Made available in DSpace on 2016-04-27T18:12:05Z (GMT). No. of bitstreams: 1 Raquel Alves Nobre.pdf: 1069573 bytes, checksum: b8d1295a1b5de37c7e8a3aac4652d769 (MD5) Previous issue date: 2014-09-16 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The Universal Newborn Hearing Screening (UNSH) aims to provide early diagnosis in newborns. The procedure uses objective measures such as the Transient Evoked Otoacustic Emissions (TEOAEs) and the Auditory Brainstem Response (ABR). Different stages and protocols are broadly used in TANU, and that may change the values of passes and fails of each program. Purpose: To study the rate of passes and fails in the protocols and stages that are used at TANU, which were performed using electroacoustic (TEOAEs) and electrophysiological (ABR) procedures through an integrative review. Methods: Type of study: An integrative review. Search strategy: The following databases were examined: PubMed, SciELO and SCOPUS.Criteria for selecting the readings: Articles that have evaluated at least a minimum of 1,000 newborns; specifying the time (hours of life of the newborn) in which the test was accomplished; articles specifying how many days later the retest was performed after the hospital discharge, if the infant failed the test; in the article´s methodology the tests that were used and its stages must be included. The method of choice should be: TEOAEs test and retest in newborns with no risk; TEOAEs in conjunction with ABR and ABR in the retest in newborns with no risk and ABR on the test and retest in newborns with a risk factor; the results should present the pass and fail results of each step, such as the diagnosis result. Results: A total of 3950 references were found in English, Portuguese and Spanish. After removing duplicated studies (300), 3650 references were obtained, that were analyzed through titles and summaries. Of this total, 3500 were excluded for being researches with different topics. Hereby, 15 filled all the inclusion criteria. The final rates of pass and fail found in the studied protocols were the following: for the TEOAEs test/retest protocol the pass rate varied from 99,53% to 97,39% and the fail rate from 2,41% to 0,44%. In the TEOAEs and ABR test protocol and in the ABR retest the pass results ranged from 99,84% to 98% and fail from 0,35% to 0,16%. And in the ABR test/retest protocol in newborns with risk factors the pass rate was reached from 98,62% to 92,74% and the fail rate from 1,7% to 1,38%. All the pass and fail rates are within of what is recommended by literature. Conclusion: The protocol that presented the smaller number of false positives was the TEOAEs combined with the ABR in the test and ABR in retest. The findings indicate that the probability of fail for the TEOAEs in the test and retest is larger than the TEOAEs and ABR in the test and ABR in retest, both for the newborns screened until 24 hours of life and for the newborns screened between 25 and 72 hours of life / A Triagem Auditiva Neonatal Universal (TANU) tem como objetivo realizar o diagnóstico precoce em neonatos. A sua realização utiliza medidas, como as emissões otoacústicas evocadas por estímulo transiente (EOAET) e o potencial evocado auditivo de tronco encefálico (PEATE). Diferentes etapas e protocolos são utilizados na TANU, o que pode alterar os índices de passa e falha de cada programa. Objetivo: Estudar os resultados de índice de passa-falha dos protocolos e etapas utilizados na TANU, realizada com procedimentos eletroacústicos (EOAET) e eletrofisiolóficos (PEATE) por meio de uma revisão integrativa. Método: Tipo de estudo: Revisão integrativa Estratégia de busca: Foram pesquisadas as seguintes bases de dados: PUBMED, SCieLO e SCOPUS. Critério para a seleção dos estudos: artigos que avaliaram um número mínimo de 1000 neonatos; artigos que especificaram as horas de vida do neonato em que foi realizado o teste; artigos que especificaram quantos dias depois da alta hospitalar foi realizado o reteste, caso o neonato falhasse no teste; no método, deveriam constar quais os testes utilizados e suas etapas. Neste caso, os testes utilizados deveriam ser: EOAET no teste e no reteste em neonatos sem risco; EOAET combinado com PEATE no teste e PEATE no reteste em neonatos sem risco e PEATE no teste e no reteste em neonatos com risco; os estudos deveriam apresentar o resultado de passa e falha de cada etapa, assim como o resultado do diagnóstico. Resultados: Foi identificado um total de 3950 referências no idioma inglês, português e espanhol. Após a remoção dos estudos duplicados (300), foram obtidas 3650 referências, que foram analisadas por meio dos títulos e dos resumos. Deste total, 3500 foram excluídos por se tratarem de pesquisas com outro tema. Desta forma, 150 estudos foram selecionados, na íntegra. Deste total, 15 preencheram todos os critérios de inclusão. Os índices de passa e falha final encontrados nos protocolos estudados foi de: para o protocolo EOAET no teste e reteste, o índice de passa variou de 99,53 a 97,39% e falha de 2,41% a 0,44%. No protocolo de EOAET combinado com PEATE no teste, e PEATE no reteste foi de passa em 99,84% a 98%, e falha de 0,35% a 0,16%. No protocolo PEATE no teste e reteste em neonatos com risco o índice de passa foi de 98,62% e 92,74% e falha de 1,7% e 1,38%. Todos os índices de passa e falha estão dentro do que é recomendado pela literatura. Conclusão: O protocolo que apresentou menor número de falso-positivo foi o EOAET combinado com PEATE no teste, e PEATE no reteste. Os resultados mostram que a probabilidade de falha para protocolo- EOAET no teste e reteste é maior do que para o protocolo- EOAET combinado com PEATE no teste, e PEATE no reteste, tanto para o neonatos triados até 24 horas de vida, quanto para o grupo de neonatos triados entre 25 e 72 horas

Made available in DSpace on 2016-04-27T18:12:26Z (GMT). No. of bitstreams: 1 Renata Mathias de Abreu.pdf: 1280744 bytes, checksum: 393c24827501b7ec922434fffb9da682 (MD5) Previous issue date: 2007-10-09 / This search´s objective was to describe and understand the development of the Speech Pathology intervention at babies in maternities from Salvador, how was the beginning of this intervention and how the practice is configured according the intitutions conditions. For this, a survey was realized to know the hospitals/maternities that exist in this city and then, a questionnaire was aplyed to verify if these places contain ICU´s and SICU s and Speech Pathologist working, the kind of relationship between this professional and the institution, and also the area that these professionals are working. Also were realized eight interviews with Speech Pathologists who introduced the service in maternities in Salvador (Ba). The interviews were transcribed, textualized, transformed to a deposition, and then analyzed and argued. From 16 maternities, only 14 answered the questionnaire, and there are Speech pathologists working in 9 of these- one of them is voluntary and another is under contract. Some Speech Pathologists just served the hospital or, in some cases, they were called by the newborn s family. The most part of these professionals work at the audiology area, realizing NHS; there are also some of them who realize sporadic sessions in oral motricity (OM). The interviews covered aspects like: scarcity at the undergraduation to act with babies; search of ways to complement the undergraduation and insert the professionals in the area; ways to spreading the service next to scientific production at the area, like the use of protocol; difficulties to be accepted at maternities, like delimitation of interested areas, resistance and lack of knowledge at others health professionals; possibility of acceptance in some multiprofessionals teams; initiative to introduce the service of Speech Pathology in maternities at audiology and oral motricity areas, like preconized at the literature; perspectives of work to Speech pathologists in public and private institutions. In spite of the area be in expansion, through this study was possible to know that there is a lack between the Speech pathologist´s presence necessity, and the way these professionals are working in hospitals/maternities in Salvador. Even with good searches around this topic, the ones that reflect the development of the most diversified clinical practices, there is already a question: why are there no Speech pathologists inserted at multiprofessionals teams in hospitals/maternities as a routine?! / Este estudo teve como objetivo descrever e compreender o desenvolvimento do trabalho do fonoaudiólogo com bebês nas maternidades de Salvador, como foi seu início e como as práticas estão configuradas diante das condições institucionais. Para tanto, foi realizado um levantamento dos hospitais/maternidades existentes nessa cidade e, em seguida, foi aplicado um questionário para verificar a existência de UTIN s e USIN s e em quais delas havia fonoaudiólogos atuando, o tipo de vínculo desse profissional com a instituição e qual a área de atuação. Foram também realizadas oito entrevistas com fonoaudiólogas que implantaram o trabalho em maternidades de Salvador (Ba). As entrevistas foram transcritas, textualizadas, transcriadas e, então, analisadas e discutidas. Das 16 maternidades existentes, apenas 14 responderam ao questionário, sendo que em 9 destas há fonoaudiólogos trabalhando - um deles como trabalho voluntário e outro, por contrato. Alguns apenas prestavam serviço ao hospital ou, em alguns casos, haviam sido contratadas pela família dos RN s. A maioria dos profissionais atua na área de audiologia, realizando a TAN; há também alguns que realizam atendimentos esporádicos de Motricidade Orofacial (MO). As entrevistadas abordaram aspectos como: escassez de formação acadêmica para a atuação com bebês; busca de recursos para complementar a formação e inserção na área; formas de divulgação do trabalho em consonância com a produção científica desse campo de conhecimento, como uso de protocolos; dificuldades de inserção nas maternidades, como delimitação de áreas afins, resistência e desconhecimento dos parte da equipe de saúde; possibilidades de inserção nas equipes multiprofissionais; iniciativas para implantação do serviço de Fonoaudiologia nas maternidades nas áreas de audiologia e motricidade oral, como preconizado na literatura da área; perspectiva do mercado de trabalho para o fonoaudiólogo em instituições públicas e privadas. Apesar de o campo estar em expansão, por meio deste estudo foi possível constatar que há ainda um descompasso entre a necessidade do trabalho fonoaudiológico e a real atuação desse profissional nas instituições hospitalares de Salvador. Mesmo com uma produção significativa de estudos na área, que refletem o crescimento das diversas práticas clínicas, ainda persiste uma pergunta: por que ainda não temos fonoaudiólogos inseridos nas equipes multiprofissionais de hospitais/maternidades como uma rotina?

Made available in DSpace on 2016-04-27T18:12:29Z (GMT). No. of bitstreams: 1 Patricia de Carvalho Monteiro.pdf: 932655 bytes, checksum: 461ce0c9497d2864e3b6c289eadbeefc (MD5) Previous issue date: 2008-02-27 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / Objective: To investigate the cost x effectiveness of five newborn hearing screening (NHS) protocols in a public hospital in São Paulo. Methods: Clinical outcomes from 2060 newborns, screened during a nine months period, using a protocol of NHS with Transient Otoacoustic Emissions (TEOAE) and Automated Auditory Brainstem Response (AABR). It was possible to analyze five protocols for cost and effectiveness. Protocol 1: UNHS with TEOAE in two stages; protocol 2: UNHS with TEOAE in the first stage, AABR in the second stage; protocol 3: UNHS - neonates without Risk Factors were screened with TEOAE in the first stage and AABR in second stage. Neonates with risk factors were screened only with AABR; protocol 4: Selective NHS (SNHS) - using TEOAE in a combination with AABR in two stages; protocol 5: SNHS - with AABR in two stages. All newborns who referred before discharge should return in 15 days for re-screen. The effectiveness of the protocols was evaluated by the indicators of quality of Joint Committee on Infant Hearing (2007) and the cost was estimated by the proposal of the National Center for Hearing Assessment and Management (2003). Results: The results were presented regarding the percentage of newborns screened, newborns referred for diagnosis and the cost per newborn screened. We found the following results: protocol 1: 92% of newborns screened, 2.1% of newborns referred for diagnosis and cost of $7.53; protocol 2: 88% of newborns screened, 0.5% of newborns referred for diagnosis and cost of $8.9; protocol 3: 86% of newborns screened, 0.6% of newborns referred for diagnosis and cost of $9.16; protocol 4: 71% of newborns screened, 7.3% of newborns referred for diagnosis and cost of $61.1; protocol 5: 71% of newborns screened, 2% of newborns referred for diagnosis and cost of $56.1. Conclusion: The protocol 3 was considered the better for cost and effectiveness in order to identify cochlear hearing loss for newborns without risk factors, and cochlear and retrocochlear hearing loss for neonates with risk factors / Objetivo: O objetivo desta pesquisa foi descrever as relações de custo x efetividade para cinco protocolos de Triagem Auditiva Neonatal (TAN), no ano de sua implementação em uma maternidade de São Paulo. Método: Durante o período de nove meses, nasceram 2060 neonatos, os quais realizaram um protocolo padrão de TAN com uso de Emissões Otoacústicas por Estímulo Transiente (EOAT) e Potencial Evocado Auditivo de Tronco Encefálico Automático (PEATE-A). Este protocolo propiciou o estudo de cinco protocolos para análise de custo e efetividade. Protocolo 1: TANU com o uso de EOAT em duas etapas; Protocolo 2: TANU com uso de EOAT na primeira etapa, PEATE-A na segunda etapa, ainda antes da alta.; Protocolo 3: TANU - neonatos sem Indicador de Risco para Perda Auditiva foi utilizada a EOAT na primeira etapa e PEATE-A ainda antes da alta para os que falharam. Para os neonatos com indicadores de risco foi utilizado o PEATE-A em duas etapas; Protocolo 4: TAN Seletiva (TANS) - com o uso de EOAT e PEATE-A combinados em duas etapas; Protocolo 5: TANS - com o uso de PEATE-A em duas etapas. Todos os neonatos que falharam no retorno foram encaminhados para diagnóstico. A efetividade dos protocolos foi avaliada pelos indicadores de qualidade do Joint Committee on Infant Hearing (2007) e o custo foi estimado por meio da proposta do National Center of Hearing Assesment and Management (2003). Resultados: Os resultados foram apresentados em relação à porcentagem de neonatos triados, neonatos encaminhados para diagnóstico e respectivo custo por neonato triado. Foram encontrados os seguintes resultados: protocolo 1: 92% de neonatos triados, 2,1% de neonatos encaminhados para diagnóstico e custo de R$13,56; protocolo 2: 88% de neonatos triados, 0,5% de neonatos encaminhados para diagnóstico e custo de R$ 16; protocolo 3: 86% de neonatos triados, 0,6% de neonatos encaminhados para diagnóstico e custo de R$16,43; protocolo 4: 71% de neonatos triados, 7,3% de neonatos encaminhados para diagnóstico e custo de R$110; protocolo 5: 71% de neonatos triados, 2% de neonatos encaminhados para diagnóstico e custo de R$101. Conclusões: Concluiu-se que o melhor protocolo na relação custo x efetividade foi o Protocolo 3, com utilização de EOAT para neonatos sem indicadores de risco, PEATEA no caso de falha antes da alta hospitalar, e apenas o PEATE-A para crianças com indicadores de risco, na TANU

Made available in DSpace on 2016-04-27T18:12:39Z (GMT). No. of bitstreams: 1 Thais Alves de Sousa.pdf: 3139846 bytes, checksum: 9b933750b8d645c37d6103a8d136a9fd (MD5) Previous issue date: 2009-02-17 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Many studies have shown that children, whose threshold of hearing sensitivity is between 15 and 50 dB, can be diagnosed only when they are experiencing difficulties in the development of speech, language, skills of reading and writing. The ASHA (2002) suggests that the prevalence of hearing loss in children is on average of 131 to 1000 at school age, taking into account all possible hearing problems that could be found. As a criterion of "failure" in the screening, the ASHA recommends that sent the child to not respond to tone of 20 dB HL at any frequency in one or both ears. Northern and Downs (1984) suggest that sent the child to submit to the average frequencies of 500, 1000, 2000 and 4000 Hz greater than or equal to 15 dB NA. Objective: To investigate the occurrence of hearing disorders in children from 1st and 2nd grade of elementary school, two schools, one from the public school system and another network of private schools, both schools of SP. Method: This was a cross sectional research, qualitative and descriptive. The sample comprised 73 children, aged between 7 and 9 years old, regularly enrolled in primary education (Group I-school) and Group II-private school). All children were subjected to the following protocol: Inventory development; otoscopy, audiometric screening to obtain the pure tone thresholds for the frequencies of 500 Hz, 1000, 2000, 3000 and 4000 kHz in audiometric booth, and tympanometric screening. The results will be analyzed as: criteria for failure ASHA X Northern and Downs; x public school private school. Results: Statistical analysis showed that there was no statistically significant difference between age and gender of the groups studied. The prevalence of children who failed otoscopy was 15.1% (n = 11), the impedance was 10.0% (n = 6) and audiometry (Northern and Downs criterion) was 12.3% (n = 9). The criterion ASHA (1991), the prevalence of failure was 15.1% (n = 11). The higher prevalence of failure to otoscopy occurred in public schools (n = 9 / 33.3%), it was also higher prevalence of failure to the hearing in public school. There was no statistically significant difference in the prevalence of failure of the impedance between the two groups. The analysis of the protocol showed that there was a higher prevalence of failure in public schools and that this difference is statistically significant (p = 0004) only when the criterion of failure is to Northern and Downs. Conclusion: The results show that there was a higher incidence of failures in public school children, especially in otoscopy and pure tone audiometry. There were no children with hearing losses of more than mild degree. The combination of procedures for identifying children with hearing disorders is the protocol to be recommended because often the only child in a failure of procedures / Muitos estudos têm mostrado que crianças, cujo limiar de sensibilidade auditiva está entre 15 e 50 dB, podem ser diagnosticadas somente quando estão apresentando dificuldades no desenvolvimento da fala, da linguagem, das habilidades de leitura e escrita. A ASHA (2002) sugere que a prevalência de perdas auditivas em crianças é, em média, de 131 para cada 1000 na idade escolar, levando-se em consideração todos os possíveis problemas auditivos que se pode encontrar. Como critério de falha na triagem, a ASHA recomenda que seja encaminhada a criança que não responder para tom de 20 dB NA em qualquer freqüência em uma ou ambas as orelhas. Northern e Downs (1984) sugerem que seja encaminhada a criança que apresentar média para as freqüências de 500, 1000, 2000 e 4000 Hz igual ou maior que 15 dB NA. Objetivo: Investigar a ocorrência de transtornos auditivos em crianças de 1ª e 2ª series do ensino fundamental, em duas escolas, uma da rede pública de ensino e a outra da rede particular de ensino, ambas as escolas de SP. Método: Esta foi uma pesquisa transversal, qualitativa e descritiva. A amostra foi composta por 73 crianças, idades entre 7 e 9 anos, regularmente matriculadas no ensino fundamental (Grupo I escola pública) e Grupo II escola privada). Todas as crianças foram submetidas ao seguinte protocolo: Inventário de desenvolvimento; otoscopia; Triagem audiométrica para obtenção dos limiares tonais para as freqüências de 500 Hz, 1000, 2000, 3000 e 4000 kHz em cabina audiométrica, e Triagem timpanométrica. Os resultados serão analisados segundo: critério de falha ASHA X Northern e Downs; escola pública x escola privada. Resultados: A análise estatística revelou que não houve diferença estatisticamente significante entre a idade e o gênero dos grupos estudados. A prevalência de crianças que falharam na otoscopia foi de 15,1% (n = 11), na imitanciometria foi de 10,0% (n=6) e na audiometria (critério Northern e Downs) foi de 12,3% (n=9). Pelo critério ASHA (1991), a prevalência de falha foi de 15,1%, (n=11). A maior prevalência de falhas à otoscopia ocorreu na escola pública (n=9 / 33,3%), constatou-se também maior prevalência de falhas à audiometria, na escola pública. Não houve diferença estatisticamente significante nas prevalências de falha da imitanciometria entre os dois grupos estudados. A análise do protocolo mostrou que houve maior prevalência de falhas na escola pública e que esta diferença é estatisticamente significante (p = 0,004) apenas quando o critério de falha é o de Northern e Downs. Conclusão: Os resultados mostram que houve maior ocorrência de falhas nas crianças da escola pública, especialmente na otoscopia e na audiometria tonal. Não foram encontradas crianças com perdas auditivas de grau superior a leve. A combinação de procedimentos para a identificação de crianças com transtornos auditivos é o protocolo a ser recomendado pois muitas vezes a criança falha somente em um dos procedimentos

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Objetivo: Analisar a etapa do reteste da Triagem Auditiva Neonatal (TAN) a partir dos dados encontrados em um hospital de Porto Alegre, bem como analisar os motivos da falta ao reteste, dos bebês que falharam no teste neste mesmo hospital e sugerir possíveis intervenções na gestão. Método: Trata-se de um estudo quanti-qualitativo, descritivo e transversal, desenhado a partir da análise dos dados da fase do reteste da TAN. Para analisar os motivos da falta ao reteste dos bebês que falharam na TAN, foram realizadas entrevistas por telefone, a fim de, obter informações que apontassem as causas das faltas. Resultados: o total de casos analisados foi de 1.202 bebês. Na indicação para o reteste foram identificados 165 (13.8%). Quanto aos faltosos - na etapa do reteste - foram encontrados 38 bebês (23%), cabe ressaltar que o número de faltosos foram calculados sobre o número dos indicados para o reteste. Das 38 famílias contatadas, 32 responderam ao contato telefônico. Os diagnosticados com surdez foram 24 (2%), ficaram em monitoramento 301 (25.2%) e tiveram alta 651 (54.5%) bebês. Quanto ao motivo mais prevalente do não comparecimento à etapa do reteste, foi esquecimento. Para reverter esse cenário, a sugestão é articulação com políticas públicas existentes, como Atenção Básica e Primeira Infância Melhor, com busca ativa dos bebês e reforço no processo de informação das mães e familiares. / Objective: To analyze the stage of retest of Newborn Hearing Screening (NHS) from data found in a hospital in Porto Alegre, analyze the reasons for the absence to the retest of infants who failed the test in this hospital and suggest possible interventions in management. Method: This is a quantitative-qualitative, descriptive and cross-sectional study drawn from the data analysis phase of the NHS retest. To analyze the reasons for the absence to the retest of babies who failed the NHS, interviews were conducted by telephone so as to obtain information that pointed out the causes of absences. Results: The total number of analyzed cases was 1.202 babies. In the indication for retesting 165 (13.8%) were indentified. As for absences – in the retest step - 38 infants (23%) were found. It is worth noting that the number of absences was calculated from the number of indications for retest. From the 38 telephone calls made to families, 32 replied to contact. Cases diagnosed with deafness were 24 (2%). Other 301 (25.2%) cases remained in monitoring and 651(54.5%) infants were discharged. The most common reason for not attending the retest step was forgetfulness. In order to reverse this scenario, the suggestion is the articulation in conjunction with existing public policies, such as Primary Care and Better Early Childhood Development Program and an active search for infants and the strengthening of the information process of mothers and family.

Objetivo: Analisar a etapa do reteste da Triagem Auditiva Neonatal (TAN) a partir dos dados encontrados em um hospital de Porto Alegre, bem como analisar os motivos da falta ao reteste, dos bebês que falharam no teste neste mesmo hospital e sugerir possíveis intervenções na gestão. Método: Trata-se de um estudo quanti-qualitativo, descritivo e transversal, desenhado a partir da análise dos dados da fase do reteste da TAN. Para analisar os motivos da falta ao reteste dos bebês que falharam na TAN, foram realizadas entrevistas por telefone, a fim de, obter informações que apontassem as causas das faltas. Resultados: o total de casos analisados foi de 1.202 bebês. Na indicação para o reteste foram identificados 165 (13.8%). Quanto aos faltosos - na etapa do reteste - foram encontrados 38 bebês (23%), cabe ressaltar que o número de faltosos foram calculados sobre o número dos indicados para o reteste. Das 38 famílias contatadas, 32 responderam ao contato telefônico. Os diagnosticados com surdez foram 24 (2%), ficaram em monitoramento 301 (25.2%) e tiveram alta 651 (54.5%) bebês. Quanto ao motivo mais prevalente do não comparecimento à etapa do reteste, foi esquecimento. Para reverter esse cenário, a sugestão é articulação com políticas públicas existentes, como Atenção Básica e Primeira Infância Melhor, com busca ativa dos bebês e reforço no processo de informação das mães e familiares. / Objective: To analyze the stage of retest of Newborn Hearing Screening (NHS) from data found in a hospital in Porto Alegre, analyze the reasons for the absence to the retest of infants who failed the test in this hospital and suggest possible interventions in management. Method: This is a quantitative-qualitative, descriptive and cross-sectional study drawn from the data analysis phase of the NHS retest. To analyze the reasons for the absence to the retest of babies who failed the NHS, interviews were conducted by telephone so as to obtain information that pointed out the causes of absences. Results: The total number of analyzed cases was 1.202 babies. In the indication for retesting 165 (13.8%) were indentified. As for absences – in the retest step - 38 infants (23%) were found. It is worth noting that the number of absences was calculated from the number of indications for retest. From the 38 telephone calls made to families, 32 replied to contact. Cases diagnosed with deafness were 24 (2%). Other 301 (25.2%) cases remained in monitoring and 651(54.5%) infants were discharged. The most common reason for not attending the retest step was forgetfulness. In order to reverse this scenario, the suggestion is the articulation in conjunction with existing public policies, such as Primary Care and Better Early Childhood Development Program and an active search for infants and the strengthening of the information process of mothers and family.

Objetivo: Analisar a etapa do reteste da Triagem Auditiva Neonatal (TAN) a partir dos dados encontrados em um hospital de Porto Alegre, bem como analisar os motivos da falta ao reteste, dos bebês que falharam no teste neste mesmo hospital e sugerir possíveis intervenções na gestão. Método: Trata-se de um estudo quanti-qualitativo, descritivo e transversal, desenhado a partir da análise dos dados da fase do reteste da TAN. Para analisar os motivos da falta ao reteste dos bebês que falharam na TAN, foram realizadas entrevistas por telefone, a fim de, obter informações que apontassem as causas das faltas. Resultados: o total de casos analisados foi de 1.202 bebês. Na indicação para o reteste foram identificados 165 (13.8%). Quanto aos faltosos - na etapa do reteste - foram encontrados 38 bebês (23%), cabe ressaltar que o número de faltosos foram calculados sobre o número dos indicados para o reteste. Das 38 famílias contatadas, 32 responderam ao contato telefônico. Os diagnosticados com surdez foram 24 (2%), ficaram em monitoramento 301 (25.2%) e tiveram alta 651 (54.5%) bebês. Quanto ao motivo mais prevalente do não comparecimento à etapa do reteste, foi esquecimento. Para reverter esse cenário, a sugestão é articulação com políticas públicas existentes, como Atenção Básica e Primeira Infância Melhor, com busca ativa dos bebês e reforço no processo de informação das mães e familiares. / Objective: To analyze the stage of retest of Newborn Hearing Screening (NHS) from data found in a hospital in Porto Alegre, analyze the reasons for the absence to the retest of infants who failed the test in this hospital and suggest possible interventions in management. Method: This is a quantitative-qualitative, descriptive and cross-sectional study drawn from the data analysis phase of the NHS retest. To analyze the reasons for the absence to the retest of babies who failed the NHS, interviews were conducted by telephone so as to obtain information that pointed out the causes of absences. Results: The total number of analyzed cases was 1.202 babies. In the indication for retesting 165 (13.8%) were indentified. As for absences – in the retest step - 38 infants (23%) were found. It is worth noting that the number of absences was calculated from the number of indications for retest. From the 38 telephone calls made to families, 32 replied to contact. Cases diagnosed with deafness were 24 (2%). Other 301 (25.2%) cases remained in monitoring and 651(54.5%) infants were discharged. The most common reason for not attending the retest step was forgetfulness. In order to reverse this scenario, the suggestion is the articulation in conjunction with existing public policies, such as Primary Care and Better Early Childhood Development Program and an active search for infants and the strengthening of the information process of mothers and family.

The field of early detection and intervention of hearing loss in neonates and infants has been marked by a growing international body of research investigating hearing screening programmes, protocols and outcomes of early detection for hearing loss. In South Africa, screening for neonates and infants in general and particularly for hearing loss is not common practice and is not meeting the needs of the South African population, with very few infants identified with hearing loss early in life. The Year 2002 Hearing Screening Position Statement recommends an intermediate step toward universal screening in the form of Targeted Newborn Hearing Screening (TNHS) as an option for developing countries with limited resources. The Neonatal Intensive Care Unit (NICU) provides a starting point for TNHS because it encompasses a number of risk factors for hearing loss. A combined descriptive and exploratory research methodology was followed to provide a comprehensive perspective on longitudinal hearing screening for NICU neonates and infants at a provincial hospital in South Africa. The quantitative methods included a structured interview to compile risk factor information. Immittance measurements used included acoustic reflex measurements, 226 Hz and 1000 Hz tympanometry. Automated Otoacoustic Emission (AOAE) as well as Automated Auditory Brainstem Response (AABR) screening was conducted. Routine follow-up visits at three month intervals were booked if a subject passed the screen and a follow-up screening for further testing was booked if a subject referred the screening. A total of 49 neonates and infants as well as mothers were enrolled in the first year and followed up for the second year of data collection period. The results indicated that the NICU had potential as platform for TNHS in South Africa. The high incidence of risk factors reported is more when compared with developed countries and highlights the importance of hearing screening in the at risk population for a developing country. The results confirmed reports that 226 Hz probe tone tympanometry produces erroneous responses in young infants. A high correspondence between high frequency tympanometry and AOAE results was found and underlines the need for differential diagnosis to accurately detect middle ear effusion and/or sensorineural hearing loss in neonates and infants. The unilateral AOAE refer rate (7%) was within range of the reported values for initial screening at discharge from the NICU. AABR results indicated a relatively high unilateral refer result (24%) and may be attributed to irritability and restlessness. The highest referral rates in the current study were recorded during the second and third visit and may be attributed to the presence of middle-ear pathology in older infants. The perceptions of mothers emphasized the lack of awareness regarding hearing and hearing loss in South Africa. Lack of knowledge may be a contributing actor to poor compliance with screening follow-up. Despite prevailing challenges, such as a low follow-up return rate, lack of awareness regarding the benefits of early detection of hearing loss, the effect of middle ear effusion on screening results, the cost of hearing screening and different priorities of the national healthcare system, such as Human Immunodeficiency Virus, demonstrated the NICU promise as platform for TNHS in South Africa. TNHS programmes may serve as starting point to direct universal neonatal hearing screening programmes in South Africa. / Dissertation (MCommunication Pathology)--University of Pretoria, 2008. / Speech-Language Pathology and Audiology / MComm Path / unrestricted

Rapid implementation of universal newborn hearing screening programs has exposed a need for a reliable test of middle ear function for timely identification of middle ear pathology and for differentiation between true sensorineural and conductive hearing losses. Use of higher probe tone frequencies for the assessment of immitance measures have proven to be more reliable and accurate in identifying MEE in infants. However a lack of classification-guidelines and age specific normative data exists. This study investigated the characteristics and normative values of high frequency tympanometric and acoustic reflex results for infants (n = 936 ears). Participants were 510 infants (262 male, 248 female) aged 0 – 12 months (mean age = 12.8 weeks) recruited from primary health care and immunization clinics in a South African community. A three-part procedure was performed on each test ear: 1) OAEs were recorded and pass results served as control variable for normal middle ear functioning; 2) 1000 Hz probe tone admittance, susceptance and conductance tympanograms were recorded and analysed in terms of shape, tympanometric peak pressure and maximum (peak) admittance; 3) 1000 Hz probe tone acoustic reflexes, measured with a 1000 Hz ipsilateral stimulus, were recorded and thresholds determined. Significant associations were observed between tympanogram shape, and OAE pass or fail results. 93% of ears with an OAE pass result displayed peaked tympanograms, while 79% of ears with absent OAE’s displayed flat tympanograms. Single peaked tympanograms were recorded in 782 ears (84%), double peaked tympanograms in 41 (4%) ears and flat sloping tympanograms in 112 (12%) ears. Admittance (Ya) tympanograms for the total sample displayed a mean admittance value of 2.9 mmho, with a standard deviation of 1.1 mmho. The 90th percent range was determined at 1.5 mmho (5th percentile) to 4.9 mmho (95th percentile). Mean tympanometric peak pressure in Ya tympanograms was 0.1 daPa, with a standard deviation of 61 daPa. The 90th percent range was -110 daPa to 90 daPa for the 5th and 95th percentiles respectively. Gender specific norms indicated a higher admittance for male ears. Age specific norms indicate a gradual increase in admittance indicating the need for age specific normative classification systems. Ipsilateral 1000 Hz stimuli acoustic reflex measurement proved successful with a 1000 Hz probe tone and present reflexes were recorded in 84% of ears tested. Significant association between acoustic reflex presence, OAE pass and peaked tympanogram results were observed. The normative tympanometric values derived from the cohort may serve as a guide for identification of middle ear effusion in neonates. High frequency tympanometry in combination with acoustic reflexes proves a useful measure for verifying middle ear functioning in young infants. / Dissertation (M (Communication Pathology))--University of Pretoria, 2006. / Speech-Language Pathology and Audiology / M (Communication Pathology) / unrestricted