RESUMO
INTRODUCTION: The Universal Newborn Hearing Screening Program in Mexico began in 2010. Its results, published in 2013 by the National Council for the Development and Inclusion of Persons with Disabilities (CONADIS), report low coverage and, currently, there is a dearth of information about its activities. This study describes the process of the program from the epistemological perspective of women whose children participated in the program, evaluating it under the sustenance of the constructivist-respondent model in search of aspects that could help explain its results. METHODS: Descriptive study with a qualitative approach based on the constructivistrespondent paradigm. We elected the 14 women who participated in the study through trial and number until theoretical saturation. After signing an informed consent form and respecting the confidentiality and anonymity, these women underwent semi-structured interviews that were audio-recorded and transcribed as were conducted. The researchers separately analyzed and coded categories and conjointly summarized categories and subcategories. Validity and reliability were obtained through the credibility, transferability and triangulation. RESULTS: From the speeches, we obtained the general profile of the interviewed, evolution of their children in the program process and four categories with 15 subcategories related to the reconstruction of the process: knowledge, needs, feelings and attitudes. One was evaluated as favorable, six without agreement and eight as unfavorable. The latter refer to our own context. CONCLUSIONS: The epistemological perspective of the interviewed women showed aspects that could help explain the low coverage of the program. Attention from public policies could improve this feature. With the establishment of the program, children with deafness are diagnosed and treated at a lower age than before the program.
INTRODUCCIÓN: El Programa de Tamiz Auditivo Neonatal Universal se inició en México en 2010. Sus resultados, publicados en 2013 por el Consejo Nacional para el Desarrollo y la Inclusión de las Personas con Discapacidad, informan baja cobertura. Actualmente hay escasez de información sobre sus actividades. Este estudio describe el proceso del programa desde la perspectiva epistemológica de mujeres cuyos hijos participaron en el mismo, evaluándolo bajo el sustento del modelo constructivista-respondente en busca de aspectos que puedan ayudar a explicar sus resultados. MÉTODOS: Estudio de tipo mixto, con enfoque en el paradigma constructivista respondente. En él participaron 14 mujeres, elegidas por juicio y su número hasta la saturación teórica. A ellas, previa firma de consentimiento informado, respetando la confidencialidad y anonimato; se les aplicaron entrevistas semi estructuradas. Estas fueron audio grabadas y transcritas tal como se expresaron. Las investigadoras analizaron y codificaron categorías por separado; juntas resumieron categorías y subcategorías. La validez y confiabilidad se obtuvieron a través de la credibilidad, transferibilidad y triangulación. RESULTADOS: De los discursos se obtuvieron el perfil general de las entrevistadas, evolución de sus hijos en el proceso del programa y cuatro categorías con 15 subcategorías relacionadas con la reconstrucción del proceso: conocimientos, necesidades, sentimientos y actitudes. Estas categorías se evaluaron como favorable (una), sin acuerdo (seis) y desfavorables (ocho). Estas últimas, son propias de nuestro contexto. CONCLUSIONES: La perspectiva epistemológica de las entrevistadas, mostró aspectos que podrían ayudar a explicar la baja cobertura del programa. Retomarlo desde las políticas públicas puede mejorarlo. Con el establecimiento del programa, los niños con sordera son diagnosticados e intervenidos a menor edad que antes del programa.
Assuntos
Surdez/diagnóstico , Transtornos da Audição/diagnóstico , Triagem Neonatal/métodos , Pais , Adulto , Surdez/congênito , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Transtornos da Audição/congênito , Humanos , Lactente , Recém-Nascido , Entrevistas como Assunto , Masculino , México , Reprodutibilidade dos Testes , Adulto JovemRESUMO
OBJECTIVE: To verify and correlate the rate of failure in the newborn hearing screening in relation to the time of life of the newborn when the procedure is carried out. METHODS: The study focused on babies born on a maternity, from October/2010 to March/2011. Newborns possessing one or more risk indicators for auditory impairment as described by the JCIH, 2007 or with time of life longer than 60 h were excluded. An automated transient evoked otoacoustic emission equipment was used. The "pass" criterion adopted was: signal to noise ratio greater than 6dB and a minimum signal level of -5dbNPS in at least three frequencies. Babies were divided in three groups: GI: fewer than 24 h old, GII: between 24 and 36 h, and GIII: more than 36 h. RESULTS: 890 babies were included, 52% male and 48% female. Of all newborns, 70% passed the test and 30% failed. Regarding gender, 30% female and 31% male failed the test. 35% of the newborns were in GI, 53% in GII and 12% in GIII. Comparing the three groups simultaneously, we conclude that there is evidence of differences between them (P value <0.001). When compared two by two, we conclude that the distributions of GII and GIII may be considered the same (P=0.443), but both are different from GI (P<0.001). We noticed that in GII and GIII, the proportion of patients who presented de "pass" result is much higher than that of patients who presented this result in GI. The result of logistic regression shows that with the passing of each hour after birth, a newborn's chance of failing the test decreases by 5%. CONCLUSION: We have concluded that the failure rate in the newborn hearing screening was much higher in the newborns screened within 24 h from birth, deviating statistically from the newborns screened between 24 and 36 h. There was no statistically significant difference between the latter two time brackets.
Assuntos
Audiometria/métodos , Transtornos da Audição/congênito , Transtornos da Audição/diagnóstico , Triagem Neonatal/métodos , Estudos de Coortes , Feminino , Transtornos da Audição/epidemiologia , Humanos , Incidência , Recém-Nascido , Masculino , Emissões Otoacústicas Espontâneas , Controle de Qualidade , Medição de Risco , Fatores de TempoRESUMO
UNLABELLED: To investigate the transient evoked otoacoustic emissions (TEOAE) contralateral suppression in neonates at risk for hearing loss, 55 neonates at risk for hearing loss (risk group) and 72 full-term neonates not at such risk (control group) were bilaterally tested. In all neonates, the TEOAE were recorded in two stimulation modes (linear and nonlinear clicks), with and without contralateral acoustic stimulation. Findings revealed significant contralateral suppression of otoacoustic emissions in both groups, but the amount of TEOAE contralateral suppression was reduced for at risk group (p=0.001), supporting the hypothesis that medial olivocochlear bundle function is reduced in neonates at risk for hearing loss. The combination of contralateral acoustic stimulation and TEOAE enables easy and noninvasive study of auditory efferent function. However it should be emphasized that the reduction in TEOAE contralateral suppression in the risk group, statistically identified as a group effect, might not be detectable in individual cases. Further studies are needed in order to determine whether the lower amount of TEOAE contralateral suppression in neonates at risk for hearing loss represents a risk for developing auditory processing disorders. LEARNING OUTCOMES: The reader will be introduced to the study using auditory efferent pathway activation by contralateral acoustic stimulation (CAS), resulting in the TEOAE suppression effect. The characteristics of TEOAE suppression in the neonatal population, in which it provides evidence of the reduced medial olivocochlear system function in those at risk for hearing loss, will also be addressed.
Assuntos
Audiometria de Resposta Evocada/métodos , Dominância Cerebral/fisiologia , Transtornos da Audição/congênito , Doenças do Prematuro/diagnóstico , Emissões Otoacústicas Espontâneas/fisiologia , Processamento de Sinais Assistido por Computador , Estimulação Acústica , Núcleo Coclear/fisiopatologia , Vias Eferentes/fisiopatologia , Feminino , Transtornos da Audição/diagnóstico , Transtornos da Audição/fisiopatologia , Humanos , Recém-Nascido , Doenças do Prematuro/fisiopatologia , Masculino , Núcleo Olivar/fisiopatologia , Valores de Referência , Fatores de RiscoRESUMO
We studied 81 children, mostly boys, who experienced language acquisition delay but whose audiometric thresholds were normal. We assessed the evolution of children with delayed maturation of auditory pathways by brainstem evoked response audiometry (BERA). We also used a questionnaire administered during diagnostic procedures to determine if there was a probable etiology in each patient. In addition, we further studied language evolution in 29 patients by means of a second questionnaire that was administered approximately 2 years later. Finally, we studied the evolution of the I-V interwave interval and the I/V amplitude ratio in 16 patients by performing a second BERA after a mean interval of 3 years. We observed improvement in both brainstem transmission time and language acquisition in all 81 patients. However, only a few patients achieved normal range results. Morphologic alterations, which were most common in patients who had had perinatal jaundice, remained unchanged. The most common possible risk factors for the delayed maturation pattern observed on BERA were parental consanguinity, prematurity, perinatal anoxia and jaundice, and postnatal seizure and infection. Some patients had more than one of these possible risk factors. We conclude that high-risk newborns and 2-year-old children who have no primitive verbal language skills should undergo BERA as well as investigation of hearing thresholds, interwave intervals, and I/V amplitude ratios. The alteration of the parameters points out the need for early intervention if there is no favorable prognosis.
Assuntos
Transtornos da Percepção Auditiva/complicações , Transtornos da Percepção Auditiva/diagnóstico , Transtornos da Audição/complicações , Transtornos do Desenvolvimento da Linguagem/diagnóstico , Transtornos do Desenvolvimento da Linguagem/etiologia , Fatores Etários , Audiometria/métodos , Vias Auditivas/fisiologia , Limiar Auditivo , Pré-Escolar , Estudos de Coortes , Potenciais Evocados Auditivos do Tronco Encefálico , Feminino , Transtornos da Audição/congênito , Humanos , Lactente , Masculino , Prognóstico , Estudos Prospectivos , Medição de Risco , Sensibilidade e Especificidade , Inquéritos e QuestionáriosRESUMO
Brainstem auditory evoked potentials provide a simple, noninvasive method of evaluating hearing function and have been widely used for early detection of hypoacusis in children. Between April 1992 and May 1994, a stydy was done of 400 Mexican children who presented at least one neonatal risk factor for hearing impairment. The average age of the children studied was 6.6 months and their average gestational age at birth was 35.1 weeks. Just over half of the children had been treated with amikacin. The study found 1427 risk factors (about 3.5 per child), the most common ones being exposure to ototoxic substances, hyperbilirubinemia, and birthweight <1500 g. In 27 por cent of the children, peripheral auditory changes were found, and 13 por cent did not respond to auditory stimuli. Low birthweight and young gestational age at birth, high serum concentration of bilirubin, sepsis, subependymal or intraventricular hemorrhage, mechanical ventilation, and exposure to ototoxic substances were significantly associated with the presence of severe or profound hypoacusis
Los potenciales provocados auditivos del tallo cerebral son un método sencillo y no invasor de evaluación de la función auditiva, que se utiliza ampliamente en niños para detectar tempranamente hipoacusia. Entre abril de 1992 y mayo de 1994, se estudiaron 400 niños mexicanos que presentaban, al menos, un factor de riesgo neonatal de hipoacusia. La media de la edad de los niños estudiados fue 6,6 meses y la media de la edad gestacional al nacer, 35,1 semanas. El 51% de ellos fueron tratados con amikacina. Se registraron 1 427 factores de riesgo (3,5 por niño), entre los que predominaron la exposición a ototóxicos, la hiperbilirrubinemia y el peso al nacer <1 500 g. En 27% se encontraron alteraciones auditivas de tipo periférico y en 13%, ausencia de respuesta a estímulos auditivos. El bajo peso y la menor edad gestacional al nacer, la concentración máxima de bilirrubina en el suero, la presencia de sepsis, la hemorragia subependimaria o intraventricular, la ventilación mecánica y la exposición a ototóxicos se asociaron significativamente con la presencia de hipoacusia grave o profunda
Assuntos
Humanos , Gravidez , Fatores de Risco , Potenciais Evocados Auditivos , Transtornos da Audição/congênito , MéxicoRESUMO
Hearing loss and its functional consequences were evaluated retrospectively in children with congenital hypothyroidism. From a cohort of 101 children followed longitudinally to evaluate newborn screening, 75 with previous hearing tests were studied. Fifteen (20%) were found to have hearing problems. Of these, nine had unilateral or sensorineural loss mostly at high frequencies, five had a conductive loss, and one had both problems. Hearing impaired children differed from children with normal hearing in age of treatment onset (22 vs 14 days) but not disease severity or duration. A comparison of language and auditory processing skills at ages 3, 5, and 7 years revealed that early speech was delayed in hearing impaired children, whereas deficits persisted in later receptive language and auditory discrimination skills. Comparing hearing impaired children and children with normal hearing with matched control subjects at grade 3 showed that hearing impaired children were poorer readers because of less adequate phonologic processing skills.
Assuntos
Hipotireoidismo Congênito , Transtornos da Audição/congênito , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Seguimentos , Transtornos da Audição/diagnóstico , Transtornos da Audição/prevenção & controle , Perda Auditiva Condutiva/congênito , Perda Auditiva Condutiva/diagnóstico , Perda Auditiva Condutiva/prevenção & controle , Perda Auditiva de Alta Frequência/congênito , Perda Auditiva de Alta Frequência/diagnóstico , Perda Auditiva de Alta Frequência/prevenção & controle , Perda Auditiva Neurossensorial/congênito , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/prevenção & controle , Humanos , Hipotireoidismo/complicações , Hipotireoidismo/prevenção & controle , Lactente , Recém-Nascido , Transtornos do Desenvolvimento da Linguagem/diagnóstico , Transtornos do Desenvolvimento da Linguagem/etiologia , Transtornos do Desenvolvimento da Linguagem/prevenção & controle , Estudos Longitudinais , Masculino , Triagem Neonatal , Ontário/epidemiologia , Leitura , Estudos RetrospectivosRESUMO
Three families are described in which each of the mothers took trimethadione during pregnancy. From a comparison of siblings in each family and of others exposed to trimethadione in utero, a specific phenotype is delineated. Features included in the fetal trimethadione syndrome are developmental delay, speech difficulty, V-shaped eyebrows, epicanthus, low-set ears with anteriorly folded helix, palatal anomaly, and irregular teeth. Additional anomalies in some of the patients include intrauterine growth retardation, short stature, microcephaly, cardiac anomaly, ocular anomaly, hypospadias, inguinal hernia, and simian creases.