Early identification of hearing loss is very important to prevent language impairments in children. The social impact of this problem is always more topical; neonatal hearing screening implementation seems to be the most effective method in the prevention of deafness such as other important types of metabolic and not metabolic neonatal screening.
It's of critical importance to develop productive programs of rehabilitation and predict the various implementation problems under every point of view (medical, nursing, therapeutic, social and political ). Only in this context we can give a purpose to every effort of each health-care practitioner. Although technological progress will give us always more sophisticated and precise instruments, we should never forget the human issues which must be considered at the first place beyond the diagnostic protocols.
Our personal experience of neonatal screening with otoacoustic emissions has tested this concept very well. Personally, we have started to test risk babies of NICU from 1998 and from March 2001 we have implemented universal neonatal hearing screening, in accordance with a project that has been spread the screening to all other nurseries of our region (Liguria).We have tested in these 18 months 1200 babies before discharge (3th day of life) with Madsen's Echoscreen. Our protocol is based on a three-phase system where the OAE test is repeated after 15 - 30 days to cases resulted as REFER. The ones which fail the second OAE test are evaluated by an ABR . We have had 35 refer cases (3%) from which only 2 (0,16%) resulted as hearing loss cases.
The OAE testing has been performed by nurses after being instructed and motivated by the supervisor of the screening program. In our opinion, the nursing staff can to perform the screening continuously and with a high ability. The most important difficulties for the nurses have been:
- the correct choice of the best time for the test.
- the obstruction of the ear by caseous varnish
- unusual restlessness of some neonates.
The parents have been informed about the importance of the hearing screening and a questionnaire has been given to them at the neonate's discharge in order to evaluate the acoustic responses in the early months of life. If the OAE test has been a REFER the parents were reassured and informed about the test importance in order not to miss the following additional hearing screening tests. There was a close cooperation between the neonatologists and the audiologists performing the ABR.For the cases which resulted having hearing losses, the parents were also introduced to psychological and rehabilitation services. Thus the first link was the family begun in the nursery and then continued during every step of the rehabilitation protocol.
So , after this period of OAE testing we can confirm the importance of universal neonatal hearing screening as the means to confront deafness. We think that it isn't difficult to perform audiological hearing screening , but is much more difficult to manage and conduct a "good screening program". To remember that , our patients are neonates, unprotected and without communication capabilities and that their family is worried about their health and their future : so our job must not forget two human factors: emotion and sharing, because the thought of a deaf child can be "terrible" for the parents, and our way of communicating, of examining the little patient, of performing with patience the test, of explaining the program to parents and relatives is essential.
A good empathic relation with the tested neonate and his / her family is important in order to realize a complete screening project, not missing a case from the follow up tests and to be sure to have developed fully our duty, as men, fathers / mothers and physicians.
Date of the Report : November 2002
Contact: Danilo Cosso, MD
Address: Struttura Complessa Neonatologia/Nido
Ospedali Galliera -Genova, Italy
Telephone: ----------
Email: danilo.tomaso.cosso@galliera.it
|
