Winter 2013

1. INFANT HEARING PROGRAM: AccuScreen and Program - Review Winter 2013

2. INFANT HEARING PROGRAM OVERVIEW • Follow local IHP or hospital protocol for infection control procedures. • Screening occurs before discharge and will include a risk assessment. • Infant can be tested in crib or parent’s arms. • Infant should be sleeping, or resting quietly.

3. INFANT HEARING PROGRAM OVERVIEW SCREENING M. Hyde, IHP Conference 2007

4. 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.

5. IHP – Stage One Screening • OAE is a measure of outer hair cell function only and a pass does not guarantee normal hearing. • However, given normal birth and pregnancy, negative family history of hearing loss and no other complications, normal hearing is a safe assumption.

6. 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 or movements during the test will affect results. A referral to another stage of screening is needed.

7. ACCUSCREEN – ADPOAE • To screen with the ADPOAE connect the cable with the blue base. • Ensure the arrows are aligned properly. • Put on the probe tip and ear tip • Select the ear for initial screen.

8. 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.

9. 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.

10. 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.

11. 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 babies forehead.

12. 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.

13. 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.

14. ACCUSCREEN – Trouble Shooting • 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 Probe failed with possible errors.

15. ACCUSCREEN – Trouble Shooting • 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.

16. ACCUSCREEN – Trouble Shooting • Other Errors and Solutions • AABR does not start – press the triangle to start. • Black screen – unit powered off (eject battery if needed). • Timeout during pause – AABR was paused more than 2 minutes. • Not Working? Contact GeniAudio • ihpsupport@genieaudio.com • Tel: 1-866-788-1830 • Request and record the RMA number. • Fax or email the completed form. Battery Start

17. 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: results as above, provide Pass at Risk brochure, and stress the 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. Reassure parents there are many potential reasons for a refer result. Obtain consent to send the information to their regional IHP.

18. SCREENING – Communicating with Parents • General Principles: • Provide consistent and accurate information. • Do not unnecessarily alarm parents, but do 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 – the importance of the surveillance screens. • Most babies who do not pass the screen will turn out to have normal hearing, there are many possible causes of a refer result, other than hearing loss.

19. IHP – High Risks Family history – Hearing loss must have occurred in the baby’s parent or sibling under 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 lip and or palate • Pinna • Ear Canal

20. 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

21. 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 Menigitis (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

22. IHP – High Risks Syndromes: Down (Trisomy 21), Stickler, CHARGE, Pendred, Enlarged Vestibular Aqueduct (EVA), Waardenburg, Usher, Branchio-Oto-Renal (BOR), Treacher Collins, OsteogenesisImperfecta (OI), Neurofibromatosis II (NF2), Alport, Crouzon, Hunter. Other high risk indicators As specified by baby’s physician

23. IHP OVERVIEW • Stage Two Community Screening • All well babies with a refer result from Stage One 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.

24. 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 an AABR or a diagnostic ABR will start surveillance with VRA screening. • Age & type of Surveillance • 8-12 months - Surveillance VRA • 18 months - Surveillance by telephone interview

25. FOR ANY ADDITIONAL QUESTIONS: Please contact your Infant Hearing Program Regional Trainer or Infant Hearing Program Coordinator