Recommendations for All-Round Newborns and Infants Hearing Screening in Russian Federation

Abstract

Background. Nowadays there is a need to revise the Russian list of risk factors of hearing loss and deafness based on their study according to the evidence-based medicine and the analysis of the audiology service capabilities. Moreover, audiologic screening system for newborns and infants should be revised in every region to identify the reasons of mismatch with international standards and to find ways of its efficacy improvement. Objective. The aim of the study is to increase the efficacy of Russian program of all-round newborns and infants hearing screening. Methods. This study consisted of two parts. 1) The first stage of audiological screening audit on the example of 78 medical institutions in Saint-Petersburg. The availability and correct function of hearing research equipment, specialists’ qualifications, study technique and conditions, documents and results transmitting accuracy were estimated. 2) Updating the list of risk factors of hearing loss. The prevalence rate of these factors in Russian population according to the literature and official statistics was studied. Evaluation of predictive significance of risk factors was based on retrospective data in the cohort of 393 children born in 2012 (280 with hearing loss, 113 healthy) examined in National Research Centre for Audiology and Hearing Rehabilitation at the age of 0–4 years. Results. The first stage of audiological screening audit has shown that only 14% of included institutions fully meet the criteria of its effective implementation. The following problems were revealed: purchase and renewal of equipment, its timely adjustment, ensuring the continuity of screening stages, specialists training, compliance with methodology and study conditions, results documentation. We were able to increase by 8.5% (close to targeted indicator) the coverage of newborns with first stage of audiological screening as well as to increase the rate of children at the diagnostic stage from 33% to 51%, due to the results of this audit and methodological assistance to the institutions. According to the analysis of prognostic significance and prevalence of risk factors of hearing loss and deafness in Russian population of newborns, it is necessary to perform full hearing examination regardless of the results of newborns and infants hearing screening with the following risk factors: 1) cases of persistent child hearing loss in the family; 2) syndromes associated with hearing loss; 3) auricle, ear canal and dentofacial anomalies; 4) congenital infection (cytomegalovirus, rubella, syphilis, toxoplasmosis); 5) stay in newborns intensive care unit for more than 2 days; 6) prematurity of 32 weeks or less; birth weight less than 1500 g; 7) hyperbilirubinemia in perinatal period (exchange blood transfusion; total bilirubin level when exchange blood transfusion is needed); 8) usage of ototoxic drugs; 9) severe perinatal damage to the central nervous system, neurodegenerative diseases; 10) ambiguous reaction to sounds, developmental delay. Conclusion. Maintenance of all-round newborns hearing screening algorithm will allow us to avoid the diagnosis delay, to start the rehabilitation earlier and further to significantly increase the efficacy of modern high-tech methods for correcting hearing disorders in children. We have to check the presence of risk factors of hearing loss and deafness in every child. Timely referral of children with risk factors for the second stage of audiological screening, diagnosis and correction of hearing disorders creates conditions for normal child oral-aural development.