The Victorian Infant Hearing Screening Program: Update

Transcription

1 The Victorian Infant Hearing Screening Program: Update Dr Melinda Barker Co-director, Victorian Infant Hearing Screening Program Royal Children s Hospital October 2014

2 VIHSP a brief history 1992 Victorian Infant Hearing Screening Program Commenced two-tiered screening program (neonatal risk factors + behavioural screening at 7-9 months) research into hearing loss, research into effectiveness of VIHSP, lobbying government for UNHS funding 2003 Funding secured for universal screening VicNIC 2004 Funding secured for expansion to UNHS in hospitals with NICUs

3 VIHSP a brief history 2005 UNHS in Victoria commences! VIHSP Newborn Hearing Screening - 30% of Victoria s births Distraction test ceases 2006 Election promise statewide expansion 2007 May (Vic) budget: commitment for VIHSP UNHS statewide

4 VIHSP a brief history 2008 VIHSP NHS in all metro public hospitals (57%) 2009 VIHSP NHS in all regional hospitals (78%) PM announces that NHS available to all by 2011 VIHSP secures funds for Early Support Services VIHSP NHS in remaining private metro hospitals (100% of pop)

5 Why screen for hearing loss in newborns? Early Intervention crucial Without NHS, PCHI is detected late Identification by 6 months = better communication skills, including spoken language Technology to screen neonates is quick, easy, painless Diagnosis, early intervention & support services are available Potential to relieve burden of disability caused by language delays and deficits academic delays and disadvantages social impairments economic disadvantages

6 International and interstate Pre-discharge hearing screening is the international standard of care first recommended by expert panels in 2004 mandated in most states in the USA UK screening 100% of their 600K annual births all Australian states now have universal newborn hearing screening effectiveness established UNHS here to stay

7 VIHSP Newborn Hearing Screening State-wide Rollout Phase & Year Hospitals % of Vic births 1, Tertiary maternity hospitals + colocated private hosps + RCH NICU 30% 2, Public metro maternity hospitals 57% 3, Public and private regional maternity hospitals 78% 4, (Remaining) private metro hospitals 100%

8 VIHSP people Director Senior Area Manager Quality Senior Project 3 Manager 1 Officer 3 HO Admin & Support Team 4 Area Manager 22 ESS 3 Hearing Screener 81 Site Admin Assistant 24

9 The VIHSP screen Carried out at the bedside while mother and baby are still in hospital Sometimes the screen takes place during at outpatient visit The hearing screener explains the screen and answers any questions The screener provides VIHSP information brochure

10 What does the hearing screen look like? The mother will be asked to sign a consent form before the screen begins The screener places sensors on the baby and earcups that play soft clicking sounds The screen is quick and painless and many babies remain asleep

11 The VIHSP screening protocol VIHSP screen #1 Pass result in both ears Refer result in 1 or 2 ears NFA VIHSP screen #2 Pass result in both ears NFA Refer result in 1 or 2 ears Referral to audiology by VIHSP Area Coordinator

12 Who can we screen? Any well baby who is at least 34 weeks gestational age and less than 6 months Normal ear anatomy, no obvious craniofacial abnormalities Preferably quiet and calm Suspected neurological disorder* Infants on CNS stimulants or ototoxic medications** * May become BYPASS baby ** Screen close to discharge

13 Who don t we screen? Babies less than 34 weeks or greater than 6 months Severe craniofacial abnormalities or skin conditions which make the screen difficult - BYPASS Babies under palliative care unless specifically requested Tend to screen most babies even if they are going to audiology anyway Screen does not replace clinical judgement/concern

14 Screen results The screener will give the results of the screen straightaway. Some babies will need a second screen in order to achieve a clear result. The screener will organise a time for this to take place.

15 Pass result - baby showed a clear response to the sounds played. unlikely that the baby has a hearing loss that would affect early speech & language development. Hearing losses can develop at a later time;

16 We do not always get a clear response to the clicking sounds during the first screen. This might be because the baby woke up or became unsettled during the screen there was fluid or debris still in their ears from the delivery there is a hearing loss.

17 A refer result : we did not get a clear response from the baby to the sounds played. This could be because: the baby was unsettled during the screens there is still fluid or another temporary blockage in his/her ears the baby has a hearing loss.

18 What happens after a refer result? The hearing screen does not diagnose a hearing loss. A refer result does not always mean that the baby has a permanent hearing loss. A refer result simply means that the baby needs to have a full hearing test at an audiology clinic. If the baby needs to have a full hearing test, the VIHSP Area Coordinator at the hospital will arrange this appointment at the audiology centre of the parent s choice.

19 What happens after a refer result? ESS Three ESS staff across the state Contact within three days to all refer families Attend audiology appointments where necessary Provide ongoing support through to Early Intervention

20 Targeted surveillance: checking for risk factors Hearing loss risk factors assessment via universal maternal and child health service. My Health and Development Record used as the vehicle for targeted surveillance of infants at risk of progressive or acquired loss. Referral details recorded in MHDR.

21 My Health and Development Record In Birth Details section Screen Results Page 1 Screener records Results (Pass or Refer) Date of screen completion

22 My Health and Development Record In Birth Details section Screen Results Page 2 Screener records Result (Pass or Refer) Any risk factors present at time of screen

23 My Health and Development Record 8m page Targeted surveillance (risk factor follow-up)

24 Program results 2013/14 Month Eligible Declined Screened VIHSP results Screened within one month corrected age Refer rate July 6, ,505 6, August 6, ,412 6, September 6, ,319 6, October 6, ,559 6, November 6, ,242 6, December 6, ,219 6, January 6, ,390 6, February 6, ,185 6, March 6, ,558 6, April 6, ,331 6, May 6, ,336 6, June 6, ,186 6, Full Year (%) 77, ,234 75,

25 Program results 2012/ referrals to audiology 50 Bypassed to audiology Refer rate 0.9% Audiology Referral Outcomes Results not available 5% Permanent Bilateral HL 11% Other Bilateral HL 12% Detection rate 1.07 per 1000 Permanent Unilateral HL 7% Normal Hearing 57% Other unilateral HL 8%

26 Comparing Median Age at Detection (in months) Victoria

27 Points to remember Babies that don t get screened in hospital will generally get screened as outpatients don t need audiology referral. Contact VIHSP first Babies can be screened up to 6 months

28 Points to remember Will we screen Homebirths? Yes Out of state? Yes Decline and then changed mind? Yes Provided they are less than 6 months Check the VIHSP website for the local VIHSP contact numbers and Audiology referral forms and referral FAQs

29 Audiology Referral Form

30 Minor changes to My Health and Development Record Added decline section Changed wording of risk factor aminoglycoside administration to 3 consecutive days

31 VIHSP more information Contact an Area Manager via the website Visit us on Call Head Office About hearing and hearing test visit