Newborn hearing screening programme in Belgium: a consensus recommendation on risk factors.
Newborn hearing screening programme in Belgium: a consensus recommendation on risk factors.
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DOI：
10.1186/s12887-015-0479-4
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发表时间：
2015-10-16
期刊：
影响因子：
2.4
通讯作者：
Levêque A
中科院分区：
文献类型：
--
作者：
Vos B;Senterre C;Lagasse R;SurdiScreen Group;Levêque A
了解听力损失的危险因素对于设计比利时新生儿听力筛查计划至关重要。因此，它们需要根据当前的科学知识进行更新。本研究旨在更新比利时新生儿筛查计划中具有新生儿听力损失危险因素的新生儿的临床管理和随访建议。进行文献综述，并使用建议分级、评估、制定和评价（GRADE）系统评估方法来确定每个风险因素的证据质量水平和建议强度。随后使用三轮德尔菲共识流程（两份在线调查问卷和一次面对面会议）对科学知识状况、证据质量水平和分级建议进行了评估。先天性感染（即巨细胞病毒、弓形体病和梅毒）、听力损失家族史、（祖）父母的近亲结婚、畸形综合征和胎儿酒精综合征作为新生儿听力损失的危险因素，提供了“高”水平的证据质量。由于听觉功能对胆红素毒性的敏感性，高胆红素血症的证据质量处于“中等”水平。相比之下，出生体重极低、阿普加评分低、新生儿重症监护室住院率从“极低”到“低”不等，耳毒性药物则被证明为“极低”。对这些“非常低”和“低”水平的可能解释包括对这些健康状况或治疗的管理改进，以及混杂效应等方法学缺陷，这使得很难就个体风险因素得出结论。在建议声明中，专家们强调避免不明原因的新生儿听力损失，并选择即使在证据薄弱的情况下也将听力损失的危险因素纳入其中。该小组还强调了听力损失风险因素的累积影响。我们根据上述循证方法和专家的临床经验，修订了对表现出新生儿听力损失危险因素的新生儿的临床管理和随访建议。下一步是在比利时筛查计划中实施这些发现。本文的在线版本 (doi:10.1186/s12887-015-0479-4) 包含补充材料，可供授权用户使用。
Understanding the risk factors for hearing loss is essential for designing the Belgian newborn hearing screening programme. Accordingly, they needed to be updated in accordance with current scientific knowledge. This study aimed to update the recommendations for the clinical management and follow-up of newborns with neonatal risk factors of hearing loss for the newborn screening programme in Belgium. A literature review was performed, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system assessment method was used to determine the level of evidence quality and strength of the recommendation for each risk factor. The state of scientific knowledge, levels of evidence quality, and graded recommendations were subsequently assessed using a three-round Delphi consensus process (two online questionnaires and one face-to-face meeting). Congenital infections (i.e., cytomegalovirus, toxoplasmosis, and syphilis), a family history of hearing loss, consanguinity in (grand)parents, malformation syndromes, and foetal alcohol syndrome presented a ‘high’ level of evidence quality as neonatal risk factors for hearing loss. Because of the sensitivity of auditory function to bilirubin toxicity, hyperbilirubinaemia was assessed at a ‘moderate’ level of evidence quality. In contrast, a very low birth weight, low Apgar score, and hospitalisation in the neonatal intensive care unit ranged from ‘very low’ to ‘low’ levels, and ototoxic drugs were evidenced as ‘very low’. Possible explanations for these ‘very low’ and ‘low’ levels include the improved management of these health conditions or treatments, and methodological weaknesses such as confounding effects, which make it difficult to conclude on individual risk factors. In the recommendation statements, the experts emphasised avoiding unidentified neonatal hearing loss and opted to include risk factors for hearing loss even in cases with weak evidence. The panel also highlighted the cumulative effect of risk factors for hearing loss. We revised the recommendations for the clinical management and follow-up of newborns exhibiting neonatal risk factors for hearing loss on the basis of the aforementioned evidence-based approach and clinical experience from experts. The next step is the implementation of these findings in the Belgian screening programme. The online version of this article (doi:10.1186/s12887-015-0479-4) contains supplementary material, which is available to authorized users.