一个中等收入国家使用OAE和ABR的新生儿听力筛查项目的诊断表现和临床随访

IF 1.3 4区医学 Q3 OTORHINOLARYNGOLOGY

International journal of pediatric otorhinolaryngology Pub Date : 2025-08-20 DOI:10.1016/j.ijporl.2025.112511

Claudia Alarcón Avila , Angie Tatiana Saenz González , Luisa Fernanda Vivas Gómez , Maira Alejandra Rivero Centeno , María José Silva Ortiz , Laura Camila Salazar Vera , Daniela Alejandra Osorio Beltrán , David Díaz-Báez

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引用次数: 0

摘要

先天性听力损失（CHL）影响儿童的语言发育和生活质量。尽管高收入国家已经实施了新生儿听力筛查（NHS）计划，但关于中等收入国家实施此类计划的数据有限。本研究评估了中等收入国家的国民保健服务覆盖范围和听力损失发生率、两项筛查测试的诊断表现、相关风险因素（RFs）、特征和两年随访数据。方法2020-2023年在哥伦比亚波哥大一家高复杂度医院进行双视角队列研究。筛选分两个阶段进行，分别采用耳声发射（OAE）和自动脑干反应（ABR）评估。两个阶段都失败的婴儿被转到耳鼻喉科进行评估。使用泊松回归识别相关RFs，并以ABR数据为参考估计OAE评估的诊断性能指标。结果全国医疗服务体系覆盖率为69.8%。诊断为CHL的儿童有4例（3/ 1000）。随访率为75%。新生儿住院与CHL的高风险相关（相对危险度：10.77,95%可信区间：2.10-5.18）。第一阶段OAE评估的敏感性为72.2%，特异性为99.4%；第二阶段OAE评估的敏感性和特异性分别为71.4%和100%。OAE和ABR评估在第一阶段一致（κ = 0.791），在第二阶段一致（κ = 0.397）。结论这些研究结果强调了在中等收入国家实施战略以提高NHS覆盖率和确保全面随访的重要性，从而提高这些国家患者的生活质量。尽管具有高特异性和敏感性，但测试协议的可变性强调了将OAE和ABR评估结合起来的结构化两阶段筛选方案的必要性。

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Diagnostic performance and clinical follow-up of a universal newborn hearing screening program using OAE and ABR in a middle-income country

Background

Congenital hearing loss (CHL) affects language development and quality of life of children. Although high-income countries have implemented neonatal hearing screening (NHS) programs, data regarding the implementation of such programs in middle-income countries are limited. This study evaluated NHS coverage and the incidence of hearing loss, the diagnostic performance of two screening tests, and the associated risk factors (RFs), characterizations, and two-year follow-up data of affected infants in a middle-income country.

Methods

An ambispective cohort study was conducted in a high-complexity hospital in Bogotá, Colombia (2020–2023). Screening was performed in two stages using otoacoustic emissions (OAE) and automated brainstem response (ABR) evaluations. Infants who failed both stages were referred to otolaryngological assessments. Poisson regression was used to identify the associated RFs, and the diagnostic performance metrics for OAE assessment were estimated using the ABR data as the reference.

Results

The NHS coverage was 69.8 %. CHL was diagnosed in four children (3/1.000). The follow-up rate was 75 %. Neonatal unit admission was associated with a higher risk of CHL (relative risk: 10.77, 95 % confidence interval: 2.10–5.18). In the first stage, OAE assessment showed 72.2 % sensitivity and 99.4 % specificity, while in the second stage, their sensitivity and specificity were 71.4 % and 100 %, respectively. The agreement between OAE and ABR assessments was substantial in the first stage (κ = 0.791) and moderate in the second stage (κ = 0.397).

Conclusions

These findings emphasize the importance of implementing strategies to improve NHS coverage and ensure comprehensive follow-up in middle-income countries, thereby improving the quality of life of patients in these countries. Despite the high specificity and sensitivity, the variability in test agreement highlights the need for structured two-stage screening protocols combining OAE and ABR assessments.

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来源期刊

International journal of pediatric otorhinolaryngology 医学-耳鼻喉科学

CiteScore

3.20

自引率

6.70%

发文量

276

审稿时长

62 days

期刊介绍： The purpose of the International Journal of Pediatric Otorhinolaryngology is to concentrate and disseminate information concerning prevention, cure and care of otorhinolaryngological disorders in infants and children due to developmental, degenerative, infectious, neoplastic, traumatic, social, psychiatric and economic causes. The Journal provides a medium for clinical and basic contributions in all of the areas of pediatric otorhinolaryngology. This includes medical and surgical otology, bronchoesophagology, laryngology, rhinology, diseases of the head and neck, and disorders of communication, including voice, speech and language disorders.