Statewide Infant Screening - Hearing (SWISH) Elisabeth Murphy Lara Harvey Carlie Naylor NSW Health Department

Transcription

1 Statewide Infant Screening - Hearing (SWISH) Elisabeth Murphy Lara Harvey Carlie Naylor NSW Health Department

2 Introduction Epidemiology Why screen? Background to program Evidence Program development in NSW

3 NSW population at a glance In million / by million Approximately 86,000 babies born each year Approximately 130,000 Aboriginal and Torres Strait Islander peoples (29% of Australian indigenous population) Around 25% of residents were born overseas Half the NSW population is over 35 years old 9.2% of population is 70+ years old / by 2017, will be 11.3% 77.3% of the population lives in an urban area, and 85% live within 50km of coast.very low population density in western 2/3 of State Average life expectancy at birth: females 81.9y; males 76.4y (Australia is 8th among the 21 OECD countries)

4 Epidemiology Incidence of significant permanent hearing loss: 1-2/1000 newborns In NSW: approximately 86,000 babies born each year approximately babies are predicted to be born with significant permanent hearing loss

5 Severe 14.2% Profound 13.4% Moderate 26.8% Mild 45.7% Mild 25-39dB HL Moderate 40-69dB HL Severe 70-94dB HL Profound >95 db HL Proportion of Hearing Loss by Severity in NSW From: Australia Hearing Data

6 Why screen? Important health problem Accepted form of treatment Natural history understood Early recognisable symptomatic stage Suitable test cont. WHO Criteria (1968)

7 Why screen? (Cont) Facilities for diagnosis and treatment Agreed policy on whom to treat Treatment influences prognosis Economically balanced (to be confirmed) WHO Criteria (1968)

8 Key stakeholders NSW primary health care program Community service organisations and individuals Multidisciplinary support PHAA National Forum Consensus statement SOUNDS National and international issue

9 Literature International experience Australian / NSW experience

10 International experience Universal newborn hearing screening implemented in USA Currently mandated in 32 states US Preventative Services Task Force Review (2002) Currently being introduced in UK

11 Adjusted Mean Total Language Quotient Age of Identification (Months) Mean language quotient by age of identification From:Yoshinago-Itano et al (1998)

12 Task performance (%) No early language Early signed language Early spoken language Early experience Second language performance in adults by early language experience Mayberry et al (2002)

13 Australian experience Victoria: Distraction Testing Russ et al, Arch Dis Child, 86, 2002 Western Australia Pilot trial Bailey et al, MJA,2002 South Australia Commencing pilot trial 2002 ACT Targeted screening commenced 2002

14 NSW NHMRC Guidelines (1993) South Eastern Sydney Pilot trial Targeted screening in NICUs In NSW, the average age of: detection of hearing impairment was 18 months fitting of hearing aids was years for severe loss and years for moderate loss.

15 Development phase: process SWISH Steering Committee established Multidiscipline and community representation Subcommittees to address specific issues AABR screening technology Diagnostic Audiology IT / data management Parent brochure development Consultation with stakeholders NSW State Forum NSW Private Hospital Forum

16 Development phase: implementation Commenced on 1 December 2002 Workforce - Dedicated screeners Area Health Service coordinators (17) State Coordinator Technology - Automated Auditory Brainstem Response units

17 Technology Otoaccoustic Emissions (OAE) Quick Easy Inexpensive Sensitivity 78-99% Referral rates 34-44% Specificity 90-99% Automated Auditory Brainstem Response units (AABR) Less quick (8-20min) More complicated More expensive Sensitivity 96-99% Referral rates % Specificity %

18 Bilateral pass rate (%) day or less 1-2 days old 2-3 days old 3-4 days 4-5 days older than 5 days Age of babies in days Bilateral pass rate using TEOAE by babies age Bailey H (2001)

19

20

21 AHS SWISH coordinator provides support + notification (with consent) to GP, paediatrician and ECHC The NSW Universal Newborn Hearing Screening Program First screening event (AABR) 86,000 babies Second screening event (AABR) babies (8-10%) Refer Diagnostic audiology ( %) Pass-written info provided Pass Routine age-specific hearing surveillance Greater Eastern and Southern Child Health Network ( babies) Greater Western Child Health Network ( babies) Hunter and Northern Child Health Network ( babies) Australian Hearing (Option of fitting hearing aids) Significant permanent hearing impairment (approx babies) Paediatric assessment including: *Developmental disability review *Genetic assessment *ENT assessment *Counselling and development/behavioural Early intervention coordination program Catholic Centre For Hearing Impaired Children Department of Education and Training Hear the Children St Gabriel s Royal Institute For Deaf and Blind Children The Shepherd Centre Families First

22 The NSW Universal Newborn Hearing Screening Program First screening event (AABR) 86,000 babies Second screening event (AABR) babies (8-10%) Pass Routine age-specific hearing surveillance AHS SWISH coordinator provides support + notification (with consent) to GP, Paediatrician and ECHC Refer Pass-written info provided Greater Eastern and Southern Child Health Network ( babies) Diagnostic audiology ( %) Greater Western Child Health Network ( babies) Hunter and Northern Child Health Network ( babies) Australian Hearing (Option of fitting hearing aids) Significant hearing impairment (approx babies) Paediatric assessment including: *Developmental disability review *Genetic assessment *ENT assessment *Counselling and development/behavioural

23 The NSW Universal Newborn Hearing Screening Program Australian Hearing (Option of fitting hearing aids) Significant hearing impairment (approx babies) Paediatric assessment including: *Developmental disability review *Genetic assessment *ENT assessment *Counselling and development/behavioural Early intervention coordination program Catholic Centre For Hearing Impaired Children Department of Education and Training Hear the Children St Gabriel s Royal Institute For Deaf and Blind Children The Shepherd Centre Families First

24 Area Health Services

25 Paediatric Networks

26 Greater Western Paediatric Network Linked with The Children s Hospital at Westmead Central Coast AHS (Gosford LGA) Central Sydney AHS (Ashfield, Burwood, Concord, Drummoyne, Strathfield LGAs) Northern Sydney AHS (Hornsby, Kuring-gai, Hunters Hill, Ryde LGAs) South Western Sydney AHS Wentworth AHS Western Sydney AHS Mid West AHS Far West AHS Northern Rivers AHS

27 Greater Eastern and Southern Paediatric Network Linked with Sydney Children s Hospital Central Sydney AHS (Leichhardt, Canterbury, Marrickville, Sydney/South Sydney LGAs) Illawarra AHS Northern Sydney AHS (Mosman, North Sydney, Manly, Pittwater, Willoughby, Warringah, Lane Cove LGAs) South East Sydney AHS South Western Sydney AHS (Liverpool Campbelltown, Bankstown Hospitals) Southern AHS Macquarie AHS Greater Murray AHS Australian Capital Territory

28 Northern Paediatric Network Linked with John Hunter Children s Hospital Central Coast AHS (Wyong LGA) Hunter AHS Mid North Coast AHS New England AHS

29 Update (1) Commenced 1 December Sunday papers, ABC radio, local press coverage In the first 7 months of the program, approximately 36,000 babies have been screened The data is continually being updated as the program develops. Please contact Lyndal Le Bas, State Coordinator, SWISH on if updated information is required.

30 Update (2) % coverage of newborns varies across the State All Area Health Services are progressively improving coverage rate as capture arrangements refined for both public and private hospital births The data is continually being updated as the program develops. Please contact Lyndal Le Bas, State Coordinator, SWISH on if updated information is required.

31 Update (3) In the first 7 months of the program, the coverage across NSW was 73% Coverage rate has increased in each month that the program has been operational The data is continually being updated as the program develops. Please contact Lyndal Le Bas, State Coordinator, SWISH on if updated information is required.

32 Update (4) Coverage across NSW in the month of June 2003 was 95% In the first 7 months of the program, 10 Area Health Services achieved a screening coverage rate of 90% or more The data is continually being updated as the program develops. Please contact Lyndal Le Bas, State Coordinator, SWISH on if updated information is required.

33 Update (5) In the first 7 months of the program: refer to second screen was approximately 8% (the literature suggests 8% -10%) the overall bilateral referral rate to diagnostic audiology was 0.2% (the literature suggests %) The data is continually being updated as the program develops. Please contact Lyndal Le Bas, State Coordinator, SWISH on if updated information is required.

34 Update (6) In the first 7 months of the program, 31 babies were diagnosed with significant bilateral permanent hearing loss This represents an incidence of 0.9 per 1000 babies screened The data is continually being updated as the program develops. Please contact Lyndal Le Bas, State Coordinator, SWISH on if updated information is required.

35 Future Directions Establishment of Statewide database Review of audiology arrangements? Tele-audiology technology Continuing education programs for clinicians, paediatricians, GPs