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Abstract(s)
Introdução: A audição desempenha um papel fundamental no desenvolvimento da linguagem
e cognição. A perda auditiva limita a aquisição de competências linguísticas durante a fase
crítica do desenvolvimento psicomotor e tem uma prevalência de 1-3/1000 nascimentos. O
Rastreio Auditivo Neonatal Universal (RANU) permite a deteção precoce de hipoacusia,
possibilitando uma intervenção atempada. Em Portugal, está recomenda a implementação de
programas de RANU, seguindo os preceitos do Joint Comitee on Infant Hearing (JCIH). Todas
as crianças devem ser testadas até aos 30 dias de vida e no caso de perda auditiva
confirmada, a intervenção deverá ter início até aos seis meses.
Objetivo: Avaliação da implementação do RANU realizado no Centro Hospitalar da Cova da
Beira (CHCB) nos últimos 5 anos e o seguimento a longo prazo das crianças de risco.
Materiais e Métodos: Estudo retrospetivo por revisão dos processos clínicos de todos os
recém-nascidos (RN) internados no Departamento de Saúde da Criança e da Mulher,
submetidos a avaliação audiológica inicial por otoemissões acústicas (OEA), complementada
em fases subsequentes por potenciais evocados auditivos do tronco cerebral (PEATC). Foram
analisadas as avaliações periódicas (AP). Estudo relativo ao período entre 1 de janeiro de
2011 e 1 de dezembro de 2016.
Resultados: O rastreio auditivo é constituído por 3 fases segundo o binómio “passa”/“refere”.
Foi aplicado a 3237 (95,1%) de um total de 3402 RN. Na primeira fase, aplicaram-se OEA antes
da alta hospitalar, 15 RN (0,5%) não passaram e 165 (5,1%) não puderam ser avaliados, a
maioria por falta de comparência (65,5%). Nas fases subsequentes foram aplicadas OEA e
PEATC. Apenas 1 RN foi encaminhado à terceira fase. O índice de falsos positivos foi de 0%. O
fator de risco (FR) mais frequente foi a história familiar de surdez (49,0%). 568 RN (16,7%)
necessitaram de cuidados intensivos (CI) e 28 de cuidados diferenciados. Das 290 crianças
acompanhadas em AP, apenas 100 (34,5%) não apresentaram intercorrências.
Discussão e Conclusões: A implementação do RANU cumpriu com os indicadores de qualidade
referidos pelo JCIH. Não se identificaram casos positivos no final das 3 fases do rastreio.
Verificou-se um maior número de RN que necessitaram de CI relativamente ao que é referido
pela JCIH. No entanto, não foi identificado nenhum caso de perda auditiva confirmada pelo
RANU, e todas as crianças que concluíram as AP tiveram alta. As faltas de comparência
mostraram ser a intercorrência mais frequente. De forma a melhorar o programa de rastreio
do CHCB propõe-se a reorganização das fases de rastreio, a reformulação da Folha de
Codificação dos FR, a adoção das guidelines da JICH relativamente à avaliação das crianças que necessitam de CI e entrega de um folheto informativo aos cuidadores no momento do
rastreio.
Introduction: Hearing plays a key role in the development of language and cognition. Hearing loss limits the acquisition of language skills during the critical phase of psychomotor development and has a prevalence of 1-3/1000 births. The Universal Newborn Hearing Screening (UNHS) allows the early detection and intervention in newborns and infants with hearing loss. In Portugal, it is recommended the implementation of UNHS programs, following Joint Committee on Infant Hearing (JCIH) principles. All children should have access to hearing screening at no later than 30 days of age. Those who do not pass screening with confirmed hearing loss should receive appropriate intervention at no later than 6 months of age. Objective: Analysis of the implementation of UNHS performed at the Centro Hospitalar da Cova da Beira in the last 5 years and long-term follow-up of infants at risk. Materials and Methods: Retrospective study from January 1, 2011 to December 1, 2016, by review of the clinical records of all newborns (NB) hospitalized in the Department of Children's and Women's Health. They were submitted to an initial audiological evaluation by otoacoustic emissions (OEA), complemented in subsequent phases by evoked Auditory Brainstem Response (ABR). Periodic evaluations (PE) were analyzed as well. Results: The auditory screening consists of 3 phases according to the binomial "pass" / "refer". It was applied to 3237 (95,1%) of a total of 3402 NB. In the first phase, OEA was applied before hospital discharge, 15 NB (0,5%) did not pass and 165 (5,1%) could not be evaluated, most of them due to lack of attendance (65,5%). In subsequent phases OEA and ABR were applied. Only 1 NB was sent to the third phase. The percentage of false-positives was 0%. The most frequent risk factor (RF) was family history of deafness (49,0%). 568 NB (16,7%) required intensive care (IC) and 28 differentiated care. Of the 290 children followed up in PE, only 100 (34,5%) did not show any intercurrences. Discussion and Conclusions: The implementation of UNHS complied with the quality indicators referred by JCIH. There were no positive cases identified after the 3rd screening phase. The occurrence of RF was similar between the analyzed years. Compared with what is reported by JCIH, it was registered a higher number of newborns who needed IC. However, no cases of hearing loss confirmed by RANU were identified, and all children who completed PE were discharged. The most frequent circumstance was missed appointments. In order to improve some of these aspects, some changes are suggested, such as, reorganization of the screening phases, reformulation of the RF Coding Sheet, application of the JICH guidelines regarding the use of PEATC in the evaluation of children who require IC and the delivery of an information leaflet to the caregivers at the time of screening.
Introduction: Hearing plays a key role in the development of language and cognition. Hearing loss limits the acquisition of language skills during the critical phase of psychomotor development and has a prevalence of 1-3/1000 births. The Universal Newborn Hearing Screening (UNHS) allows the early detection and intervention in newborns and infants with hearing loss. In Portugal, it is recommended the implementation of UNHS programs, following Joint Committee on Infant Hearing (JCIH) principles. All children should have access to hearing screening at no later than 30 days of age. Those who do not pass screening with confirmed hearing loss should receive appropriate intervention at no later than 6 months of age. Objective: Analysis of the implementation of UNHS performed at the Centro Hospitalar da Cova da Beira in the last 5 years and long-term follow-up of infants at risk. Materials and Methods: Retrospective study from January 1, 2011 to December 1, 2016, by review of the clinical records of all newborns (NB) hospitalized in the Department of Children's and Women's Health. They were submitted to an initial audiological evaluation by otoacoustic emissions (OEA), complemented in subsequent phases by evoked Auditory Brainstem Response (ABR). Periodic evaluations (PE) were analyzed as well. Results: The auditory screening consists of 3 phases according to the binomial "pass" / "refer". It was applied to 3237 (95,1%) of a total of 3402 NB. In the first phase, OEA was applied before hospital discharge, 15 NB (0,5%) did not pass and 165 (5,1%) could not be evaluated, most of them due to lack of attendance (65,5%). In subsequent phases OEA and ABR were applied. Only 1 NB was sent to the third phase. The percentage of false-positives was 0%. The most frequent risk factor (RF) was family history of deafness (49,0%). 568 NB (16,7%) required intensive care (IC) and 28 differentiated care. Of the 290 children followed up in PE, only 100 (34,5%) did not show any intercurrences. Discussion and Conclusions: The implementation of UNHS complied with the quality indicators referred by JCIH. There were no positive cases identified after the 3rd screening phase. The occurrence of RF was similar between the analyzed years. Compared with what is reported by JCIH, it was registered a higher number of newborns who needed IC. However, no cases of hearing loss confirmed by RANU were identified, and all children who completed PE were discharged. The most frequent circumstance was missed appointments. In order to improve some of these aspects, some changes are suggested, such as, reorganization of the screening phases, reformulation of the RF Coding Sheet, application of the JICH guidelines regarding the use of PEATC in the evaluation of children who require IC and the delivery of an information leaflet to the caregivers at the time of screening.
Description
Keywords
Perda Auditiva Rastreio Auditivo Neonatal Universal (Ranu) Recém-Nascidos Retrospetivo