Page 96 - Portuguese Journal - SPORL - Vol 61. Nº1
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factors and re-evaluation intervals according risk of auditory neuropathy, we suggest that
to the clinical entity seeing the child. this subgroup should also be preferentially
With regard to the introduction of new risk assessed by AEP. 5,6
factors, intrauterine infection with the Zika With regard to the introduction of new
virus was only linked to neonatal hearing loss intervals between evaluations, we propose
in 2016; therefore, it has not yet been included that some groups, already included in the
in the currently used clinical standards in clinical standards in effect in Portugal, should
Portugal. 2,5,6 We think it is essential to introduce be monitored until school age (given the
this risk factor, given the increasing prevalence increased risk of late-onset hearing loss),
of this infectious disease in Brazil and the such as NBs with intrauterine CMV infection,
37
fact that Brazilians accounted for 25.67% of the because deafness may develop up to school
Portuguese immigrant community in 2019. age. Children diagnosed with bacterial/viral
15
38
Another recent factor is the exponential meningitis who have shown some degree of
growth in the use of ECMO in recent years. hearing loss in the audiological evaluation at
From 1989 to March 2022, 46,667 NBs have the time of discharge should also be monitored
undergone ECMO, according to the records of until school age due to the risk of worsening. 43
the Extracorporeal Life Support Organization. Retrospective studies conducted in maternity
NBs undergoing ECMO, regardless of the units of the Portuguese national health service
duration of the extracorporeal support, are a have shown rates of neonatal screening
subgroup at major risk of hearing loss, which effectiveness between 98% and 98.7%, with
may present at a later stage: the literature 2% of the NBs being referred for an ORL
describes correlations up to 13 years of age. consultation, which is in line with the goals
14
Therefore, we suggest that these infants are defined by the JCIH. 44,45 The introduction of
included in the at-risk group under the existing new risk factors and warning signs for referral
standards in Portugal and that their hearing is to child health and pediatric consultations
monitored in ORL clinics at least until school aims at increasing the rate of effectiveness
age. Between 6 to 13 years of age, they should of UNHS and increasing the referrals to
6
be followed by their assistant physician and childhood deafness consultations so that
referred for an ORL consultation when there the prognosis of children with deafness in
is a suspicion of hypoacusis, either reported by Portugal is improved.
the child or by his/her caregivers. The algorithm developed in this study still
There are other risk factors in the context of NICU requires an evaluation of its impact on the
hospitalization, namely exposure to noise. This improvement of health care in Portugal and a
may exceed the mean 45 dB recommended formal cost-benefit analysis.
by the AAP 39–41 and be related to the degree of Some of the parameters introduced in this
hearing loss six months after discharge from algorithm require further studies with larger
the NICU. Due to the exposure to noise and samples to allow establishing a stronger
42
coexistence of other comorbidities associated correlation between the risk factor and
with hearing loss (such as hyperbilirubinemia, childhood hearing loss. In this group, we
exposure to ototoxic substances, and invasive highlight intrauterine exposure to toxic
mechanical ventilation), these NBs are a substances and/or tobacco, as suggested by
subgroup at risk of hearing loss. We believe the Societé Française de Pédiatrie .
13
that unlike the current standards in use in In addition, we believe that it is essential to
Portugal , all NBs who were in the NICU for create a national database of the audiological
2
more than five days should be included in the results of all the tests of the population with
at-risk subgroup of UNHS, regardless of the confirmed or at-risk of hearing loss to avoid
NB’s comorbidities. Similar to the JCIH and delayed diagnoses due to absenteeism or
EUSCREEN recommendations and due to the difficulties in referral to a specialist. Moreover,
96 Portuguese Journal of Otorhinolaryngology - Head and Neck Surgery
