Presentation
# 9
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6th Internet World Congress for Biomedical Sciences |
Jesús García Domínguez(1), Teresa Cueto Guerreiro(2)
(1)Hospital Materno Infantil "10 de Octubre" - Ciudad de La Habana.. Cuba
(2)Facultad de Ciencias Mèdicas - Ciudad De La Habana . Cuba
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Many of normally developed Central Nervous System deviations could be safely avoided it preventive measures were taken in high risk individuals. It’s specially important to identify preconceptional and prenatal risk factors (e.g.: biological, psychosocial, economic and environment ones) which may alter the physiological development of children teenagers and adults, whether isolated or acting in combination. Widely spread preventive programs in Cuba (1) are able to achieve this goal and their efficiency is systematically controlled by different care levels. Their purposes are mainly to improve people’s standard of living end to transform the family, community and school surroundings, searching for a constructive and collaborative relationship among each program’s members. This is the first prevention level which major goal is to remove or minimize the hearing loss-qualitative and quantitative risk factors.
The National Mother and Infant, Family physician and Nurse, Genetic Diseases, Congenital Malformations Prenatal Diagnosis and Register, Immunizations, Family Plan and Low Birth Weight Reduction Programs are decisive contributors to this matters(1,2,3,4,5,6).
Failure to attain this purpose before birth is followed by a group of preventive actions in order to early avoid deficiencies (second level of prevention) (7). It’s possible with the aplication The Early Screening Child’s Program for The High Auditive Risk child (during the first three months of age) (8) and the arrangement of 36 Pediatric Intensive Care Units and 40 Neonatal Intensive Therapies.
If hipoacusia is a helpless fact then preventive actions aim to elude handicap’s appearance by a well-grounded pedagogic strategy through a National Special Education Program (9) (third level of prevention).
The cuban high auditive risk screening began during the last decade. Information on National Preventive Basic Health Care Programs results is not yet available in our area. So the purpose of this study is to fulfill these objective. The identification of hipoacusia’s morbidity in newborns and infants was our general goal.
We specifically tried to determine the hearing loss incidence according to the moment of diagnosis, to gather the neonatal auditive search results, to classify and show hipoacusia’s severity among the studied children taken into account the time of diagnoses and finally to discern the risk factors appearance frequency related to the patients age.
The transversal cohort of patients was offtained by clustering the 52825 children discharged from our mother and infant Teaching Hospital "10 de October" between 1986 and 1995.
A total of 950 newborns with high auditive risk were refereed to the regional Neurophisiology service located at Willian Soler Hospital in order to undergo the Brain Sten Auditive Evoked Potentials which exhibit a highly trustful efficacy as a screening tool for hearing loss diagnosis(10-15). All tests were performed before three months of corrected age.
At the same time, hospitals and health care área’s pediatricians, otorhinolaryngologists and family phisicians also transfered those infantns discharged from aur unit who were suspected to have hearing deficits. The type and magnitude of H. was taken into account on each patient.
To gathered the most complete information the neonatology service controls and newborns or infants clinical charts were reviewed, we visited their homes and questioned their parents about possible family deafness history.
The screening results, classification and severity of hearing loss were related to the neonatal and post neonatal period. A data base was created using the statiscal pachage Epi Info6 which was also used to process information(16). The frecuency distribution was obtained and percentage was used as summary measurement.
From the 52,825 investiged children , we found hearing loss in 30 (18 newborns and 12 infants). So 52,795 (999.43 per 1000 live born) were normal. (Chart # 1).
Hipoacusia’s incidence seems to be was 0,57 per 1000 live born (l.b.) with 0,34 x 1000 l.b. as the neonatal componente and 0,23 x 1000 l.b. as the post neonatal one. (Chart # 2).
This low incidence semms to be the result of the massively applied preconceptional, prenatal and early neonatal preventive programs in Cuba together outh the use of highly advanced medical technologies and qualified personnel formation(1-6).
Among non-comparable populations H.s at birth has been estimated around 1 x 1000 l.b. Considering less severe hearing losses the incidence approaches 1x 10. If risk factor chlidren are also taken into consideration then indexes arise considerabley, realsing ciphers of 2,5-5 % acording to the Joint Committe on Infant Hearing and of 10 % as other authors have reported(11,17-22).
Nine hundred and fifty neonates with high hearing loss risk were studied from the total of live born during that period. Sensorineural H. was found in 16 cases (1,68 %) and mixed en 2 cases (0,21 %). (Chart # 3). These are relative frequencies much lower than those found by by Lauffer-H and cols. (14) and similar to those reported by Kuan-Mi and Sekula-J (11,12).
From the thirty hipoacusic chlidren, 60 % had bilateral SN hippoacusia and 26,6 % unilateral. Sexty % belonged to the neonatal screening program. During the neonatal period 55,5 % and 33,3 % were bilateral and unilateral SN H. respectively. On the other han 66 % was bilateral during the post neonatal period.
The thoughtful use of a neonatal high auditive risk register allows us to diagnose the three fifths parts of H. population (18 of 30) and this is accomplished by studies only 1,8 % (950 children in our case) from the newborns universe.
This time and cost-saving strategy which renders possible the early phono-audiologic intervention on the majority of chlildren with special hearing needs and during the critical language ages. Kuan-Mi, of Taiwan (11) and other authors have reached to a similar conclusion (22-27).
There was in general 20% of moderate hearing loss (41-60 dbs); 23,3% of severe (61-80 dbs) and of deep hearing loss (80 and more db). Among newborn there was 33,3% moderate; 22,2% severe and 44,4% deep H. Finally, 75% of patients from from the post-neonatal group had severe H. and 44,4% had deep H. (Chart # 5). Tucker-Sm and Cabbage (10) on his hearing loss and Eisglas-Kuperus-N and al. (20) on their posneonatal study reported lower ciphers of severe and deep H.
CONCLUSIONES
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