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Assessment of the feasibility and coverage of a modified universal hearing screening protocol for use with newborn babies of migrant workers in Beijing.

Qi B, Cheng X, En H, Liu B, Peng S, Zhen Y, Cai Z, Huang L, Zhang L, Han D - BMC Pediatr (2013)

Bottom Line: Although migrant workers account for the majority of newborns in Beijing, their children are less likely to undergo appropriate universal newborn hearing screening/rescreening (UNHS) than newborns of local non-migrant residents.We hypothesised that this was at least in part due to the inadequacy of the UNHS protocol currently employed for newborn babies, and therefore aimed to modify the protocol to specifically reflect the needs of the migrant population.This incorporated two additional/optional otoacoustic emissions (OAE) tests at 24-48 hours and 2 months after birth.

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Affiliation: Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 17 HouGouHuTong, DongCheng District, Beijing, 100005, China.

ABSTRACT

Background: Although migrant workers account for the majority of newborns in Beijing, their children are less likely to undergo appropriate universal newborn hearing screening/rescreening (UNHS) than newborns of local non-migrant residents. We hypothesised that this was at least in part due to the inadequacy of the UNHS protocol currently employed for newborn babies, and therefore aimed to modify the protocol to specifically reflect the needs of the migrant population.

Methods: A total of 10,983 healthy babies born to migrant mothers between January 2007 and December 2009 at a Beijing public hospital were investigated for hearing abnormalities according to a modified UNHS protocol. This incorporated two additional/optional otoacoustic emissions (OAE) tests at 24-48 hours and 2 months after birth. Infants not passing a screening test were referred to the next test, until any hearing loss was confirmed by the auditory brainstem response (ABR) test.

Results: A total of 98.91% (10983/11104) of all newborn children underwent the initial OAE test, of which 27.22% (2990/10983) failed the test. 1712 of the failed babies underwent the second inpatient OAE test, with739 failing again; thus significantly decreasing the overall positive rate for abnormal hearing from 27.22% to 18.36% ([2990-973 /10983)]; p = 0). Overall, 1147(56.87%) babies underwent the outpatient OAE test again after1-month, of whom 228 failed and were referred for the second outpatient OAE test (i.e. 2.08% (228/10983) referral rate at 1month of age). 141 of these infants underwent the referral test, of whom 103 (73.05%) tested positive again and were referred for a final ABR test for hearing loss (i.e. final referral rate of 1.73% ([228-38/10983] at 2 months of age). Only 54 infants attended the ABR test and 35 (0.32% of the original cohort tested) were diagnosed with abnormal hearing.

Conclusions: Our study shows that it is feasible and practical to achieve high coverage rates for screening hearing loss and decrease the referral rates in newborn babies of migrant workers, using a modification of the currently employed UNHS protocol.

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The currently recommended UNHS protocol.
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Figure 1: The currently recommended UNHS protocol.

Mentions: Universal newborn hearing screening (UNHS) is an effective way of identifying hearing loss in newborns [10], and in conjunction with initiation of appropriate intervention within 6 months of diagnosis of hearing loss in infants shown to result in the development of significantly better language abilities, compared with infants identified with hearing loss later on in life [9,11]. Consequently, an increasing number of countries, including China, have incorporated the UNHS program into their public health systems. In China, a directive from the Beijing Municipal Government has been in place since July 2003, which requires all hospitals with an obstetrical department to implement a mandatory UNHS program (Figure 1) for all newborn babies in Beijing’s urban or rural areas [12,13]. Despite a political drive to intensify and expand the hospital-based newborn hearing screening, diagnosis, and intervention services [14], there has been disparity in the overall screening rates for hearing loss in newborn babies in urban (95.4%) or rural (84.1%) areas of Beijing, and likely other cities, over the last decade [15]. Whilst differences in economic development and health resources are likely to contribute to this difference in screening rates between the urban and rural areas, it is likely that migration from the rural to urban areas associated with the economic development also plays a major role. This is reflected by a 10-fold increase in the number of babies born to migrant mothers in 2007 (80,000 babies) compared with 1995 (8,000 babies) [16]. In view of this dramatic demographic change, the internal migrants (also known as “floating population”) have become increasingly relevant to the health care system, especially as they lose their government health care insurance when they leave their local areas. Moreover, frequent migration from one job to another has led to many pregnant migrants being examined in prenatal clinics in several hospitals. This in turn leaves them without consistent or structured pre-natal education or understanding of the importance of screening newborns for impaired hearing and the interventions available for impaired hearing.


Assessment of the feasibility and coverage of a modified universal hearing screening protocol for use with newborn babies of migrant workers in Beijing.

Qi B, Cheng X, En H, Liu B, Peng S, Zhen Y, Cai Z, Huang L, Zhang L, Han D - BMC Pediatr (2013)

The currently recommended UNHS protocol.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750515&req=5

Figure 1: The currently recommended UNHS protocol.
Mentions: Universal newborn hearing screening (UNHS) is an effective way of identifying hearing loss in newborns [10], and in conjunction with initiation of appropriate intervention within 6 months of diagnosis of hearing loss in infants shown to result in the development of significantly better language abilities, compared with infants identified with hearing loss later on in life [9,11]. Consequently, an increasing number of countries, including China, have incorporated the UNHS program into their public health systems. In China, a directive from the Beijing Municipal Government has been in place since July 2003, which requires all hospitals with an obstetrical department to implement a mandatory UNHS program (Figure 1) for all newborn babies in Beijing’s urban or rural areas [12,13]. Despite a political drive to intensify and expand the hospital-based newborn hearing screening, diagnosis, and intervention services [14], there has been disparity in the overall screening rates for hearing loss in newborn babies in urban (95.4%) or rural (84.1%) areas of Beijing, and likely other cities, over the last decade [15]. Whilst differences in economic development and health resources are likely to contribute to this difference in screening rates between the urban and rural areas, it is likely that migration from the rural to urban areas associated with the economic development also plays a major role. This is reflected by a 10-fold increase in the number of babies born to migrant mothers in 2007 (80,000 babies) compared with 1995 (8,000 babies) [16]. In view of this dramatic demographic change, the internal migrants (also known as “floating population”) have become increasingly relevant to the health care system, especially as they lose their government health care insurance when they leave their local areas. Moreover, frequent migration from one job to another has led to many pregnant migrants being examined in prenatal clinics in several hospitals. This in turn leaves them without consistent or structured pre-natal education or understanding of the importance of screening newborns for impaired hearing and the interventions available for impaired hearing.

Bottom Line: Although migrant workers account for the majority of newborns in Beijing, their children are less likely to undergo appropriate universal newborn hearing screening/rescreening (UNHS) than newborns of local non-migrant residents.We hypothesised that this was at least in part due to the inadequacy of the UNHS protocol currently employed for newborn babies, and therefore aimed to modify the protocol to specifically reflect the needs of the migrant population.This incorporated two additional/optional otoacoustic emissions (OAE) tests at 24-48 hours and 2 months after birth.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 17 HouGouHuTong, DongCheng District, Beijing, 100005, China.

ABSTRACT

Background: Although migrant workers account for the majority of newborns in Beijing, their children are less likely to undergo appropriate universal newborn hearing screening/rescreening (UNHS) than newborns of local non-migrant residents. We hypothesised that this was at least in part due to the inadequacy of the UNHS protocol currently employed for newborn babies, and therefore aimed to modify the protocol to specifically reflect the needs of the migrant population.

Methods: A total of 10,983 healthy babies born to migrant mothers between January 2007 and December 2009 at a Beijing public hospital were investigated for hearing abnormalities according to a modified UNHS protocol. This incorporated two additional/optional otoacoustic emissions (OAE) tests at 24-48 hours and 2 months after birth. Infants not passing a screening test were referred to the next test, until any hearing loss was confirmed by the auditory brainstem response (ABR) test.

Results: A total of 98.91% (10983/11104) of all newborn children underwent the initial OAE test, of which 27.22% (2990/10983) failed the test. 1712 of the failed babies underwent the second inpatient OAE test, with739 failing again; thus significantly decreasing the overall positive rate for abnormal hearing from 27.22% to 18.36% ([2990-973 /10983)]; p = 0). Overall, 1147(56.87%) babies underwent the outpatient OAE test again after1-month, of whom 228 failed and were referred for the second outpatient OAE test (i.e. 2.08% (228/10983) referral rate at 1month of age). 141 of these infants underwent the referral test, of whom 103 (73.05%) tested positive again and were referred for a final ABR test for hearing loss (i.e. final referral rate of 1.73% ([228-38/10983] at 2 months of age). Only 54 infants attended the ABR test and 35 (0.32% of the original cohort tested) were diagnosed with abnormal hearing.

Conclusions: Our study shows that it is feasible and practical to achieve high coverage rates for screening hearing loss and decrease the referral rates in newborn babies of migrant workers, using a modification of the currently employed UNHS protocol.

Show MeSH
Related in: MedlinePlus