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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

Apart from isolated programs in private and public health care sectors, South Africa has no existing systematic public infant hearing screening program at community level. As a result, early identification of hearing loss is certainly not being attained for the majority of infants in South Africa with far-reaching effects for individuals, families and society at large. Screening programs at primary health care immunization clinics have been proposed as an alternative to hospital-based programs in South Africa. The objective of this study was to evaluate the first systematic community-based infant hearing screening program in a developing South African community in the Western Cape. A combined descriptive and exploratory research methodology was followed incorporating aspects of a program evaluation design. The study was of a quantitative nature and the required data were collected by means of a questionnaire and OAE testing conducted by clinic nurses on subjects. A community-based universal infant hearing screening program initiated at eight primary health care clinics in the Cape Metropolitan area was evaluated over a 19-month research period. During this time 6227 infants who were candidates for screening attended their 6, 10 or 14-week immunization visit at the relevant clinic. Clinic nurses were trained as screening personnel. A two-stage distortion product otoacoustic emissions screening protocol was utilized. The target disorder for this study was bilateral permanent congenital and early onset hearing loss and infants referring the first screen were scheduled for a 4-week follow-up visit at the clinic. Diagnostic audiological and medical evaluations were scheduled at referral hospitals when indicated. The study evaluated the efficacy of the program based on coverage, referral and follow-up rates and diagnostic outcomes according to guidelines specified by the Health Professions Council of South Africa 2007 Position Statement. Overall coverage rate across the eight clinics was 32.4% with 2018 infants (aged 0- 14 weeks) screened. The mean age of the sample at first stage screen was 3.9 weeks of age and 13.5 weeks of age for first hospital visit. Overall first stage screen referral rate was 9.5% with 62 subjects (3%) referred for diagnostic services at hospital level after a follow-up screen. The average follow-up rate for rescreens at clinic level was 85.1% and for initial diagnostic assessments at hospital level it was 91.8%. Although minimal hearing loss was not the primary focus of the screening program the outcomes did include those subjects with fluctuating conductive hearing loss and permanent unilateral hearing loss. Prevalence rates were 4.5/1000 with significant hearing loss, including sensorineural (1.5/1000) and conductive (3/1000) losses, and 12.9/1000 for subjects with middle ear effusion.<p-> The community-based infant hearing screening program was valuable in attaining high follow-up return rates but reaching sufficient coverage may require dedicated screening personnel as opposed to existing nursing personnel. Furthermore, consideration of an alternative community-based platform such as midwife obstetric units may improve coverage and referral rates and prevalence of permanent congenital and early onset hearing loss. / Dissertation (MCommunication Pathology)--University of Pretoria, 2013. / Speech-Language Pathology and Audiology / Unrestricted