Current status and development trend of newborn hearing screening
In November 1999, the World Hearing Health Organization published a figure that 25% of American newborns received hearing screening. There are severe hearing loss in 33 newborns born in the United States every day. According to the American Academy of Pediatrics, the World Hearing Health Organization, and the American Hearing Screening Center, the results of hearing screening in newborns in the United States indicate that newborn hearing screening has increased by 64.8%, and the number of newborns who have received hearing screening has reached an unprecedented proportion. , increased to 89.8%. Experts emphasize that screening for newborns is very important. Early testing and early intervention can be performed through screening. In the United States, newborn hearing screening is now part of routine hearing testing, with 43% of audiologists performing hearing screening; hospitals and research institutions becoming the main participating agencies, 71% and 69% respectively; This is followed by universities (41%), health organizations (35%) and secondary schools (26%). Neonatal hearing screening is performed in 31% of all American audiologists' institutions. Audiologists are usually responsible for managing the project and conducting screenings (60%), and nurses often join the work. In the United States, three common methods for hearing screening are: Otoacoustic Emission Screening - ABR Rescreening (31%), Otoacoustic Emission Screening - Otoacoustic Emission Screening (30%) and Distortion Product Otoacoustic Emission Screen Check (28%). Follow-up hearing tests and implementation of tracking programs include: letters to health care institutions (60%), letters to families (58%), and appointment time notifications (50%).
However, although 89.8% of newborns in the United States have received hearing screening so far, this means that at least three hearing-impaired newborns are not diagnosed every day. Therefore, the former US Health Minister KOOP commented that the hearing rate of newborns in the United States is 1‰, and the situation is still serious. Without proper hearing screening, especially if hearing screening and early intervention are not performed within 3 months of birth, it will have a serious impact on children's language formation, social communication and growth.
Similarly, although newborn hearing screening started late in China, it has been rapidly developed throughout the country in the past decade and has made great progress. Newborn hearing screening has become an important clinical and basic research topic, and has achieved many gratifying results. Whether it is the standardization and management of the screening process, the application of screening equipment and technology, or the training of professionals, newborn hearing screening can be said to have matured from the start. Recently, the author has been exposed to a large number of domestic and foreign materials in assisting some provinces and cities to carry out newborn hearing screening. Among them, it is said that the policies issued by the state and local governments have played a key role. At the end of the last century, the United Kingdom’s newborn hearing screening program had little progress due to lack of national policy. Hall and Davis pointed out in their famous comments that the “National Screening Committee could not explain the policy because it was not authorized. In action "powerless situation. However, since then, the British government has made substantial progress by adjusting its strategy and direction of hearing screening and vigorously supporting the screening of grassroots systems. Therefore, the author feels that when studying the current trend of Chinese newborn hearing screening development, it must pay attention to the important role of “incubation” and “catalysis” of domestic macroeconomic policies. Therefore, in this issue of the Listening Mechanics Dictionary, the author tries to review the development trend of newborn hearing screening from the perspective of medical reform and policy on the basis of reviewing the current situation of newborn hearing screening at home and abroad, and talk about personal views. I hope readers can understand and understand hearing screening from different angles is not an isolated field.
Recent developments in newborn hearing screening
There are currently about 500 million hearing impaired people in the world. Studies have shown that the incidence of hearing-impaired diseases varies from country to country. According to the World Health Organization report in 2001, there are about 250 million hearing-impaired patients worldwide with at least moderate hearing loss, and two-thirds of them live. In developing countries. Hearing impairment is the most common congenital defect in newborns, accounting for about 20% of all birth defects, and is the leading cause of disability. The incidence of normal live births and NICU hearing disorders reported in foreign countries was 1‰～3‰ and 2%～4%, respectively. Reports in different regions of China are not the same. Qiu Shengsheng reported that the incidence of hearing loss in perinatal children in some areas of China was 9.52 ‰, and Helu et al reported that the hearing disability rate was 7.78 新生儿. These differences may be due to differences in the standards used throughout the country, and a wider range of epidemiological investigations are needed to give the incidence of hearing impairment in our country.
It will have a serious impact on children's communication, education, quality of life, etc. More and more studies have proved that early intervention of children with hearing impairment will maximize their language development. Many studies have clearly shown that hearing impairment has a serious impact on society and individuals. The important topic of Untreated Hearing Loss on Family Income, published by the Good Hearing Institute in August 2005 by Dr. Kochkin, once again reveals the serious consequences of hearing impairment on society, families and individuals. Dr. Kochkin conducted a comprehensive survey of 40,000 families in the United States using the National Family Opinion Survey to determine the negative impact of hearing impairment on household income. The results of this study indicate that with varying degrees of hearing loss, the average annual economic loss caused by hearing loss to each family can reach $12,000. For the 24 million people with hearing disabilities in the United States, the economic loss caused by untreated hearing loss exceeds $100 billion annually. If calculated according to the 15% tax, at least 18 billion US dollars of tax revenue will be lost to society.
We must recognize that the joint committee on infant hearing (JCIH) plays a very important role in defining and regulating the meaning and flow of newborn hearing screening work. It can be said that since the promulgation, the global hearing The screening work has had a major impact, including China. In its 2000 situation report, the committee proposed the meaning of Universal newborn hearing screening (UNHS): all infants and young children undergo hearing screening using physiological testing methods, which refers to hearing of all newborns born. Screening. This concept has two implications: for newborns born in hospitals (or maternal and child health centers), hearing screening during their hospitalization; for newborns born in hospitals (or maternal and child health centers), in their births Hearing screening is performed within 1 month. The United States has implemented UNHS in 35 states in 50 states, and more than a dozen states are enacting legislation.
It is the application of certain quick and simple experiments to identify the presence or absence of hearing in large populations who may have hearing loss. The methods currently used for the detection of neonatal hearing function mainly include auditory function behavior screening, auditory brainstem evoked potential method, and otoacoustic emission method. Listening behavioral audiometry is often used for infants older than six months. For infants younger than six months, because of the high false positive rate and false negative rate, only the good ear is assessed by audiology, the test environment is required to be quiet, and the mild hearing loss cannot be discerned. A reliable and effective method of screening.
In June 2000, the UK Health Minister announced that he would first introduce a universal newborn hearing screening mechanism in 20 regions. China started late in the work of early hearing detection and intervention. In 1994, the Law on Maternal and Infant Health Care of the People's Republic of China was promulgated, and it was proposed to gradually carry out screening for neonatal diseases throughout the country and to identify hearing care as a component of child health. In 1999, the Chinese Disabled Persons' Federation and the Ministry of Health and other 10 ministries and commissions jointly issued the "Notice on the Determination of Love Ears", which first proposed the implementation of prevention-oriented guidelines, and incorporated newborn hearing screening into the routine examination of maternal and child health care. The project identified this work as one of the job responsibilities of the health sector. Since 2004, hearing screening has been managed and implemented as part of screening for neonatal diseases along with phenylketonuria and congenital hypothyroidism.
In 2004, Dr. Lu Peo's paper from Hannover, Germany, "Newborn Hearing Screening in Germany - Introduction to Hanover's Screening Models and Results", introduced the experience of newborn hearing screening in Hanover, Germany, and the definition of newborn screening. method. In the screening of 23,632 newborns in the area, the screening rate was 87.4%, the referral rate was 2.5%, 19 newborns were diagnosed with binaural hearing loss, and 5 newborns had single ears. Moderate to severe hearing loss. The results of newborn hearing screening in Hanover, Germany, showed that the hearing rate of newborns in the region was 0.8‰, and the results were basically consistent with internationally accepted data. The study pointed out that the cost of hearing screening for newborns in Hanover, Germany, was 16 euros, while the cost of newborns diagnosed with hearing loss rose to 15,560 euros, or about 170,000 yuan. The investigators emphasized that early screening of newborns can be effectively screened through proper training of screening personnel. Dr. Karapoka of Poland's "National Newborn Hearing Screening Methods and Monitoring of Hearing Loss Results" paper introduces the pattern of newborn hearing screening in Poland. Polish newborn hearing screening is different from other developed countries and is basically sponsored by religious organizations. The steps and methods of screening are based on international current standards. By connecting 500 computer terminals to the National Hearing Screening Center, newborn hearing was screened and managed according to standard methods. The number of screenings exceeded 530,000 newborns, and the results were consistent with internationally accepted data. Today, universal hearing screening for newborns is not only widely carried out in developed countries, but also in many developing countries (such as Thailand and Latin America).
However, the current global situation is still grim, especially in the third world countries, where 665,000 newborns worldwide suffer from hearing loss, 90% of which live in underdeveloped regions and countries. The current incidence of hearing loss in newborns in China is higher than that in developed countries, between 0.3 and 0.5%. According to this calculation, there are at least 170,000 hearing-impaired newborns and infants in China. The National Institutes of Health's White Paper on Newborns indicates that if there is no newborn hearing screening, the average age at which children are diagnosed with hearing is three years old. If traditional neonatal high-risk indicators are used, at least 50% of hearing-impaired newborns will miss the diagnosis. Therefore, it is very important to establish a standardized and scientific newborn screening test center.
The great environment of China's population determines the importance and necessity of conducting newborn hearing screening. In the coming decades, under the premise of achieving stable low fertility levels, China's population will transition from low growth to zero growth. After the peak population reaches a peak (nearly 1.4 billion), it will begin to decline slowly and the quality of the population will continue to increase. Excessive population remains the top priority for our country. In the next decade or so, China's population will continue to grow. It is estimated that the annual average net increase will be more than 10 million. The situation of low population quality is difficult to fundamentally change in the short term. The goal of China's population and family planning work in the next ten years is: By the end of 2010, the total population of the country (excluding Hong Kong, Macao Special Administrative Region and Taiwan Province) will be controlled within 1.4 billion, and the annual birth rate will not exceed 15‰; the quality of the birth population Significantly improved; the sex ratio of born babies tends to be normal; the people of childbearing age enjoy basic reproductive health services, and the “informed choices” of contraceptive and birth control measures are generally carried out; the new concept of marriage and childbearing and birth culture are initially formed; the establishment of regulation and control is effective and effective, Family planning security system and working mechanism with complete policies and regulations.
At the same time, the current state of Chinese audiology is another issue we must consider. Currently in China, audiology as an independent discipline and profession has not yet been recognized by official government agencies. The development of the discipline of domestic listening and speech diseases still has a large gap compared with developed countries. Mainly manifested in: the lack of professional education institutions and systems to train high-level audiology professional and technical personnel, and the lack of professional audiology and related discipline research institutions, resulting in lack of audio-visual medical rehabilitation institutions; the formation of hospitals, schools, and disabled The joint venture, the hearing professional company and the society have independently developed and are unable to provide the public with integrated medical rehabilitation services. Compared with developed countries, although there are nearly two million doctors in China, there are only 632 ENT doctors, 751 assistant physicians and less than 30 audiologists. In comparison, there are nearly a thousand audiologists in Canada, and nearly 10,000 audiologists and 5,200 otologists in the United States. Therefore, the current Chinese audiologists and otologists are far from meeting the needs of many patients. There are still no specialized agencies in China to train audiologists. Most doctors who work in listening work learn by doing. Obviously, the lack of professionals has greatly limited the rapid development of hearing screening for newborns. At the same time, we must also realize that the entire society in China is not paying enough attention to the rehabilitation of hearing patients, especially children with hearing disabilities. Awareness.
On April 1, 2006, the second National Disability Sample Survey was organized by 16 ministries and commissions including the National Bureau of Statistics, the Ministry of Civil Affairs, the Ministry of Health and the China Disabled Persons' Federation. It was launched in 31 provinces, autonomous regions and municipalities directly under the Central Government. Basically completed at the end of the year. This statistic is an unprecedented sample survey since the first statistics in the late 1980s. The depth and method of adoption fully demonstrates the Chinese government's high regard for the situation of disabled people. According to the survey data, the total number of disabled people in the country is 82.96 million. According to the national population at the end of 2005 published by the National Bureau of Statistics, the total population of China at the time of this survey was 130,948 people. According to this, the proportion of disabled people in the country's total population was 6.34% on April 1, 2006. . Among them, the hearing disability was 2004 million, accounting for 24.16%; the speech disability was 1.27 million, accounting for 1.53%.
However, we must see that our country still lacks epidemiological data on hearing loss in newborns. Every year, more than 20 million newborns are born in the country. If calculated according to the proportion of foreign countries, about 20,000 to 60,000 newborns with hearing impairment appear every year. In recent years, newborn hearing screening has also made substantial progress in China. Since 1999, China has promoted the technology of newborn hearing screening. By 2005, in addition to the Tibet Autonomous Region, China has carried out different levels of hearing screening for newborns in 30 provinces, autonomous regions and municipalities across the country. In some provinces and cities, the level of hearing screening is close to international standards. For example, the screening rate in Shanghai is over 90%. More than 200 hearing-impaired children are diagnosed before 6 months of age, and the satisfaction rate is 90%. The goal of newborn hearing screening is to maximize the language, communication, and literacy of hearing-impaired babies and deaf children.