed to
get an accurate estimate of AN/AD prevalence Follow-up studies needed to determine the natural
history of AN/AD Program managers should be aware of the
advantages of ABR for hearing screening in the NICU
Any questions?