Transcript DESIGNING THE INFANT HEARING PROGRAM

INFANT HEARING PROGRAM:
New Screener Presentation
Spring 2015
INFANT HEARING PROGRAM: Quick review
• Hearing loss at birth is more common (~2/1000)
than any other disorder for which newborns are
screened.
• Only about half of all newborns with hearing loss
have known risk indicators (5-10% of all newborn
are at risk).
• Targeted high-risk hearing screening violates the
principles of equal access and universal rights.
• Universal screening IS practicable and IS NOT
costly, in light of the ensuing benefits to the child,
family and society.
M. Hyde, IHP Conference 2007
INFANT HEARING PROGRAM OVERVIEW
• Screening occurs before discharge and should
include a risk assessment.
• Infant can be tested in crib or parent’s arms.
• Infant should be sleeping or resting quietly.
• Test environment should be as quiet and free
from interruption as possible.
• Local infection control procedures should be
followed.
• Privacy legislation must be followed.
INFANT HEARING PROGRAM OVERVIEW
SCREENING
M. Hyde, IHP Conference 2007
ACCUSCREEN – Getting Started
• The AccuScreen is a touchscreen unit that has the
capability to screen using Automated Distortion
Product Otoacoustic Emissions (ADPOAE) or
Automated Auditory Brainstem Response (AABR)
or both, depending what the configuration is.
• The AccuScreen is a hand-held, battery powered
unit that can be charged in the docking station.
The battery will be fully charged after six hours.
A full charged battery will last eight hours,
depending on use.
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.
ACCUSCREEN – Getting Started
• To turn it ‘on’ press the grey button on
the side of the unit, press and hold the
bottom of the button to turn it ‘off’.
Probe Test
Battery
release
• To remove the
battery (reboot or
change battery)
press the battery
release and the
back will open.
• To self calibrate insert the probe
into the back of the unit.
On
Battery
ACCUSCREEN – Getting Started
Home page
• Find a Patient
• Create a New Patient
• View the Tests
• Print the Tests
• Delete Patients
• Quick Test to check your hearing
• Quality test to troubleshoot
• Settings to change i.e. date, time, log in
ACCUSCREEN – New Patient
• We do not store personal health information without encryption. Select
New Patient to get a new ID and perform the test.
ACCUSCREEN – New Patient
• To enter a numerical ID touch ‘123’ to switch from ‘aaa’. Touch the
checkmark after you entered the desired number.
ACCUSCREEN - Probe Tips and Eartips
• There are five sizes of disposable eartips
available for use with infants; 3.7mm
yellow, 4.0mm green, 4.5mm pink, 5.0mm
blue and the transparent tree tip 4-7mm.
• A clean eartip must always be used when
placing the probe tip into the ear canal.
Eartip
Probe Tip
ACCUSCREEN – Connecting the probe tip
• Click the probe tip onto the speaker cable, then slide the appropriate
sized eartip on.
• To remove, hold the probe tip at the top and bottom along the groves,
push together then outward.
IHP – Stage One Screening
Babies NOT at Risk
• A two step process.
• Step one with ADPOAE equipment.
• Step two if needed with AABR equipment.
• Step two should be done as soon as possible
to reduce parental anxiety.
IHP – Stage One Screening
• DPOAEs are generated by the outer
hair cells (OHCs) of the cochlea.
• Normal DPOAEs usually mean that
hearing is normal (at the time of
screening…)
• Absent DPOAEs suggest that
hearing may be abnormal and
further testing is needed.
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, fluid in the
middle-ear or movements during the
test will effect results. A referral to
another stage of screening is needed.
ACCUSCREEN – ADPOAE
• The hearing screening is a quick, easy,
non-invasive screening test that does
not involve the performance of any of the
controlled acts under the Regulated
Health Professions Act, 1991.
• Provision of parental consent is required,
unless hearing screening is performed as
part of a hospital’s standard of care.
• Consent to share results with the
regional IHP is always required.
ACCUSCREEN – ADPOAE
• To screen with the ADPOAE connect the
cable with the blue base.
• Ensure the arrows are aligned properly.
• Select an appropriate eartip.
• Put on the probe tip and eartip.
• 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 – ADPOAE
• The Test Menu has tests completed and test results. The Test View
shows all attempts including missed calibrations and aborted tests.
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 baby’s
forehead (high midline).
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 – Troubleshooting
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
as ‘Probe failed’ with possible errors.
ACCUSCREEN – Troubleshooting
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 – Troubleshooting
Other Errors and Solutions
• AABR does not start – press the black triangle to start.
• Black screen – unit powered off (eject battery if needed).
• Timeout during pause – AABR was paused more than two minutes.
Not Working? Contact Genie Audio
• [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: as above, but provide Pass at Risk
brochure and stress 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. Assess
parents’ anxiety level and counsel as needed to achieve reasonable
concern but not overwhelming anxiety. Do NOT dismiss a valid refer as
‘nothing to worry about’ or as ‘something the equipment always does….’.
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 before 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 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 Meningitis (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 StageTwo 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.
• Many babies will pass the re-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.
IHP OVERVIEW
Assistive Technology
• Once a permanent hearing loss is confirmed, babies can return to the
audiologist for hearing aid evaluation/selection, if chosen by the family.
• All requirements of the Assistive Devices
Program are followed so that the parents
can apply for financial support for hearing aids.
• Babies will begin hearing aid use no later
than six months of age.
IHP OVERVIEW
Family Support Worker
• The family may choose to access family support services.
• Services provided include: counseling, information about
communication development services and local resources.
IHP OVERVIEW
Follow-up Supports and Services
• The family will have access to IHP services
until six years of age.
• IHP audiologists will monitor the child’s
hearing loss.
• The child’s communication development
progress will be monitored, within their
individualized program, to promote optimal
success.
FOR ADDITIONAL
QUESTIONS CONTACT:
Contact your Infant Hearing Program Coordinator or Regional
Trainer