Download DESIGNING THE INFANT HEARING PROGRAM

INFANT HEARING PROGRAM:
AccuScreen and Program - Review
Spring 2015
INFANT HEARING PROGRAM OVERVIEW
• Follow local IHP or hospital protocol for infection control procedures.
• Screening occurs before discharge
and will include a risk assessment.
• Infant can be tested in crib or
parent’s arms.
• Infant should be sleeping, or resting
quietly.
INFANT HEARING PROGRAM OVERVIEW
SCREENING
M. Hyde, IHP Conference 2007
ACCUSCREEN – Getting Started
Caring for the equipment
• What pieces are disposable?
• What is the easiest way to maintain equipment?
• Can we prevent breaks?
-Hold equipment carefully, to avoid dropping it.
-Keep wires tidy, avoid knots.
-Insert connections into the correct ports.
IHP – Stage One Screening
• OAE is a measure of outer hair cell
function only and a pass does not
guarantee normal hearing.
• However, given normal birth and
pregnancy, negative family history of
hearing loss and no other
complications, normal hearing is a
safe assumption.
IHP – Stage One Screening
Infants will either receive a pass or a refer result.
• A pass means that the baby is hearing at this time.
But it is always important to monitor.
• A refer does not necessarily mean that the
infant has a hearing loss. Commonly
debris in the ear canal or movements
during the test will affect results. A
referral to another stage of screening
is needed.
ACCUSCREEN – ADPOAE
• To screen with the ADPOAE connect the
cable with the blue base.
• Ensure the arrows are aligned properly.
• Put on the probe tip and ear tip
• Select the ear for initial screen.
ACCUSCREEN – ADPOAE
• Touch the black arrow to begin. The equipment will calibrate and then
initiate screen. The screen is completed once three frequencies have a
clear response.
ACCUSCREEN – DPOAE Errors
• If there is too much noise, reduce environmental noise i.e. turn off cell
phones and/or check the ear for debris. You can also try a Quality Test
to make sure the probe is OK.
ACCUSCREEN – AABR
• Soft sounds are played in the
baby’s ear and the brain’s
electrical response is recorded
using three sensors (electrodes).
• The brain’s response to the
sounds is automatically
analyzed and interpreted by the
AccuScreen.
ACCUSCREEN – AABR
• To conduct an AABR connect both the green
and blue cords.
• Make sure the arrows are aligned properly.
• The red electrode goes on the right mastoid.
• The black electrode goes on the left mastoid.
• The white electrode is placed on the babies
forehead.
ACCUSCREEN – AABR
• Touch the black arrow in the Test Menu. Once impedance values are OK,
the black arrow highlights, touch to start. The testing page will appear.
The test is complete when the ABR bar or Progress bar is full.
ACCUSCREEN – AABR Errors
• If impedance values are good the color will be green. Yellow means that
the connection is not as good. Red is unacceptable. A yellow reading
can turn red if the electrode is loose or falls off.
ACCUSCREEN – Trouble Shooting
Quality Test
• At the start of shift a probe test should be done.
Insert the probe into the test cavity at back of the
AccuScreen. The test will start automatically.
Results will appear as Probe OK or
Probe failed with possible errors.
ACCUSCREEN – Trouble Shooting
Loose Cord Error
• If your electrodes appear attached but
you still get poor impedance or loose
cord errors, perform an Electrode
Test to check the cables.
• Attach the electrode cable wires and
check with a quality test to make sure
they give good impedance.
• The Test results page will indicate the
condition of the electrode cables.
ACCUSCREEN – Trouble Shooting
Other Errors and Solutions
• AABR does not start – press the triangle to start.
• Black screen – unit powered off (eject battery if needed).
• Timeout during pause – AABR was paused more than 2 minutes.
Not Working? Contact GeniAudio
• [email protected]
• Tel: 1-866-788-1830
Start
Battery
• Request and record the RMA number.
• Fax or email the completed form.
SCREENING – Communicating with Parents
• Pass: a pass means the baby is hearing at this
time. Provide Pass brochure, get consent to send
the information to their regional IHP, encourage
parents to monitor speech and language development.
• Pass at Risk: results as above, provide Pass at Risk
brochure, and stress the need for surveillance follow
up.
• Refer: a refer does not necessarily mean the baby has a hearing loss.
A referral to another stage of screening is needed. Provide and discuss
the Refer brochure and stress the importance of the next appointment.
Reassure parents there are many potential reasons for a refer result.
Obtain consent to send the information to their regional IHP.
SCREENING – Communicating with Parents
General Principles:
• Provide consistent and accurate information.
• Many babies who do not pass the screen will turn out to have normal
hearing; there are several possible causes of a refer result, other than
hearing loss.
• Stress the importance of following through with subsequent appointments.
• Offer appropriate written information, and a contact number for them to call.
• Even if the baby passes the screening, stress the importance of monitoring
speech and language development. If there are risk factors, emphasize
the importance of the surveillance screens.
IHP – High Risks
Family history – Hearing loss must have occurred
in the baby’s parent or sibling under the age of 10
and been a clear case of hearing loss that involved:
• Hearing aid(s)
• Cochlear implant(s)
• Sign language and/or
• Went to a school for the Deaf
Cranial Facial Anomalies (obvious, very
small, absent or grossly malformed):
• Cleft lip and or palate
• Pinna
• Ear Canal
IHP – NICU High Risks
Birthweight 1000 grams or less
Gestational Age 30 weeks or less
NICU Risks: 5-minute APGAR < = 3
Severe asphyxia, hypoxia, respiratory or cardiopulmonary failure
PPHN - Persistent Pulmonary Hypertension Newborn (blood bypasses lungs)
CDH - Congenital diaphragmatic hernia (hernia causes breathing problems)
IVH - Intraventricular Hemorrhage Grade III or IV (severity of bleeding)
PVL - Peri-Ventricular Leukomalacia (damage to white matter in brain)
HIE - Hypoxic Ischemic Encephalopathy Sarnat II or III (brain injury)
ECMO - Extracorporeal Membrane Oxygenation (cardiac/respiratory support)
iNO or HFO/HFJ – Inhaled nitrous oxide or high frequency ventilation
IHP – NICU High Risks
Viruses and Infections:
CMV, CCMV (congenital) cytomegalovirus
Proven TORCHES infections (Toxoplasmosis
(from cat feces or meat), Rubella (German
Measles), Herpes, Syphilis
Proven Menigitis (Viral, Bacterial or Fungal)
Congenital HIV, Measles or mumps infection
Severe neonatal sepsis
HBR - Hyperbilirubinemia >= 400 µmol/L or exchange (jaundice)
Neonatal cancer treatment with cisplatin
IHP – High Risks
Syndromes:
Down (Trisomy 21), Stickler, CHARGE,
Pendred, Enlarged Vestibular Aqueduct
(EVA), Waardenburg, Usher, Branchio-OtoRenal (BOR), Treacher Collins,
Osteogenesis Imperfecta (OI),
Neurofibromatosis II (NF2), Alport, Crouzon,
Hunter.
Other high risk indicators
As specified by baby’s physician
IHP OVERVIEW
Stage Two Community Screening
• All well babies with a refer result from Stage One will be re-screened
with AABR.
• Community screening two to four
weeks after Stage One.
• Allows time for any debris in the ears
to clear.
• A quiet and comfortable baby is
easier to screen.
IHP – Babies at high risk
Surveillance
• Any baby who has been identified as high-risk & passed an AABR.
• Babies with meningitis or CCMV risk who have passed a diagnostic
ABR will start intensive (4, 8 and 12 month) diagnostic surveillance
with VRA.
Age & type of non-intensive Surveillance
• 8-12 months - Surveillance VRA
• 18 months - Surveillance by telephone interview
• 30 months - Surveillance by telephone interview
• 36 months - Surveillance VRA
IHP – High Risks
Intensive Surveillance Sequence
• Infants who have had meningitis or CCMV should
receive surveillance ABR as soon as possible after
recovery, and have three surveillance events,
targeted at about four, eight, and 12 months of age.
• For infants who have had meningitis, where there
Is no permanent hearing loss identified within one
year of recovery they will be discharged from IHP.
• For infants who have had CCMV, they will
continue to receive surveillance at 18 months, and
play audiometry at three and five years.
FOR ANY ADDITIONAL
QUESTIONS:
Please contact your Infant Hearing Program Regional Trainer
or Infant Hearing Program Coordinator