Evaluation der größten Follow-Up-II-Einrichtung des Neugeborenen-Hörscreenings in Mittel- und Nordhessen

Die frühzeitige Diagnose und Versorgung einer angeborenen Hörstörung ist von hoher Bedeutung. Dies soll mit dem Neugeborenen-Hörscreening, welches in Deutschland zum 01.01.2009 flächendeckend und verpflichtend eingeführt wurde, gewährleistet werden. Eine erste Evaluation des Neugeborenen-Hörscreenin...

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Bibliographic Details
Main Author: Fink, Nicola Maria
Contributors: Hey, Christiane (Prof. Dr. med. Dr. med. habil., MHBA) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2022
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Table of Contents: The early diagnosis and treatment of a congenital hearing impairment is of great importance. This should be ensured with the newborn hearing screening, which was implemented compulsorily and nationwide in Germany on January 1, 2009. An initial evaluation of newborn hearing screening in Germany for the years 2011/2012 describes the implementation of the program to be successful. However, the success of the screening program is closely related to the performance of the Follow-Up-I and -II following a conspicuous initial screening. While the quality of processes, structures and outcomes, especially of maternity facilities and screening centers, has been extensively evaluated, there is hardly any such evaluation for a Follow-Up-II facility. For this reason, the present study analyzes to what extent the largest Follow-Up-II facility in central and northern Hessen, the pediatric audiology department of the University Hospital of Marburg, was able to meet the targets defined by the “Gemeinsamer Bundesausschuss” against the background of an increase in demand. For the evaluation of the Follow-Up-II facility, the data of 2.705 newborns who were presented to the department in the context of newborn hearing screening from 2009 to 2016 were collected. The reasons for presentation and the final diagnosis were analyzed as possible influencing factors. In addition, the age at first presentation, the age of diagnosis and, in case of a permanent hearing impairment, the age of treatment were evaluated. Furthermore, the proportion of permanently hearing-impaired newborns diagnosed within the first three months of life and treated within the first six months of life was evaluated. Additionally, the effects of the department restructuring – carried out due to increasing patient numbers – on process quality and thus on the overall outcome of newborn hearing screening in the Follow-Up-II facility were examined. From 2009 to 2016, the annual patient numbers at the Follow-Up-II facility increased significantly by 91.4%. Overall, from 2009 to 2016, the median age at first presentation was 5.6 weeks, the median age at diagnosis 6.3 weeks. Initial age at presentation and diagnosis were found to be dependent on presentation reason and diagnosis. Here, newborns with an initial screening were presented significantly earlier than those with a follow-up or risk factors (median 4.6 versus 5.3 and 8.0 weeks, respectively; p < 0.001). At the same time, newborns with normal hearing were presented and diagnosed significantly earlier than those with permanent or transient hearing impairment, respectively (median age at initial presentation: 5.4 versus 6.1 and 7.6 weeks, respectively; p < 0.01 and p < 0.001, respectively; median age at diagnosis: 5.9 versus 11.4 and 23.1 weeks, respectively; p < 0.001). From 2009 to 2016, the age at treatment of permanently hearing-impaired newborns was 14.1 weeks (median). In 60% of the permanently hearing-impaired newborns, the diagnosis was confirmed by the end of the third month of life as required, and in 80.2%, treatment was provided by the end of the sixth month of life. From 2009 to 2014, the age at first presentation increased significantly for newborns with follow-up and risk factors. At the same time, the age at first presentation and at diagnosis increased significantly in newborns with normal hearing and permanent hearing loss and increased at least numerically in transient hearing-impaired newborns. These parameters were most significantly reduced again by 2016 due to the restructuring measures of the department in 2015. From 2009 to 2016, the increase of patient numbers at the Follow-Up-II facility after the implementation of newborn hearing screening was immense. The dependence of the age at first presentation and diagnosis on the reason for presentation or confirmed diagnosis reveals the need for further optimization of the entire newborn hearing screening process. Above all, the admission of newborns to a Follow-Up-II facility should take place earlier. This early admission is what ultimately makes possible what the nationwide and mandatory newborn hearing screening intends to achieve: The early detection and treatment of a congenital hearing impairment. However, in the Follow-Up-II facility studied here, the Follow-Up-II of newborn hearing screening was implemented effectively and efficiently with consistently better results of key target parameters than national and international comparisons. Despite a significant increase in patient numbers with no change in resources, it was thus possible to provide high-quality pediatric audiology care to many newborns. The diagnostic procedure in this Follow-Up-II facility is therefore a good example of how the quality of newborn hearing screening, including Follow-Up, can be maintained despite increasing demand, and how an effective and efficient implementation of the screening program can be achieved.