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

2. 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

3. - 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

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

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

6. 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

7. 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:

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

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

10. 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

11. Benefits of Newborn Screening
IDENTIFICATION
EARLY INTERVENTION
REDUCED MORBIDITY
FAMILY PLANNING

12. 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

13. HOW TO DO ?
One
Two step

14. Hearing Screening Techniques
OAE
AABR
OAE + AABR

15. ABR
OAE

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

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

18. 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

19. 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

20. 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

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

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

23. 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 (+)

24. 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

25. THANK YOU