Semiramis Zizlavsky Pre PITO 8, Sept 2,2013 Jakarta Why is newborn hearing screening important ? Semiramis Zizlavsky Pre PITO 8, Sept 2,2013 Jakarta

INTRODUCTION Babies : develop speech and language from the time they are born. Listening and interacting with sounds and voices around them. Baby is born with hearing loss: speech and language development can be delayed. Hearing screening testing : highly accurate. earlier identification and treatment of infants

- What is newborn hearing screening Why hearing screening is important ? Principles of Screening Target Risk Factors Benefit of Hearing Screening Risk of Newborn Hearing Screening Timing to test How to do ? Important to thinks

What is newborn hearing screening ? Newborn hearing screening…….. programs are designed to identify hearing loss in infants shortly after birth

Prevalence ; 2-3 per 1000 newborn will have HL Indonesia : 1-3 per 1000 1/1000 WBN 10/1000 NICU

Why is early identification of hearing loss important Hearing loss is the most common birth condition Previous methods for detecting hearing loss have been ineffective (behavioral observation) Undetected hearing loss can delay speech, language, social and academic development

Incidence of Congenital Conditions (Per 10,000) INCIDENCE PER 10,000 OF CONGENITAL CONDITIONS: When compared with other congenital birth conditions, it is easy to see that hearing loss is much more prevalent than many birth defects that receive a great deal more attention. For example, of every 10,000 babies born, 30 will have a permanent hearing loss, while only 11 will have Down Syndrome, 5 will have spina bifida and only one will have PKU. Source: http://www.infanthearing.org

Accurate, reproducible Principles of Principles of Screening Screening Quick Cheap Not Invasive Accurate, reproducible

Target All Babies Risk Factors Universal Hearing Screening Targeted Hearing Screening Risk Factors

RISK FACTORS (JCIH 2000) 29 days- 2 years -Parental/caregiverconcern -Family history -Syndrome -Postnatal infection -In-utero infection -Hyperbilirubinemia -Neurogenerative disorders -Head trauma 0-28 day -NICU > 48 hours -Syndrome -Family history -Craniofacial anomalies -In utero infection

Benefits of Newborn Screening IDENTIFICATION EARLY INTERVENTION REDUCED MORBIDITY FAMILY PLANNING

Risk of Newborn Hearing Screening Parent anxiety (false positive ) Missed diagnosis ( false negative) Unanticipated outcome - range of reactions - maternal feelings of guilt - financial problem - cultural sensitivity

HOW TO DO ? One Two step

Hearing Screening Techniques OAE AABR OAE + AABR

ABR OAE

Otoacoustic Emmision (OAE) PASS REFER Measures sound waves produced in the inner ear

Automatic Auditory Brainstem Response (AABR) PASS REFER Measures how the hearing nerve responds to sound

DIAGNOSIS (OAE,AABR/ABR) TIMING TO TEST IDENTIFICATION (OAE) BEFORE DISCHARGE 2 days DIAGNOSIS (OAE,AABR/ABR) 3 month RISK FACTORS INTERVENTION < 6 month HA CI

BIRTH: Hospital-based Screening OAE,AABR,ABR Re-Screen before discharge :possible Hearing screen pass : not guarantee (risk factors ?) Re-screening if : - any failure / incomplete - unilateral • Parents refuse screening : documentation

Minimizes parental anxiety Before one month of Age Outpatient re-screening : - failed - missed - incomplete • Unilateral failure : audiology evaluation Early re-screening : Earlier diagnosis Minimizes parental anxiety

Before Three Month of Age Audiology evaluation DIAGNOSIS If HL is confirmed (Information, amplification & communication)

Before Six months of Age Continue early intervention : WHY ??? Other evaluations : - genetics - ophthalmology - pediatrics Syndrome ? - neurology - cardiology - nephrology

HTA Hearing Screening ALUR SKRINING BAYI BARU LAHIR Bayi baru lahir / 2 hr OAE PASS REFER 1 –3 BULAN Auto ABR atau click 35 dB P R 3 bulan Otoskopi Timpanometri ABR Click & Tone B 500 Hz atau ASSR Timpanometri High Frequeny Pemantauan Speech development Audiologi Tiap 3-6 bulan smp (anak bisa bicara) usia 3 th Habilitasi usia 6 bulan Tidak perlu tindak lanjut ALUR SKRINING BAYI BARU LAHIR ABR Click + CochlearMicrophonic ABR Tone B 500 Hz atau ASSR Timpanometri ( refleks akustik) High Frequency Faktor Risiko (-) Neuropati Auditorik Tuli Sensorineural Faktor Risiko (+)

Conclusion ☺Screening is part of a system of follow-up, diagnosis, treatment and evaluation. ☺Timely and appropriate intervention have lasting effects on outcomes. ☺ Family involvement : important

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