Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
권호 표지

소아 난청의 조기진단을 위한 신생아 청력 선별검사에 대한 평가

Investigation of Automated Neonatal Hearing Screening for Early Detection of Childhood Hearing Impairment

  • Seo, Jeong Il (Department of Pediatrics, Good Moonhwa Hospital) ;
  • Yoo, Si Uk (Department of Pediatrics, Good Moonhwa Hospital) ;
  • Gong, Sung Hyeon (Department of Pediatrics, Good Moonhwa Hospital) ;
  • Hwang, Gwang Su (Department of Pediatrics, Good Moonhwa Hospital) ;
  • Lee, Hyeon Jung (Department of Pediatrics, Good Moonhwa Hospital) ;
  • Kim, Joong Pyo (Department of Pediatrics, Good Moonhwa Hospital) ;
  • Choi, Hyeon (Department of Pediatrics, Good Moonhwa Hospital) ;
  • Lee, Bo Young (Department of Pediatrics, Good Moonhwa Hospital) ;
  • Mok, Ji Sun (Department of Pediatrics, Good Moonhwa Hospital)
  • 투고 : 2005.03.17
  • 심사 : 2005.05.06
  • 발행 : 2005.07.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

목 적 : 출생 후 3세까지는 언어와 청각신경로의 발달의 가장 중요한 시기로 신생아 청력 선별검사를 통해서 선천성 난청의 조기 진단은 청력 손실로 인한 언어장애를 최소화 하고 언어 발달을 위한 재활 교육의 기회를 제공하여 정상적인 언어 생활을 하는데 중요한 역할을 하게 된다. 우리나라에는 아직 충분한 통계가 없지만 미국의 경우 정상 신생아의 1,000명당 2-7명이 선천성 영구적 난청을 가지고 태어나는 것으로 알려져 있고, 2세 이전에 난청이 발견되어 치료하지 않는다면 언어발달의 중요한 시기를 놓치게 되어 행동장애나 학습장애를 초래하게 된다. 이 연구는 신생아 청력 선별검사를 통해 신생아 난청의 빈도를 파악하여 신생아 청력검사의 중요성을 알리고자 한다. 방 법 : 2003년 5월 20일부터 2004년 5월 19일까지 좋은문화 병원에서 출생한 신생아 2,755명 중 부모의 동의를 얻은 1,718명을 대상으로 생후 1개월 이내 내간유발반응검사(AABR. ALGO-3)를 이용하여 35 dB의 소리를 주어 시행하였다. 난청의 위험요소가 있는 군과 위험요소가 없는 군으로 구분하였고 1차 청력검사에서 통과된 경우 'pass'군 통과되지 않는 경우 'refer'군으로 하였다. 생후 1개월내 청력검사에서 'pass'되지 않았으면 1개월 뒤에 재검사를 받도록 하였고 재검사에서 'refer'가 나온 경우 난청 클리닉에 의뢰하여 난청을 확진하였다. 결 과 : 총 1,718명 중 'pass'군과 'refer'군 사이의 분만형태 출생체중 재태연령에는 차이가 없었다. 1차 검사에서 'refer'가 나온 경우는 총 45명(2.6%)이었으며 이중 35명이 재검사를 받았으며 10명은 재검사를 거절하였다. 재검사한 35명 중 6명(17.0%)이 재검사를 통과하지 못하였고 모두 선천성 난청으로 진단되었다. 이는 전체 검사자 1,718명의 0.35%(1,000명당 3.5명) 해당되었다. 'refer'군에서 한 가지 이상 위험요소가 동반되는 경우는 45명 중 10명(22.2%) 'pass'군에서 위험요소가 있는 경우는 1,673명 중 263명(15.7%)으로, 위험 요소가 있으면서 'refer'가 나온 군이 위험요소가 없으면서 'refer'가 나온 군과 비교했을 때 통계적으로 의미가 없었다. 결 론 : 본 연구의 결과는 신생아기의 난청의 빈도가 1,000명 당 3.5명으로 외국 통계와 비슷한 것으로 나타났으며, 이는 선천성 대사질환보다 월등히 빈도가 높으며, 태어나는 신생아에서 반드시 신생아 청력선별검사를 해야 할 것으로 사료된다.

Purpose : Early diagnosis of congenital hearing loss through the neonatal hearing screening test minimizes language defect. This research intends to identify frequency of congenital hearing loss in infants through neonatal hearing screening test with the aim of communicating the importance of hearing test for infants. Methods : From May 20, 2003 to May 19, 2004, infants were subjected to Automated Auditory Brainstem Response test during one month of birth to conduct the test with 35 dB sound. Infants who passed the 1st round of hearing test, were classified into 'pass' group whereas those who did not were classified into 'refer' group. Infants who did not 'pass' in the hearing test conducted within one month of birth were subjected to re-test one month later, and if classified as 'refer' during the re-test, they were subjected to the diagnosis for validation of hearing loss by requesting test to the hearing loss clinic. Results : There was no difference among the 'pass' and 'refer' group in terms of form of childbirth, weight at birth and gestational age. In the 1st test, total of 45 infants were classified into 'refer' group. Six among 35 who were subjected to re-test(17%) did not pass the re-test, and all were diagnosed with congenital hearing loss. This corresponds to 0.35%(3.5 per 1,000) among total number of 1,718 subjects. Conclusion : In our study the congenital hearing loss tends to be considerably more frequently than congenital metabolic disorder. Accordingly, newly born infants are strongly recommended to undergo neonatal hearing screening test.

키워드

참고문헌

  1. National Institutes of Health. NIH Consensus Statement. Early identification of hearing impairment in infants and young children. Washington, DC : National Institutes of Health; 1993:1-24
  2. Yoshinaga-Itano C. Efficacy of early identification and early intervention. Semin Hear 1995;16:115-23 https://doi.org/10.1055/s-0028-1083709
  3. Denoyelle F, Marlin S, Weil D, Moatti L, Chauvin P, Garabedian EN, et al. Clinical features of the prevalent form of childhood deafness, DFNB1, due to a connexin-26 gene defect : implications for genetic counselling. Lancet 1999;17: 1298-303
  4. Mehl AL, Thomson V. The Colorad Newborn Hearing Screening project, 1992-1999 : On the Threshold of Universal Newborn Hearing Screening. Pediatrics 2002;109:1-8
  5. Joint Committee on Infant Hearing. Year 2000 Position Statement : Principles and Guidelines for Early Hearing Detection and Intervention Programs. Pediatrics 2000;106:798- 817 https://doi.org/10.1542/peds.106.4.798
  6. Cunningham M, Cox EO. Hearing assessment in infants and children : recommendations beyond neonatal screening. Pediatric 2003;111:4-36-40
  7. Arehart KH, Yoshinaga-Itano C, Thomson V, Gabbard SA, Brown AS. State of the states : the status of universal newborn screeing, assessment, and intervention systems in 16 states. Am J Audiol 1998;7:101-4 https://doi.org/10.1044/1059-0889(1998/019)
  8. American Academy of Pediatrics Task Force on Newborn and Infant Hearing. Newborn and infant hearing loss : detection and intervention. Pediatrics 1999;103:527-30 https://doi.org/10.1542/peds.103.2.527
  9. Vohr BR, Carty LM, Moore PE, Letourneau K. The Rhode Island Hearing Assessment Program : experience with statewide hearing screening(1993-1996). J Pediatr 1998;133: 353-7 https://doi.org/10.1016/S0022-3476(98)70268-9
  10. Joint Committee on Infant Hearing. 1994 position statement. Pediatrics 1995;95:152-6
  11. Erenberg A, Lemons J, Sia C, Trunkel D, Ziring P. Newborn infant hearing loss : detection and intervention Academy of pediatrics Task Force on Newborn and Infant Hearing, 1998-1999. Pediatrics 1999;103:527-30
  12. Mauk GW, White KR, Mortenson LB. The effectiveness of screening programs based on high-risk characteristics in early identification of hearing impairment. Ear Hear 1991; 12:312-9 https://doi.org/10.1097/00003446-199110000-00003
  13. Harrison M, Roush J. Age of suspicion, identification and intervention for infants and young children with hearing loss : a national study. Ear & Hearing 1996;17:55-62 https://doi.org/10.1097/00003446-199602000-00007
  14. Mehl AL Thomson V. Newborn hearing screening : the great omission. Pediatrics 1998;101:1-6 https://doi.org/10.1542/peds.101.1.1
  15. Moore DR. Postnatal development of the mammalian central auditory system and the neural consequences of auditory deprivation. Acta Otolaryngol Suppl 1985;421:19-30
  16. Vohr BR, Oh W, Stewart EJ, Bentkover JD, Gabbard S, Lemons J, et al. Comparison of costs and referral rates of 3 universal new born hearing screening protocols. J pediatr 2001;139:238-44 https://doi.org/10.1067/mpd.2001.115971
  17. Erenberg S. Automated auditory brainstem response testing for universal newborn hearing screening. Otolaryngol Clin North Am 1999;32:999-1007 https://doi.org/10.1016/S0030-6665(05)70190-0
  18. Van Straatan HL, Groote ME, Oudesluys-Murphy AM. Evaluation of an automated auditory brainstem response infant hearing screening method in at risk neonates. Eur J Pediatr 1996;155:702-5
  19. Shimizu H, Walters RJ, Kennedy DW, Allen MC, Markowitz. RK, Luebkert FR. Crib-o-gram vs. auditory brain stem response for infant hearing screening. Laryngoscope 1985;95:806-10
  20. Kerschner JE,Meurer JR,Conway AE, Fleischfresser S, Cowell MH, Seeliger E, et al. Voluntary progress toward universal newborn hearing screening in Wisconsin. Presented at the SENTAC Annual Meeting. New Orleans 2004; 68:165-74
  21. Clemens CJ, Davis SA, Bailey AR. The false-positive in universal newborn hearing screening. Pediatrics 2000;106:1- 5 https://doi.org/10.1542/peds.106.1.1
  22. Stewart DL, Mehl DL, Hall JW, Thomson V, Hamlett J. Universal Newborn Hearing Screening with Automated Auditory Brainstem Response : A multisite Investigation. J Perinatol 2000;20:S128-31
  23. Waltzman SB, Cohen NL, Green J. Long-term effects of cochlear implants in children. Otolaryngol Head Neck Surg 2002;126:505-11 https://doi.org/10.1067/mhn.2002.124472
  24. Hassanzadeh S, Farhadi M, Daneshi A. The effects of age on auditory speech perception development in cochlearimplanted prelingually deaf children, Otolaryngol Head Neck Surg 2002;126:524-7 https://doi.org/10.1067/mhn.2002.125110