Title: The Newborn Hearing Screening Programs At Inova Hospitals
1The Newborn Hearing Screening Programs At Inova
Hospitals
- Ken Henry, Ph.D.
- Inova Fairfax Hospital For Women Children
- Falls Church, VA
- Inova Fair Oaks Hospital
- Fairfax, VA
2 Inova Fairfax NHS Program
- Fairfax Hospital Census Approaches 11,000
Newborns Per Year - Average of 30 Per Day /Census Often Exceeds 50
Per Day - Level I NICU (50 Bed)
- Fair Oaks Hospital Census Exceeds 3,000 Per Year
- The Two Hospitals Represent Nearly 1/6 Of The
Annual Birthing Census In The State Of Virginia
3 Inova Fairfax NHS Program
- Personnel Considerations
- Two Or More Screeners Present Every Day
- One Screener Per Floor
- Twelve Part-time Screeners (3 Audiologists)
- Universal Screening Performed Daily
- Three To Five Hours Per Day
- Separate Protocols For WBN and NICU
4Equipment - Fairfax Hospital
- 2 Automated OAE Systems (EchoCheck)
- One Unit Per Floor
- One Additional Backup System
- 2 Clinical OAE Systems (EchoPort ILO 88 TEOAE)
- One Unit Per Floor
- Quickscreen Protocol
5 Inova Fair Oaks NHS Program
- Personnel Considerations
- Ave. 11 Newborns Per Day
- One Screener Daily
- Equipment
- 1 Automated OAE System (EchoCheck)
- 1 Clinical OAE System (EchoPort ILO 88)
- Quickscreen Protocol
6Inova Fairfax Hospital Protocol
- Well Newborn Screening Initially Began With 2
Stage Process - OAE (EchoPort)
- AABR (Algo 2e)
- AOAE (EchoCheck)
- Evolved To A One Stage Screening
- Rescreen Clinic Two Stage Screen
- Repeat TEOAE
- AABR If Necessary
7AOAE versus OAE
- The Efficacy of UNHS Was Well Established Using
TEOAEs - We Were Skeptical About The Capability Of
Automated OAE Technology - 247 Newborns Were Assessed With AOAE, OAE and
AABR. None Passed The AOAE And Subsequently
Failed The OAE or AABR
8AOAE versus OAE
- 33 Did Not Pass the AOAE (EchoCheck) But Did
Subsequently Pass The OAE and AABR Conducted
Immediately After Initial Screen - 12 Did Not Pass the AOAE Or OAE But Did Pass The
AABR - Implications?
9The Use Of AABRSome Unfair Statistics
- 804 AABR records
- AABR Screenings Were Conducted On Newborns Who
Referred On First Stage Screen With TEOAE - Average test time - 11.7 minutes
10Inova Fairfax Hospital For ChildrenMulti-Stage
Assessment
11Inova Fairfax HospitalMulti-Stage Screen - TEOAE
and AABR
12Inova Fairfax HospitalTEOAE ONLY
13Inova Fairfax Hospital Protocol
- Separate Protocol For Screening Well Newborns and
NICU Newborns - Active Level I Nursery
- Clinical TEOAE and ABR Depending On Medical
Status
14NICU Protocol For Diagnostic ABR
- Birthweight OR lt1000 Grams
- Birthweight 1001-1250 Grams (look at vent use
stability of baby- if rocky course- ABR - if very stable- OAE
- TORCH
- APGAR score at 5min. equal to or less than 6
- Severe asphyxia, hypoxic ischemia, encephalopathy
protracted seizures
- Craniofacial anomalies
- Chromosomal Abnormalities
- CNS Abnormalities
- IVH (Grade 2 or above)
- PVL
- hydrocephalus
- malformations
- meningitis
- PPHN
- Hyperbilirubinemia requiring exchange
transfusions
15Neonatal Screening Program For Inova
Hospitals(Well Baby Nursery)
16When Do You Refer For Diagnostic Audiology and/or
Medical Evaluation?
- JCIH 2000 recommendations for EDHI states All
infants who do not pass the birth admission
screen and any subsequent rescreening begin
appropriate audiological and medical evaluations
to confirm the presence of hearing loss before 3
months of age
17OUTPATIENT RESCREEN CLINIC
18 SUMMARY OF EHDI PROCESS
19Summary
- Newborn Census and Personnel Will Dictate Choice
in Equipment/Technology - Time-Cost Analysis Of Protocol
- Final Outcome
- Impact On The Community
- Follow-Up
- Personnel Resources
- Parental Considerations
- Insurance Considerations