A large-scale newborn hearing screening in rural areas in China

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Abstract

Objectives

Newborn hearing screening has been successfully implemented in cities of China, but not in rural areas. This study aimed to provide guidance on implementing hearing screening in the rural areas of China.

Methods

Subjects were 11,568 babies who were born in 5 counties of Hubei Province of China. Hearing screening followed a two-stage strategy with transient evoked otoacoustic emissions (TEOAEs). Infants referred after the second-stage screening were tested by diagnostic auditory brainstem response (ABR).

Results

The subjects screened included 10,665 (92.2%) normal newborns and 903 (7.8%) newborns with high-risk of hearing loss. While 8190 (70.8%) newborns passed the initial screening, 135 newborns failed in the re-screening, and 90 (66.7%) of these 135 newborns received diagnostic assessment. Finally, 58 infants were diagnosed as hearing loss, and the prevalence of congenital hearing loss among newborns in rural areas was 0.5% (58/11,568).

Conclusions

This large-scale newborn hearing screening in rural areas of Hubei Province of China demonstrated that the screening rate and referral rate for high-risk infants are low. Urgent measures should be taken by the government to promote newborn hearing screening in the rural areas.

Introduction

Hearing loss is the most common birth defect and occurs more frequently than other conditions for which newborns are routinely screened [1]. Early detection of infants with congenital or early onset hearing loss is essential for optimal development of affected children in early childhood and this has resulted in an increasing implementation of universal infant hearing screening programs worldwide [2], [3], [4], [5]. Universal newborn hearing screening (UNHS) has contributed to a significant reduction in the average age of confirmation of hearing loss (declining from 24–30 months to 2–3 months) [6].

China has a large population of 1.3 billion and more than 50% of them live in rural areas where the economic development and medical care are usually not as good as in the cities. About 16 million babies are born every year in China, among which 97.8% are delivered in hospitals. In China, the national neonatal hearing screening administration rules and technological specifications were formulated in 2004 [7]. UNHS has been recognized as an essential component of public health care in early childhood in most of the cities of China. However, such screening is still not widely implemented in rural areas of China. The present study aims to develop a practical strategy to perform hearing screening on the newborns in rural areas in order to provide reliable evidence for implementing this plan all over rural areas of China.

Section snippets

Participants

Total 12,968 babies were born between April 2008 and April 2010 in 11 regional hospitals located in 5 counties of Hubei Province of China. These newborns were all rural residence. Among them 11,568 babies participated in this study and got hearing screening.

Ethics consideration

The newborn hearing screening protocol has been approved by the Ethics Committee of Huazhong University of Science and Technology (Wuhan, China). All parents were informed about the screening process and gave the consent.

Newborn hearing screening

The screening method

Demographic characteristics and risk exposures for the cohort

Totally, 11,568 newborns received audiological tests. The demographic characteristics and risk exposures for this cohort were shown in Table 1. In this cohort of newborns, there were more males than females, with a gender ratio of 1.35:1. The majority of these newborns were Han (79.6%), Tujia (13.8%) and Miao (5.5%), and the others were from 15 ethnical minorities which made up 1.1% of the sample size. A variety of environmental risk factors were identified, with hyperbilirubinemia (358 cases,

Discussion

In China, the success of newborn screening in developed cities has had enormous personal, societal, and economic benefit in the past 10 years. However, given that more than 50% population live in rural areas of China, it is necessary to carry out newborn hearing screening in these areas.

To our knowledge, this study is the largest hearing screening so far in rural areas of China and we found 5.43 per 1000 babies with early hearing loss. This is higher than the results of most screening studies

Conclusions

It is important for the early detection and intervention of hearing loss in children. Despite a national health plan, the underdeveloped economic condition leads to the poor health care in rural areas of Hubei province of China and the inadequate implementation of UNHS there. Urgent measures should be taken by the government to promote newborn hearing screening in rural areas.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Competing interests

None.

Acknowledgements

We thank all the babies and their parents for their kind participation in the study. We greatly appreciate the editorial assistance of Dr. Yingqun Wang.

References (19)

There are more references available in the full text version of this article.

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