Marzanna Radziszewska

In December of 2003 we celebrated the first year of Universal Newborn Hearing Screening Program organized by the Great Orchestra of Christmas Charity Foundation in Poland. Without any doubt  the results from this program are quite promising considering the following:

·         The national program was initiated and implemented by a non-governmental organization but it has been  performed in public health care surrounding.

·         Running costs (except for work force) have been covered by a non-governmental organization.

·         The personnel of the various neonatal departments has offered work on the voluntary basis.

·         The hearing Diagnostics, hearing Aid fitting , and the rehabilitation policies are financed by the national health care program.

 

 

Till now we have not got any formal regulations. It means that the program is not obligatory and is not financed by the Polish government. Despite of these conditions we are able to achieve satisfactory results.  From the beginning of the program about 500 000 newborns were screened. It is estimated that currently 95,5% - 98,8% of all newborns in Poland are available for screening. Our data indicate that approximately 90% of newborns pass the first stage screening, and  10% of them need to be re-screened . At the beginning of the program we had a higher rate of REFER cases and approximately 25% of the tested babies had to be  screened again. Figure 1 and Figure 2 highlight some of the points presented above.

 

 

  Figure 1: Red - newborns who do not pass the screen at first stage. Number of newborns with positive screening result decreases systematically (from 19,3% in May of 2002 to 4,8% in May of 2003), mainly by decreasing a number of babies who failed the screening in both ear.

 

 

 

 Figure 2: Number of newborns with positive screening result in each month Currently due to the positive result of screening 4,1% of newborns are referred to audiological departments, out of which 63,4% failed in only one ear.

 

 Figure 3:Newborns with hearing impairment risk factors. We found hearing impairment risk factors in 6,1%  of newborns. 86,4% of the passed screen.

 

 

In total about 11% of all screened newborns were referred to the second level centers. At a moment we estimate that the  number of referred newborns for less than 10%.

Until January of 2004 diagnostics was performed in about 16600 infants. The first visit in diagnostic center took place before the end of 3^rd month of life in about 60% of cases. Diagnostics was completed before turning 3^rd of life in 51% of infants. 70% of children with confirmed hearing loss were referred do 3^rd level centers.

Till now sensorineural hearing loss prevalence is estimated as 1:1000. This figure refers to the results we obtained from  all hospitals for one year, therefore current estimation does not include children with late on-set hearing loss and children who are not referred on time, of course. In some centers the data are sent to the central data base a few weeks after the set of diagnostics is completed, and this fact can have an impact on our estimation, too.

Hearing impairment risk factors were confirmed in 52,5% of infants with sensorineural hearing loss. It means that in 48% of cases hearing loss could not be identify early enough without screening.

In January 2004 we found in the data base 86 infants fitted with a Hearing Aid,  but we estimate that the number of fitted children is at least twice as much. Several factors are responsible for this. In some cases sending data to the central data base has been delayed. On other occasions many infants were fitted at a 2^nd level center  who are not able to send the information about HA fitting to the data base because of limited access.

Although the actual program is not government supervised, the screening tests are free of charge now. We realize that screening costs have to be at least partially covered by the government  in the nearest future. Neonatal departments should received funding for the disposable screening items and also for any occasional  equipment repairs.  The audiological diagnosis costs are covered by the state, however unless some legal registration are settled, the actual amount of contracted services might be insufficient.

A separate problem is the reimbursement of the costs related to hearing aids. The system we have adopted  offers partial cost- reimbursement from different sources, with relatively long administration times, so in many cases it is difficult to obtain a hearing aid before turning 6 months.

The newborns’ rehabilitation takes place based on already existing speech therapy centers. Certain actions were undertaken in order to build up new network of centers specializing in newborn rehabilitation, which would be supervised by 16 local coordinators (one per district) and the general coordinator. We have to coordinate all actual activities supporting families.

In December 2003 the Council of Experts was established. It consists of 12 members and among them there are Ministry of Health consultants in neonatology, otolaryngology, speech-therapy  and Audiology. It is expected that the existence and work of the council will eventually increases the possibilities of a stronger  governmental involvement.  In January 2004,  the first Conference on UNHS in Poland took place and it was attended by 450 participants from medical and rehabilitation centers from all Poland. attended it. Honorable guests of the meeting were Dr. Karl White (USA), Dr. Ferdinando Grandori ( Italy)  and Dr.  Lindsay Kimm (UK).

 

At  the end of February of 2004 we begun a series of workshops for the program performers. The first one is dedicated for audiological centers.

 

We realize that we still have a lot to do an improve, but we are sure that we can be proud of current achievements. It was not possible, of course without the Great Orchestra of Christmas Charity Foundation.

 

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