Programa de triagem auditiva neonatal: resultados de sua aplicação em um hospital universitário

Abstract

Data collected during the implementation of the Neonatal Hearing Screening (NHS) need to be recorded, evaluated and disseminated in the scientific environment in order to ensure its quality and to encourage the creation and improvement of other services. Risk indicators (RI) for the hearing loss can influence in the occurrence of transients evoked otoacoustic emissions (TEOAE) and distortion product (DPOAE), as well as in the result of the NHS. This study aimed to analyze the NHS at the University Hospital of Santa Maria during one year; to verify the influence of the presence of RI for the hearing loss on the TEOAE and DPOAE as well as on the result of NHS with TEOAE. The sample consisted of 1198 neonates and infants users of Unified Health System. The criterion for passing was the presence of Cochlea Palpebral Reflex (CPR) and TEOAE bilaterally. RI were investigated through medical history and records, and were related to pass/fail variables in the NHS and to the occurrence of TEOAE and DPOAE for each frequency measured. Children who failed were retested after two weeks, using the same procedures. The evaluation of auditory evoked potentials in brainstem response (ABR) was carried out when the absence of Cochlea Palpebral Reflex and/or TEOAE persisted. When alterations in the examination were observed, children were referred to the use of prostheses. The NHS could not be considered universal, since the rate of children affected was 66.56%. The first hearing screening occurred up to 28 days of life in 78.80% (n = 944) The rate of children who passed the first test was 91.49% (n = 1096). Among the ones who failed, 17.65% (18) did not attend the retest. Of the 84 children who returned, 17 failed again and were referred for ABR. Eight children presented deafness, and the rate of hearing loss was 0.67%. The referral for diagnosis rate was 1.41% and the false-positive result was 0.17%. The result of the NHS is dependent on the occurrence of RI for the hearing impairment. The absence of TEOAE and DPOAE is dependent on the presence of RI for hearing impairment. Besides, the presence of TEOAE and DPOAE is dependent on the absence of indicator(s) in some ears and frequencies. The rates of referral for diagnosis and falsepositive results of this study suggest that the program is implemented effectively and demonstrate the adequate experience professionals who work with it have. However, the universal and mandatory character of the NHS is still to be achieved. The presence of RI may influence in the occurrence of EOAE and in the result of the NHS. The RI that offered the greatest risk of failure in the NHS was jaundice. Some key aspects in the planning, effectiveness, maintenance and improvement of the program have been outlined, and some of them are already being used.