A Modified Model for Universal Neonatal Hearing Screening in Remote Areas

BACKGROUND: This study evaluated a practical strategy for conducting universal neonatal hearing screening (UNHS) to increase the coverage rate in remote areas. METHODS: Between July 2012 and Jan 2021, 1,040 newborns were screened for hearing loss in south Hualien. The automated auditory brain stem response (AABR) was performed as a two-stage test. Under the supervision of the Hualien Health Bureau, all new mothers were notified by local hospitals or birth clinics to send their baby to the Yuli Tzu Chi Hospital (YLTCH) in southern Hualien at a fixed time to undergo an AABR test. A qualified audiologist from the Hualien Tzu Chi Hospital (HTCH) traveled to the YLTCH to perform AABR tests twice per month. The babies with a two-stage test result of ＂referral＂ were sent to the HTCH for definitive diagnoses and treatment. RESULTS: From July 2012 to January 2021, 1,255 babies were born in the southern Hualien area. First-stage screening was performed on 1,040 children at the YLTCH with a coverage rate of 82.8% (1,040/1,255). The mean screening age was 28±15 (3-90) days. There were 4 babies (0.38%) who had a ＂referral＂ result in at least one ear in the two-stage screening test; these babies were sent to the Hualien Tzu Chi Medical Center for definitive diagnoses. One infant had bilateral profound hearing loss, one had unilateral microtia with mixed type hearing loss, one had bilateral mild hearing loss, and one had cleft palate syndrome with otitis media. CONCLUSIONS: The modified UNHS model that integrates local hospitals, obstetric clinics, medical centers, and the government showed good results in a remote area that lacks sufficient medical resources.

關鍵字

auditory brainstem response ； congenital hearing loss ； remote area ； universal neonatal hearing screen

並列摘要

目的：花蓮地處台灣東部且地形狹長，南花蓮的偏鄉地區因經費補助不足更缺乏專業人才與設配，花蓮慈濟醫院配合政府新生兒聽力篩檢補助服務方案，於2012年7月1日至2021年1月31日為止，每兩周的星期三派遣聽力師支援南花蓮聽力篩檢，希望能發展出一個高篩檢率（coverage rate）低轉介率（referral rate）的方案。方法：於2012年7月到2021年1月期間，我們共收錄了1,040位於南花蓮地區玉里出生的新生兒。這項計畫用的第一階段篩檢工具為自動聽性腦幹反應檢查（automated auditory brainstem response）且採兩階段篩檢。以35 dB的click刺激音為測試音量，選擇安靜入睡或餵食後無哭鬧狀態的嬰兒進行篩檢，測試之電腦會標示通過（pass）或需追蹤（refer），若兩次聽篩未過則轉介確診與治療。結果：從2012年7月到2021年1月於花蓮玉里榮民醫院與地區婦產科診所的新生兒出生人數為1,255人，其中接受聽力篩檢的人數共1,040名，篩檢率為82.8%，平均篩檢年齡為28 ± 15（3-90）天，其中兩次篩檢中至少1耳須轉介診斷的人數為4人（0.38%）。其中1名是嚴重神經性聽損，1名是單側小耳症合併混合性聽損，1名是雙側輕度神經性聽損，最後1名是唇顎裂合併混合性聽損。結論：本方案結合了花蓮縣政府、地區醫院與婦產科診所的協助，並提供醫療資源缺乏的南花蓮偏鄉地區一個新生兒聽力篩檢的機會，藉由聽力師支援偏鄉計畫，這4名聽力受損的新生兒可進行早期介入與治療。

並列關鍵字

auditory brainstem response ； congenital hearing loss ； remote area ； universal neonatal hearing screen（聽性腦幹反應；先天性聽力損傷；偏鄉地區；新生兒聽力篩檢）

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