Mogelijkheden en beperkingen van vroegtijdige gehoorscreening met automatische hersenstamaudiometrie op een neonatale intensievezorgafdeling

Abstract

Since 1998, newborn babies in Flanders are screened for hearing loss before the age of six weeks by a community-based screening program. Neonates staying in a neonatal intensive care unit (NICU) are at high risk of hearing impairment. The National Institutes of Health and the Joint Committee on Infant Hearing advise that all infants admitted to the NICU should be screened for hearing loss prior to discharge. Early recognition of hearing impairment leads to early remediation, favoring the child's linguistic and cognitive development. Since 2004, the NICU of the Ghent University Hospital (Belgium) has at its disposal an automated auditory brainstem response neonatal hearing screening device (Algo 3). This instrument may be used on the neonatal ward by the nurses, enabling hearing screening from a postmenstrual (PML) age of 34 weeks on. The charts of 2.074 newborns admitted to the NICU over a 4-year-period were reviewed. This study revealed that more than half of these high-risk babies could be screened before discharge, even before the PML age of 34 weeks; thus 28 babies (1,6%) with confirmed hearing impairment were identified in a very early stage. Causes for not being screened included early death, directly performed diagnostic brainstem evoked response audiometry or a too high workload among the nurses of the department. One of every 5 patients with an abnormal hearing screening result turned out to have no hearing loss at the subsequent diagnostic evaluation, being due to the early age of the baby when screening and the absence of a microotoscopic evaluation to exclude middle-ear effusion.